Lung Cancer Treatment with Radio Frequency Ablation

RF ablation eligibility criteria include biopsy-proven malignancy, radiographically visible lesion, and three or fewer lesions with no lesion larger than 6cm. Uncorrectable coagulopathy is an exclusion criterion.
Patients with primary nonresectable lung cancer (poor pulmonary function, marginal cardiac function, extension into other structures).
Patients with multiple tumors.

Tumors adjacent the chest wall would more safely be ablated during a state of partial collapse of the lung to create a safety barrier or zone to minimize injury to the neurovascular bundle in the chest wall or other nearby vital structures such as esophagus.
Nearby pulmonary vessel or bronchus to the tumor. Tumors located near vital structures such as heart, esophagus, diaphragm, etc. unless mobilization of the tumor containing lobe of the lung away from the vital structure affording a “safety zone” for RF ablation to occur. For example, in a lower lobe tumor, it would be beneficial to deflate the lung then mobilized the inferior pulmonary ligament endoscopically and retract this lobe away from the diaphragm to then allow safe administration of RF energy to the tumor during ventilation since the 3D geometry of the proximity of the diaphragm and other vital structures to the lower lobe change drastically during ventilation.

• Treatment of multiple tumor types in various locations that are unable to be successfully treated with surgery.
• Multiple lung lesions can be treated without destroying or resecting too much healthy lung tissue.
• Multiple tumors in both lungs can be treated successfully.
• Can be performed multiple times on different occasions.
• Recurrence of tumors can be easily treated.
• RFA of the lung is an emerging treatment.

a. Liver tumors has FDA approval
b. RFA of Metastatic bone disease has been shown to significantly reduce pain from the lesions

• Improved survival might be possible.
• Patients with Metastatic disease can be treated with RFA while the primary tumor could be treated with surgical resection (ie: Breast cancer metastasized to the lung(s) Mastectomy and RFA of lung metastases).
• RFA is not intended to replace surgery and/or chemotherapy, but rather to be used in conjuction.

a. Chemotherapy causes tumors to be more sensitive to RFA.
b. Debulking can be achieved using RFA allowing chemotherapy to be more effective on remaining tumor cells.

• Provides a treatment option where few existed given all patients with nonresectable primary lung or metastatic cancer to the lung.
• Associated with lower morbidity and mortality compared to other treatment options for patients with nonresectable lung lesions*.
• Precise delivery of high energy to the tumor with less adjacent tissue injury or tissue loss.
• Multi-modalities (i.e. percutaneous, thoracoscopic, or open surgical)

*Data on file, Boston Scientific Corporation

• 10-15% chance of pneumothorax (air leak from the lung, collapsed lung)
• 5% chance of bleeding (hemoptysis, hemorrhage into lung tissue, or around lung)
• 2-5% chance of infection.

• Skin burn

• Effusion (fluid around lung)

• Sensitive Pleurae (chest lining sensitivity) limiting exercise

• Horners Syndrome

• Phrenic nerve injury (paralysis of the diaphragm)

• Postop Neuralgia and parasthesias

• Damage to heart if pacemaker present

• Subcutaneous emphysema

• Possible conversion to open thoracotomy

• Possible recurrence of symptoms

• Possible necessity for re-do operations

• Rare chance of:

Death (small chance)
Heart attack
Stroke

Damage to adjacent organs or tissues (diaphragm, heart, esophagus, arteries, veins, bronchus, intercostal neurovascular bundle)
Seeding needle tract with tumor.