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A phase II study of radiofrequency ablation therapy for thoracic malignancies with evaluation by FDG-PET



Computed tomography (CT)-guided radiofrequency ablation (RFA) is safe and effective for patients with unresectable primary, recurrent, or metastatic thoracic malignancies. Several studies have shown the benefit of employing 18-fluoro-deoxyglucose positron-emission tomography (FDG-PET) to follow thoracic malignancies treated with RFA. In this prospective study, we show the safety and therapeutic efficacy of RFA and the utility of FDG-PET as tool for early detection of local recurrence.


Twenty patients were enrolled in this study, and 24 lesions were ablated. Seven lesions were primary lung cancer, and 17 lesions were recurrent tumors or metastases from extrathoracic sites. Tumor size was in the range of 0.4–3.3 cm in diameter (mean: 1.5 cm). CT and FDG-PET scans were scheduled 7–14 days and 3–6 months after RFA treatment.


There were 17 adverse events (70.8 %) in 24 ablations included 13 pneumothoraces, two cases of chest pain, and two episodes of fever. With a median follow-up of 35.9 months (range 1–62 months), the overall 2-year survival rate was 84.2 %. Local recurrence occurred at four sites (2-year local control rate was 74.3 %). The FDG-PET results 7–14 days after RFA did not predict recurrence, whereas positive findings 3–6 months after RFA significantly correlated with local recurrence (p = 0.0016).


We confirmed the effectiveness of RFA for unresectable primary and secondary thoracic malignancies. FDG-PET analysis 3–6 months after ablation is a useful tool to assess local control.

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Fig. 1
Fig. 2



Computed tomography


Radiofrequency ablation


18-Fluoro-deoxyglucose positron-emission tomography

ppo FEV 1:

Predictive postoperative forced expiratory volume in one second


Carbon monoxide diffusing capacity

PaO2 :

Arterial oxygen pressure

SpO2 :

Saturated oxygen in arterial blood


Stereotactic body radiotherapy


Intensity-modulated radiation therapy


  1. Abe Y, Matsuzawa T, Fujiwara T, Itoh M, Fukuda H, Yamaguchi K, Kubota K, Hatazawa J, Tada M, Ido T, Watanuki S (1990) Clinical assessment of therapeutic effects on cancer using 18F-2-fluoro-2-deoxy-d-glucose and positron emission tomography: preliminary study of lung cancer. Int J Radiat Oncol Biol Phys 19:1005–1010

  2. Akeboshi M, Yamakado K, Nakatsuka A, Hataji O, Taguchi O, Takao M, Takeda K (2004) Percutaneous radiofrequency ablation of lung neoplasms: initial therapeutic response. J Vasc Interv Radiol 15:463–470

  3. Akhurst T, Downey RJ, Ginsberg MS, Gonen M, Bains M, Korst R, Ginsberg RJ, Rusch VW, Larson SM (2001) An initial experience with FDG-PET in the imaging of residual disease after induction therapy for lung cancer. Ann Thorac Surg 73:259–264

  4. Alafate A, Shinya T, Okumura Y, Sato S, Hiraki T, Ishii H, Gobara H, Kato K, Fujiwara T, Miyoshi S, Kaji M, Kanazawa S (2013) The maximum standardized uptake value is more reliable than size measurement in early follow-up to evaluate potential pulmonary malignancies following radiofrequency ablation. Acta Med Okayama 67:105–112

  5. Ambrogi MC, Lucchi M, Dini P, Melfi F, Fontanini G, Faviana P, Fanucchi O, Mussi A (2006) Percutaneous radiofrequency ablation of lung tumours: results in the midterm. Eur J Cardiothoracic Surg 30:177–183

  6. Dupuy DE, Zagoria RJ, Akerley W, Mayo-Smith WW, Kavanagh PV, Safran H (2000) Percutaneous radiofrequency ablation of malignancies in the lung. AJR Am J Roentgenol 174:57–59

  7. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J (2009) New response evaluation criteria in solid tumors: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247

  8. Ettinger DS, Akerley W, Borghaei H, Chang AC, Cheney RT, Chirieac LR, D’Amico TA, Demmy TL, Govindan R, Grannis FW Jr, Grant SC, Horn L, Jahan TM, Komaki R, Kong FM, Kris MG, Krug LM, Lackner RP, Lennes IT, Loo BW Jr, Martins R, Otterson GA, Patel JD, Pinder-Schenck MC, Pisters KM, Reckamp K, Riely GJ, Rohren E, Shapiro TA, Swanson SJ, Tauer K, Wood DE, Yang SC, Gregory K, Hughes M (2013) National comprehensive cancer network (2013) Non-small cell lung cancer, version 2.2013. J Natl Compr Canc Netw, 11(6):645–653

  9. Frank A, Lefkowitz D, Jaeger S, Gobar L, Sunderland J, Gupta N, Scott W, Mailliard J, Lynch H, Bishop J, Thorpe P, Dewan N (1995) Decision logic for retreatment of asymptomatic lung cancer recurrence based on positron emission tomography findings. Int J Radiat Oncol Biol Phys 32:1495–1512

