Radiofrequency heat ablation for lung tumors: potential applications

Radiofrequency ablation (RFA) is an image guided percutaneous procedure using thermal energy that is used to treat malignant lesions in various organs including liver, breast and lungs. It has also been used bronchoscopically to treat endobronchial tumors. Current passing through tissue from the active electrode leads to ion agitation, which is converted by means of friction into heat leading to irreparable cellular damage and coagulation necrosis. The potential benefits include decreased cost and morbidity, treating patients who are not surgical candidates due to age, co-morbidity or extent of disease and the possibility of performing the procedure on an outpatient basis. The aim is usually to reduce tumor size. Whether it can be used with a curative intent in well localized primary tumors remains to be determined by well designed studies. However, caution should be exercised because selective tumor resection is not the gold standard to treat potentially resectable lung malignancies that are treated with lobectomy. Obviously, lung volume reduction surgery combined with tumor resection has challenged this approach. RFA might be the treatment of choice for multiple lung metastases that are usually approached surgically for long-term remission. A specific indication may also be bilateral pulmonary metastases. Other potential applications might be tumor size reduction by a non-surgical procedure followed by adjuvant chemotherapy. Currently, these thoughts remain only speculations, until proven by clinical trials with medium to long-term follow up. Furthermore, the risk of this procedure for pulmonary application has to be better defined.