Radiofrequency Ablation (RFA) For Lung Tumors: Seven Years Experience.
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1 Radiofrequency Ablation (RFA) For Lung Tumors: Seven Years Experience. Poster No.: C-1619 Congress: ECR 2011 Type: Scientific Exhibit Authors: G. DE VENUTO 1, G. XHEPA 1, M. DE CHIARA 1, M. Mangini 2, Keywords: DOI: A. Leonardi 3, N. Lucchina 2, A. M. IERARDI 1, G. Carrafiello 1, C. Fugazzola 2 ; 1 VARESE/IT, 2 Varese/IT, 3 Varese (VA)/IT Interventional non-vascular, Lung, Thorax, CT-Angiography, Fluoroscopy, Ablation procedures, Neoplasia /ecr2011/C-1619 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 9
2 Purpose To review recurrence patterns in patients with lung cancer (primary or secondary) treated with percutaneous image-guided radiofrequency (RF) ablation. Methods and Materials From January 2003 to August 2010, thirty-two patients (24 with primary non-small-celllung-cancer (NSCLC) and 8 with metastases) with single tumors were treated. Posttreatment imaging results were available for each patient. Follow up was performed using CT scan at 1, 3, 6, 12, 18, 24 months after the procedure, than annually. Patterns of recurrence were classified as local, intra-pulmonary, nodal, mixed and distant. We evaluated the overall survival after RFA and factors associated with recurrences. Images for this section: Page 2 of 9
3 Fig. 1: CT scan performed before a peripheric lung lesion (A); RF electrode is positioned perfectly within the tumor (B); CT scan performed after one month revealed a complete necrosis (C); CT scan performed after six months revealed the absence of local recurrence and a further reduction in volume of the lesion (D. Fig. 2: Patients and lesions characteristics Page 3 of 9
4 Results Seventeen (53.1%) patients demonstrated no evidence of recurrence at follow-up imaging (range, months; mean, 32.5 months). Recurrence was seen in 15 (46.9 %) patients (range, 6-36 months; mean, 14.8 months). Local recurrence (40%) after RFA was the most frequent. Median disease free survival was 20 months. Sex, tumor location, tumor size and tumor stage were not associated with risk of recurrence. Patient age ( P >0.10) was related to risk of recurrence. Images for this section: Fig. 1: Patients subdivided in two groups (recurrence and no-recurrence) on the basis of tumor stage. Page 4 of 9
5 Fig. 2: Progression-free survival (PFS) after RFA. Page 5 of 9
6 Fig. 3: Box-plots show the significative influence (p>0.10) of age on the risk of recurrence. Page 6 of 9
7 Conclusion Local recurrence as most common pattern suggests that more aggressive initial RFA may offer improvement in outcomes. Images for this section: Fig. 1: Lesions recurrence after RF ablation (*Recurrence patterns: local, intrapulmonary, nodal, mixed, and distant) Page 7 of 9
8 References 1. Shugarman LR, Mack K, Sorbero ME et al (2009) Race and sex differences in the receipt of timely and appropriate lung cancer treatment. Med Care 47: Laganà D, Carrafiello G, Mangini M et al(2006)radiofrequency ablation of primary and metastatic lung tumors: preliminary experience with a single center device. Surg Endosc 20: Carrafiello G, Laganà D, Mangini M et al (2008) Microwave tumors ablation: principles, clinical applications and review of preliminary experiences. Int J Surg 6: Simon CJ, Dupuy DE, Mayo-Smith WW (2005) Microwave ablation: principles and applications. RadioGraphics 25:S69-S83 5. Goetz MP, Callstrom MR, Charboneau JW et al (2004) Percutaneous image guided radiofrequency ablation of painful metastases involving bone. A multicenter study. J Clin Oncol 22: Solbiati L, Livraghi T, Goldeberg SN et al (2001) Percutaneous radiofrequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. Radiology 221: Simon CJ, Dupuy DE, DiPetrillo TA et al (2007) Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients. Radiology 243: Nishino M, Jackman DM, Hatabu H et al (2010) New Response Evaluation Criteria in Solid Tumors (RECIST) guidelines for advanced non-small cell lung cancer: comparison with original RECIST and impact on assessment of tumor response to targeted therapy. AJR Am J Roentgenol 195:W Goldberg SN, Grassi CJ, Cardella JF et al (2005) Image-guidanced tumor ablation: standardization of terminology and reporting criteria. Radiology 235: Beland MD, Wasser EJ, Mayo-Smith WW et al (2010) Primary non-small cell lung cancer: Review of Frequency, Location, and Time of Recurrence after Radiofrequency Ablation. Radiology 254: Kaplan EL, Meier P (1958) Non parametric estimation from incomplete observations. J Am Stat Assoc 53: Dupuy DE, Zagoria RJ, Akerley W et al (2000) Percutaneous radiofrequency ablation of malignancies in the lung. AJR Am J Roentgenol 174: Wang H, Littrup PJ, Duan Y et al (2005) Thoracic masses treated with percutaneous cryotherapy: Initial experience with more than 200 procedures. Radiology 235: Dupuy DE (2009) Microwave ablation compared with radiofrequency ablation in lung tissue-is microwave not just for popcorn anymore? Radiology 251: Fernando HC (2008) Radiofrequency ablation to treat non-small cell lung cancer and pulmonary metastases. Ann Thorac Surg 85:S780-S784 Page 8 of 9
9 16. Grieco CA, Simon CJ, Mayo-Smith WW et al(2007) Image-guided percutaneous thermal ablation for the palliative treatment of chest wall masses. Am J Clin Oncol 30: Lencioni R, Crocetti L, Cioni R et al (2008) Response to radiofrequency ablation of pulmonary tumours: a prospective, intention- to-treat, multicentre clinical mtrial (the RAPTURE study). Lancet Oncol 9: Lu DS, Raman SS, Limanond P et al(2003) Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 14: Anderson EM, Lees WR, Gillams AR (2009) Early indicators of treatment success after percutaneous radiofrequency of pulmonary tumors. Cardiovasc Intervent Radiol 32: Pennathur A, Luketich JD, Abbas G et al (2007) Radiofrequency ablation for the treatment of stage I non-small cell lung cancer in high-risk patients. J Thorac Cardiovasc Surg 134: Dupuy DE, DiPetrillo T, Gandhi S et al(2006) Radiofrequency ablation followed by conventional radiotherapy for medically inoperable stage I nonsmall cell lung cancer. Chest 129: Fernando HC, Schuchert M, Landreneau R et al (2010) Approaching the high-risk patient: sublobar resection, stereotactic body radiation therapy, or radiofrequency ablation. Ann Thorac Surg. 89:S Pua BB, Thornton RH, Solomon SB et al (2010) Ablation of Pulmonary Malignancy: Current Status. J Vasc Interv Radiol 21:S223-S Wolf FJ, Grand DJ, Machan JT et al (2008) Microwave ablation of lung malignancies: effectiveness, CT findings, and safety in 50 patients. Radiology 247: Liu Z, Ahmed M, Weinstein Y et al (2006) Characterization of the RF ablation-induced "oven effect": the importance of background tissue thermal conductivity on tissue heating. Int J Hyperthermia 22: Carrafiello G, Mangini M, De Bernardi I et al (2010) Microwave ablation therapy for treating primary and secondary lung tumours: technical note. Radiol Med 115: Personal Information Page 9 of 9
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