Radiofrequency Ablation of Lung Metastasis Not Suitable for Surgery: Experience in Siriraj Hospital

Percutaneous image-guided radiofrequency ablation (RFA) is being promoted as a novel technique with low morbidity rate in treatment of inoperable lung tumor either primary lung tumor or metastatic disease.

To report our experiences of RFA treated for lung metastasis in Siriraj Hospital and to evaluate the efficacy and complication of RFA.

All patients who underwent RFA for lung metastasis at Siriraj Hospital, between January 2007 and December 2013, were included in the present study. Clinical data, pre-procedure image findings including lesion size, location, post-procedure image findings, complications, and outcome were retrospectively reviewed.

Fourteen patients (10 male, 4 female) with 27 lung metastasis were treated with RFA. The ablated lung nodules consist of metastasis from hepatocellular carcinoma (n = 13), colorectal adenocarcinoma (n = 9), insular cell thyroid carcinoma (n = 3), and adenocarcinoma of prostate gland (n = 2). Mean patient age was 50 years (age range 28-67 years). Size of the ablated nodules range from 0.5 to 5.0 cm (median = 1.3 cm). The most common complication was pneumothorax, occurring in 71% (10 of 14 patients). Other complications included surgical site infection, atelectasis, loculated hemothorax, loculated empyema, and bronchopleural fistula, occurred in one patient each. Post-procedure image findings showed complete ablations without local tumor recurrence in 81% (22 of 27 nodules). Local tumor recurrences were seen in 19% (5 of 27 nodules).

Radiofrequency ablation for lung metastasis can be considered as a relatively safe, effective alternative treatment for lung metastasis. Risk factors that may associate with local recurrence include large size nodules and subpleural location.