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Radiofrequency ablation using a monopolar wet electrode for the treatment of inoperable non-small cell lung cancer: a preliminary report.

Jin GY, Han YM, Lee YS, Lee YC - Korean J Radiol (2008 Mar-Apr)

Bottom Line: The mean maximum ablated diameter in the technically successful group of patients ranged from 3.5 to 7.5 cm (mean 5.1 +/- 1.3 cm).Complete necrosis was attained for eight (80%) of 10 lesions, and partial necrosis was achieved for two lesions.There were two major complications (2/10, 20%) encountered: a hemothorax (n = 1) and a bronchopleural fistula (n = 1).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Chonbuk National University Medical School, Research Institute for Medical Science, Chonbuk, Korea. gyjin@chonbuk.ac.kr

ABSTRACT

Objective: To assess the technical feasibility and complications of radiofrequency ablation (RFA) using a monopolar wet electrode for the treatment of inoperable non-small cell lung malignancies.

Materials and methods: Sixteen patients with a non-small cell lung malignancy underwent RFA under CT guidance. All the patients were non-surgical candidates, with mean maximum tumor diameters ranging from 3 to 6 cm (mean: 4.6 +/- 1.1 cm). A single 16-gauge open-perfused electrode with a 2 cm exposed tip was used for the procedure. A 0.9% NaCl saline solution was used as the perfusion liquid with the flow adjusted to 30 mL/h. The radiofrequency energy was applied for 10-40 minutes. The response to RFA was evaluated by performing contrast-enhanced CT immediately after RFA, one month after treatment and then every three months thereafter.

Results: Technical failure was observed in six (37.5%) of 16 patients: intractable pain (n = 2) and non-stop coughing (n = 4). The mean follow-up interval was 15 +/- 8 months (range: 9-31 months). The mean maximum ablated diameter in the technically successful group of patients ranged from 3.5 to 7.5 cm (mean 5.1 +/- 1.3 cm). Complete necrosis was attained for eight (80%) of 10 lesions, and partial necrosis was achieved for two lesions. There were two major complications (2/10, 20%) encountered: a hemothorax (n = 1) and a bronchopleural fistula (n = 1).

Conclusion: Although RFA using a monopolar wet electrode can create a large ablation zone, it is associated with a high rate of technical failure when used to treat inoperable non-small cell lung malignancies.

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73-year-old woman with lung cancer (adenocarcinoma) in the right middle lobe.A. Before radiofrequency ablation, contrast-enhanced CT scans showed 3-cm, triangular-shaped, enhanced mass in right middle lobe of lung.B. Monopolar electrode was inserted once within lung mass.C. Immediately after radiofrequency ablation, ablated zone showed almost no enhancement on contrast-enhanced CT scans and this was judged as complete ablation.D. Two years later, contrast-enhanced CT scans revealed small subpleural nodule, such as fibrotic nodule, at previous ablated zone.
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Figure 1: 73-year-old woman with lung cancer (adenocarcinoma) in the right middle lobe.A. Before radiofrequency ablation, contrast-enhanced CT scans showed 3-cm, triangular-shaped, enhanced mass in right middle lobe of lung.B. Monopolar electrode was inserted once within lung mass.C. Immediately after radiofrequency ablation, ablated zone showed almost no enhancement on contrast-enhanced CT scans and this was judged as complete ablation.D. Two years later, contrast-enhanced CT scans revealed small subpleural nodule, such as fibrotic nodule, at previous ablated zone.

Mentions: The changes in the tumor size were highly significant for predicting treatment response. Table 2 summarizes the results of RF therapy according to tumor size. In the technically successful group of patients (n = 10), the mean maximum diameter of the tumor before RFA and the mean maximum diameter of the ablated zones after RFA were 43.6 ± 11.3 and 51 ± 13.5 mm, respectively. There were statistically significant differences between the mean maximal diameter of the tumor before RFA and of the ablated zone after RFA (p < 0.05). Complete ablation was attained in eight (80%) of 10 lesions (Fig. 1), and partial ablation was achieved in two (20%) of 10 lesions (Fig. 2). Complete ablation (100%) was achieved for all tumors with a mean diameter < 3 cm. The mean maximum diameter of the tumor before RFA and the mean maximum diameter of the ablated zones after RFA as seen on the last follow-up CT were 4.3 cm ± 1.1 and 3.7 cm ± 2.3, respectively. On the immediate follow-up CT, it was believed that two patients achieved partial ablation after RFA. One patient had a recurrence after 24 months, but one patient showed a decreased size of the primary lung mass on the 31-month follow-up CT, and it was thought that this patient had achieved complete ablation. On the follow-up CT, two of ten patients had a recurrence, and the remainder of the patients showed no change or a decreased size of the primary lung mass. On the immediate CT, a round shape of the ablated zone was seen in nine (90%) of 10 patients and a smooth margin of the ablated zone was also seen in nine (90%) of 10 patients.


