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CT-guided RFA shows promise for chest tumors
CT-guided radio-frequency tumor ablation, once confined primarily to the abdomen, is becoming a possibility for chest tumors. It may be ready for larger-scale outcomes studies, according to presentations at the RSNA meeting.
Researchers presented studies with up to 185 patients in which RF ablation was used to destroy both metastatic and primary chest tumors, including those in the lung, with generally good results. The procedure is not without complications, including pneumothorax, but it has the potential to attack tumors that cannot be treated with surgery or other therapy techniques.
The studies seem to have established the feasibility of RF ablation for chest tumor treatment and to have set the platform for outcomes studies, said comoderator Dr. Jonathan G. Goldin, an associate professor of thoracic radiology at the University of California, Los Angeles. The scientific session was the first at an RSNA meeting on the subject of RF ablation in the chest.
The largest study was conducted by Dr. Patrick Sewell, an interventional radiologist at the University of Mississippi, who used RFA to treat 379 tumors in 185 patients. Most of the tumors were non-small cell carcinoma, but they included colon, renal, and breast metastases and sarcomas. Treatment times ranged from 20 minutes to 13 hours, with a mean time of 3.5 hours. The mean hospital stay was 4.6 days.
In addition to pneumothorax, complications included parenchymal bleeding and skin burns. The retreatment rate was 6.3%.
Sewell said that primary lung tumors larger than 4 mm are difficult to treat. Among metastatic tumors, the best results are found when the tumor is stable and there are three or fewer lesions.
An important issue in chest RFA is knowing when the tumor is actually destroyed. Papers at the session explored two options: a change in Hounsfield unit enhancement under contrast and a ground-glass appearance at the margins of the tumor after ablation.
A study from Japan found that the ground-glass attenuation sign on CT was 95% successful in predicting tumor necrosis. The study included 75 patients with 99 tumors. A study at UCLA measuring HU enhancement before and after ablation in 19 patients found that mean values dropped from 46.8 HU to 9.6 HU one month after therapy. Follow-up was available for two patients at six months, with one above and one below baseline enhancement levels.
"It seems a surrounding halo of ground-glass is a likely predictor of necrosis," Goldin said.
-- By John C. Hayes
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