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Lung cancer is the most common cause of cancer related death in the USA. Surgical resection is the treatment of choice in non-small cell lung cancer (NSCLC). Many patients have poor pulmonary function or other medical co-morbidities and are not suitable for resection. Such patients are offered alternative treatments such as radiotherapy and chemotherapy, with poorer long term survival. Radiofrequency ablation (RFA) is a thermal energy delivery system that applies alternating current through a needle electrode into the tumour. It has been used for treating unresectable liver tumours.
In this pilot study at the University of Pittsburgh, 33 tumour nodules in 18 patients were treated with RFA. Five of the patients had NSCLC (stage I (n=3), stage IV (n=2)) and 13 had pulmonary metastases from an extrathoracic malignancy (sarcoma, colon, melanoma, renal). Two of the five patients with NSCLC had recurrence of disease after thoracotomy and resection. All patients underwent a chest CT scan before and after RFA. Patients were followed up at 1 and 3 month intervals with a CT scan of the chest. At a median follow up of 6 months (range 1–10) four of the five patients with NSCLC were alive; the other patient died at the age of 95 years without evidence of disease progression. Seven of the 13 patients with pulmonary metastases were alive at a median follow up of 4 months. The response rate was better for lesions less than 5 cm in diameter.
Although RFA will not replace surgical resection as the treatment of choice for NSCLC, it may offer better survival in selected patients and additional trials are needed to determine its role.
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