Radiofrequency ablation: identification of the ideal patient

Radiofrequency (RF) ablation (RFA) is a relatively new modality that is being used for lung tumors with increasing frequency. Radiofrequency energy consists of an alternating current that moves from an active electrode that is placed within the tumor to dispersive electrodes that are placed on the patient. As the RF energy is applied, frictional heating of tissues results, with cell death occurring at temperatures > 60 degrees C. This article discusses preclinical and early clinical experience with RFA for lung tumors. Radiofrequency ablation has been used for patients with primary lung cancer and limited pulmonary metastases. Current data suggest that RFA is most suitable for tumors < or = 4 cm in size and is better for peripheral rather than centrally based nodules. Additionally, studies of RFA followed by resection have demonstrated a learning-curve effect with improved tumor kill in the later cases performed in these series. Surgical resection should continue to be the primary modality offered to patients with early-stage non-small-cell lung cancer and limited metastatic disease to the lungs (when the primary tumor is controlled). Radiofrequency ablation is a good option for those patients who are believed to be at increased risk for resection or who refuse resection, when operation would otherwise be appropriate therapy. Additionally, RFA may be used for local control of peripheral tumors in patients with more advanced cancers in combination with other therapies.