Eric vanSonnenberg MD, Abstract Co-Author: Nothing to Disclose

Sridhar Shankar MD, Abstract Co-Author: Nothing to Disclose

Paul Richard Morrison MS, Abstract Co-Author: Nothing to Disclose

Rashmi Thottathil Nair MD, Abstract Co-Author: Nothing to Disclose

Stuart George Silverman MD, Abstract Co-Author: Nothing to Disclose

Kemal Tuncali MD, Abstract Co-Author: Nothing to Disclose

Lawrence Cheung, Presenter: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Purpose: To report our initial experience with patients who underwent percutaneous image-guided radiofrequency ablation of thoracic lesions, and to emphasize adjunctive procedures specific to thoracic tumor ablation.

M&M: Thirty patients with a spectrum of primary (n=18) and secondary (n=11) lung tumors, one mesothelioma, and 5 secondarily eroded, painful ribs underwent CT guided ablation of 36 total lesions (1 patient had 2 ablations). Patients were either non-surgical candidates from medical comorbidities or extent of disease, had exhausted chemotherapy and/or radiation therapy options, or refused or had unsuccessful surgery. Pain (n=11) and tumor cure or control (n=19) were the primary indications for the procedures. Adjunctive procedures to the radiofrequency ablations included the instillation of saline or water windows (n=3), establishment of transosseous and transchondral routes (n=4), intercostal and paravertebral nerve blocks (n=15), and intraprocedural catheter (n=1), needle (n=1), and sheath (n=3) treatment of pneumothoraces. Follow-up was from 2 to 26 months.

Results: All ablations were technically successful. No peri-procedural mortality occurred. Necrosis of tumor was greater than 90% in 26/30 lesions, based on imaging (CT, PET, MRI). In the 11 patients who were undergoing ablation for pain, relief was complete in 4 patients, and partial in the other 7. 2 patients were transiently reintubated after extubation. Four patients died within 1 year of ablation from extra-thoracic spread of tumor.

Conclusion: Radiofrequency ablation for a variety of thoracic tumors can be performed safely and with a high degree of efficacy for pain control and tumor killing. The effect of ablation can be assessed with CT, MRI, and/or PET imaging. Numerous other thoracic Interventional Radiology procedures are beneficial to assist the radiofrequency ablation.

E.v.: Author is a consultant for Cook and Boston Scientific.

vanSonnenberg, E, Shankar, S, Morrison, P, Nair, R, Silverman, S, Tuncali, K, Cheung, L, et al, , Radiofrequency Ablation of Thoracic Lesions: Part II Initial Clinical Experience—Technical and Multidisciplinary Considerations in 30 Patients.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4415773.html