  10. Grills IS, Hope AJ, Guckenberger M, Kestin LL, Werner-Wasik M, Yan D, Sonke JJ, Bissonnette JP, Wilbert J, Xiao Y, Belderbos J (2012) A collaborative analysis of stereotactic lung radiotherapy outcomes for early-stage non-small-cell lung cancer using daily online cone-beam computed tomography image-guided radiotherapy. J Thorac Oncol 7(9):1382–1393. doi:10.1097/JTO.0b013e318260e00d

  11. Guckenberger M, Allgäuer M, Appold S, Dieckmann K, Ernst I, Ganswindt U, Holy R, Nestle U, Nevinny-Stickel M, Semrau S, Sterzing F, Wittig A, Andratschke N (2013) Safety and efficacy of stereotactic body radiotherapy for stage I non-small-cell lung cancer in routine clinical practice: a patterns-of-care and outcome analysis. J Thorac Oncol 8(8):1050–1058

  12. Hebert ME, Lowe VJ, Hoffman JM, Patz EF, Anscher MS (1996) Positron emission tomography in the pretreatment evaluation and follow-up of non-small cell lung cancer patients treated with radiotherapy: preliminary findings. Am J Clin Oncol 19:416–421

  13. Herrera LJ, Fernando HC, Perry Y, Gooding WE, Buenaventura PO, Christie NA, Luketich JD (2003) Radiofrequency ablation of pulmonary malignant tumors in nonsurgical candidates. J Thorac Cardiovasc Surg 125:929–937

  14. Higaki F, Okumura Y, Sato S, Hiraki T, Gobara H, Mimura H, Akaki S, Tsuda T, Kanazawa S (2008) Preliminary retrospective investigation of FDG-PET/CT timing in follow-up of ablated lung tumor. Ann Nucl Med 22:157–163

  15. Kang S, Luo R, Liao W, Wu H, Zhang X, Meng Y (2004) Single group study to evaluate the feasibility and complications of radiofrequency ablation and usefulness of post treatment positron emission tomography in lung tumours. World J Surg Oncol 2:30. doi:10.1186/1477-7819-2-30

  16. Lencioni R, Crocetti L, Cioni R, Suh R, Glenn D, Regge D, Helmberger T, Gillams AR, Frilling A, Ambrogi M, Bartolozzi C, Mussi A (2008) Response to radiofrequency ablation of pulmonary tumours: a prospective, intention-to-treat, multicenter clinical trial (the RAPTURE study). Lancet Oncol 9:621–628

  17. National Cancer Institute: Cancer Therapy Evaluation Program. Common Terminology Criteria for Adverse Events. Version 4.0 http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm. Accessed August 2, 2012

  18. Nguyen CI, Scott WJ, Goldberg M (2006) Radiofrequency ablation of lung malignancies. Ann Thorac Surg 82:365–371

  19. Nishida T, Inoue K, Kawata Y, Izumi N, Nishiyama N, Kinoshita H, Matsuoka T, Toyoshima M (2002) Percutaneous radiofrequency ablation of lung neoplasms: a minimally invasive strategy for inoperable patients. J Am Coll Surg 195:426–430

  20. Patz EF Jr, Connolly J, Herndon J (2000) Prognostic value of thoracic FDG PET imaging after treatment for non-small cell lung cancer. AJR Am J Roentgenol 174:769–777

  21. Pua BB, Solomon SB (2009) Radiofrequency ablation of primary and metastatic lung cancer. Semin Ultrasound CT MR 30:113–124

  22. Rose SC, Thistlethwaite PA, Sewell PE, Vance RB (2006) Lung cancer and radiofrequency ablation. J Vasc Interv Radiol 17:927–951

  23. Silvestri GA, Sherman C, Williams T, Leong SS, Flume P, Turrisi A (2001) Caring for the dying patient with lung cancer. Chest 122:1028–1036

  24. Simon R (1989) Optimal two-stage designs for phase II clinical trials. Control Clin Trials 10:1–10

  25. Soldà F, Lodge M, Ashley S, Whitington A, Goldstraw P, Brada M (2013) Stereotactic radiotherapy (SABR) for the treatment of primary non-small cell lung cancer; systematic review and comparison with a surgical cohort. Radiother Oncol 109(1):1–7

  26. Surveillance, Epidemiology, and End Results (SEER) Cancer Statistics Review, 1975–2010 http://seer.cancer.gov/csr/1975_2010. Accessed 14 June 2013

  27. Vansteenkiste J, De Ruysscher D, Eberhardt WE, Lim E, Senan S, Felip E, Peters S; ESMO Guidelines Working Group (2013) Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 24 (Suppl 6):vi89–vi98

  28. Zhu JC, Yan TD, Morris DL (2008) A systematic review of radiofrequency ablation for lung tumor. Ann Surg Oncol 15:1765–1774

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All authors declare that they have no conflict of interest.

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Correspondence to Mitsunori Higuchi.

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Higuchi, M., Honjo, H., Shigihara, T. et al. A phase II study of radiofrequency ablation therapy for thoracic malignancies with evaluation by FDG-PET. J Cancer Res Clin Oncol 140, 1957–1963 (2014). https://doi.org/10.1007/s00432-014-1743-y

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