Thoracic Ablation: Primary Lung Cancer, Metastases, Chest Wall Disease

Abstract

Radiofrequency ablation (RFA) of small volume primary and metastatic lung tumor is being increasingly performed in a curative setting as well as to control symptoms in a palliative setting. When used judiciously in a multidisciplinary setting it can deliver results comparable to other treatment modalities. In this chapter we will review the technical and clinical aspects of lung RFA to deliver a safe and effective service. Multiplanar review of the preprocedure CT is essential to plan access and treatment volumes. CT guidance is used for needle positioning to create an appropriate ablation geometry. Overtreatment is the key to success – a ground glass margin of 5 mm or greater all around the tumor with complete tumor necrosis and good local control reduces risk of recurrence. Rigorous imaging follow-up is critical – CT is usually performed, although PET at 3–6 months could be better. Local nodular recurrence, if detected early, can be successfully retreated. Complications like pneumothorax, haemorrhage, pleural reaction and post embolisation syndrome do occur, more than RFA of other sites. Although less used, microwave ablation, cryoablation, or sequential radiofrequency ablation may offer several advantages over standard unipolar radiofrequency ablation in the lungs.