Longkanker: RFA - Radio Frequency Ablation bewijst waarde en effectiviteit bij inoperabele longtumoren in twee studies bij totaal 63 patiënten

9 april 2005: Bron: J Vasc Interv Radiol. 2004 May;15(5):463-70. Radiology. 2004 Jan;230(1):125-34. Epub 2003 Nov 26.

Twee gerandomiseerde studies bewijzen waarde van Radio Rrequency Ablation - RFA bij longtumoren. Zie achtereenvolgens de twee abstracten van deze studies hieronder.

Comment in:
Radiology. 2004 Sep;232(3):931; author reply 931-2.

Percutaneous radiofrequency ablation for inoperable non-small cell lung cancer and metastases: preliminary report.

Lee JM, Jin GY, Goldberg SN, Lee YC, Chung GH, Han YM, Lee SY, Kim CS. Departments of Radiology and Medicine, Chonbuk National University Hospital, South Korea. leejm@radcom.snu.ac.kr

PURPOSE: To assess technical feasibility, efficacy, and complications of percutaneous computed tomography (CT)-guided transthoracic radiofrequency (RF) ablation for treating inoperable non-small cell lung cancer (NSCLC) and lung metastases.

MATERIALS AND METHODS: Twenty-six patients with 27 NSCLCs and four patients with five lung metastases underwent RF ablation with cooled-tip electrodes with CT guidance. Patients were not candidates for surgery because of either advanced-stage disease (n = 20) and/or comorbid processes (n = 4) or refusal to undergo surgery (n = 6). The procedure was performed with the intent to cure in 10 (33%) patients with stage I tumors and as palliative therapy in 20 (67%) patients. Contrast material-enhanced CT was performed immediately, 1 month, and then every 3 months after RF ablation to evaluate the response to therapy. Time to death for each patient was calculated with Kaplan-Meier analysis, and the effect of tumor size and the extent of coagulation necrosis on time to death were determined.

RESULTS: Complete necrosis was attained in 12 (38%) of 32 lesions; partial (>50%) necrosis, in the remaining 20 (62%) lesions. Tumor size was a major discriminator in achieving complete necrosis. Complete necrosis was attained in all six (100%) tumors smaller than 3 cm but only in six (23%) of 26 larger tumors (P <.05). Mean survival of patients with complete necrosis (19.7 months) was significantly better than that of patients with partial necrosis (8.7 months) (P <.01). There were three (in 30 patients, 10%) major complications, which included acute respiratory distress syndrome, and two pneumothoraces that required thoracostomy.

CONCLUSION: RF ablation appears to be a safe and promising procedure for the treatment of inoperable NSCLC and metastases. Copyright RSNA, 2004

PMID: 14645875 [PubMed - indexed for MEDLINE]

Percutaneous radiofrequency ablation of lung neoplasms: initial therapeutic response.

Akeboshi M, Yamakado K, Nakatsuka A, Hataji O, Taguchi O, Takao M, Takeda K. Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.

PURPOSE: To evaluate the feasibility, safety, and initial therapeutic effect of radiofrequency (RF) ablation in the treatment of unresectable malignant lung tumors.

MATERIALS AND METHODS: Fifty-four lung neoplasms in 31 patients were treated with RF ablation. Thirteen tumors were primary lung cancers and 41 were pulmonary metastases. Tumor sizes ranged from 0.7 to 6.0 cm, with a mean size of 2.7 +/- 1.3 cm. After the RF electrode was placed in the tumor with computed tomographic (CT) fluoroscopic guidance, RF energy was applied. Initial therapeutic response was evaluated by (18) F fluorodeoxyglucose positron emission tomography (FDG-PET) and contrast-enhanced CT. The disappearance of FDG uptake on PET images and tumor enhancement on CT images were considered to indicate complete tumor necrosis. Complete necrosis rates were evaluated according to tumor size and type (primary or secondary lung neoplasm).

RESULTS: RF ablation was technically successful in all lesions. Complete necrosis was achieved in 32 of the 54 tumors (59%) after initial RF session. There was a significant difference in the rate of complete tumor necrosis between tumors 3 cm or less and tumors larger than 3 cm (69% vs. 39%; P <.05). Tumor type did not influence complete necrosis rates. Lung abscesses developed in two patients with large tumors.

CONCLUSION: Lung RF ablation is a feasible, relatively safe, and promising treatment for unresectable lung neoplasms. Tumor size is an important factor in achieving complete tumor necrosis.

PMID: 15126656 [PubMed - indexed for MEDLINE]

longtumoren, longkanker, Radio Frequency ablation, RFA