Radiofrequency ablation of pulmonary malignancies

Several surgical, medical, irradiative, and image-guided focal ablative therapies are available for patients with primary non-small-cell lung cancer (NSCLC) or pulmonary metastases. The most appropriate therapy depends on cell type; the size, location, and number of tumors; the degree of local tumor spread and regional and distant metastases; the cardiopulmonary and functional status of the patient; symptoms; and therapeutic goals and desires of the patients and their caregivers. When potential cure or survival benefit is the goal, the most appropriate patients for radiofrequency (RF) ablation are those with stage I NSCLC or a few peripheral metastases limited to the lungs that are preferably less than 3 cm diameter, and who are not candidates for surgical resection. Because many of these patients will demonstrate local residual viable tumor or develop metastases or new primary tumors elsewhere, lifelong imaging surveillance with potential reintervention is warranted. When relief of tumor-related symptoms is the therapeutic goal, RF ablation may be applied to larger more advanced tumors with a reasonable expectation of improvement in a significant proportion of this population. In addition to judicious case selection, precise device placement with careful attention to RF ablation technique is essential to achieve optimized outcome with respect to complete tumor necrosis and avoidance of injury to critical nontargeted structures. Awareness of potential complications, use of techniques to minimize the probability of complications, and early recognition with aggressive management of complications are paramount to maintaining a satisfactory safety profile for RF ablation.