Radiofrequency ablation using a monopolar wet electrode for the treatment of inoperable non-small cell lung cancer: a preliminary report.

Jin GY, Han YM, Lee YS, Lee YC - Korean J Radiol (2008 Mar-Apr)

73-year-old woman with lung cancer (adenocarcinoma) in the right middle lobe.A. Before radiofrequency ablation, contrast-enhanced CT scans showed 3-cm, triangular-shaped, enhanced mass in right middle lobe of lung.B. Monopolar electrode was inserted once within lung mass.C. Immediately after radiofrequency ablation, ablated zone showed almost no enhancement on contrast-enhanced CT scans and this was judged as complete ablation.D. Two years later, contrast-enhanced CT scans revealed small subpleural nodule, such as fibrotic nodule, at previous ablated zone.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627221&req=5

Figure 1: 73-year-old woman with lung cancer (adenocarcinoma) in the right middle lobe.A. Before radiofrequency ablation, contrast-enhanced CT scans showed 3-cm, triangular-shaped, enhanced mass in right middle lobe of lung.B. Monopolar electrode was inserted once within lung mass.C. Immediately after radiofrequency ablation, ablated zone showed almost no enhancement on contrast-enhanced CT scans and this was judged as complete ablation.D. Two years later, contrast-enhanced CT scans revealed small subpleural nodule, such as fibrotic nodule, at previous ablated zone.
Mentions: The changes in the tumor size were highly significant for predicting treatment response. Table 2 summarizes the results of RF therapy according to tumor size. In the technically successful group of patients (n = 10), the mean maximum diameter of the tumor before RFA and the mean maximum diameter of the ablated zones after RFA were 43.6 ± 11.3 and 51 ± 13.5 mm, respectively. There were statistically significant differences between the mean maximal diameter of the tumor before RFA and of the ablated zone after RFA (p < 0.05). Complete ablation was attained in eight (80%) of 10 lesions (Fig. 1), and partial ablation was achieved in two (20%) of 10 lesions (Fig. 2). Complete ablation (100%) was achieved for all tumors with a mean diameter < 3 cm. The mean maximum diameter of the tumor before RFA and the mean maximum diameter of the ablated zones after RFA as seen on the last follow-up CT were 4.3 cm ± 1.1 and 3.7 cm ± 2.3, respectively. On the immediate follow-up CT, it was believed that two patients achieved partial ablation after RFA. One patient had a recurrence after 24 months, but one patient showed a decreased size of the primary lung mass on the 31-month follow-up CT, and it was thought that this patient had achieved complete ablation. On the follow-up CT, two of ten patients had a recurrence, and the remainder of the patients showed no change or a decreased size of the primary lung mass. On the immediate CT, a round shape of the ablated zone was seen in nine (90%) of 10 patients and a smooth margin of the ablated zone was also seen in nine (90%) of 10 patients.

Bottom Line: The mean maximum ablated diameter in the technically successful group of patients ranged from 3.5 to 7.5 cm (mean 5.1 +/- 1.3 cm).Complete necrosis was attained for eight (80%) of 10 lesions, and partial necrosis was achieved for two lesions.There were two major complications (2/10, 20%) encountered: a hemothorax (n = 1) and a bronchopleural fistula (n = 1).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Chonbuk National University Medical School, Research Institute for Medical Science, Chonbuk, Korea. gyjin@chonbuk.ac.kr

ABSTRACT

Objective: To assess the technical feasibility and complications of radiofrequency ablation (RFA) using a monopolar wet electrode for the treatment of inoperable non-small cell lung malignancies.

Materials and methods: Sixteen patients with a non-small cell lung malignancy underwent RFA under CT guidance. All the patients were non-surgical candidates, with mean maximum tumor diameters ranging from 3 to 6 cm (mean: 4.6 +/- 1.1 cm). A single 16-gauge open-perfused electrode with a 2 cm exposed tip was used for the procedure. A 0.9% NaCl saline solution was used as the perfusion liquid with the flow adjusted to 30 mL/h. The radiofrequency energy was applied for 10-40 minutes. The response to RFA was evaluated by performing contrast-enhanced CT immediately after RFA, one month after treatment and then every three months thereafter.

Results: Technical failure was observed in six (37.5%) of 16 patients: intractable pain (n = 2) and non-stop coughing (n = 4). The mean follow-up interval was 15 +/- 8 months (range: 9-31 months). The mean maximum ablated diameter in the technically successful group of patients ranged from 3.5 to 7.5 cm (mean 5.1 +/- 1.3 cm). Complete necrosis was attained for eight (80%) of 10 lesions, and partial necrosis was achieved for two lesions. There were two major complications (2/10, 20%) encountered: a hemothorax (n = 1) and a bronchopleural fistula (n = 1).

Conclusion: Although RFA using a monopolar wet electrode can create a large ablation zone, it is associated with a high rate of technical failure when used to treat inoperable non-small cell lung malignancies.

Show MeSH
Related in: MedlinePlus