BACKGROUND:
Treatment options for high surgical risk patients with non-small cell lung cancer (NSCLC) are limited. Previously we reported our experience with radiofrequency ablation (RFA) for tumors that were mostly pulmonary metastases. This report describes our early experience with RFA for peripheral primary NSCLC.
METHODS:
We treated 18 non-small cell lung cancers (median diameter 2.5 cm) in 15 patients (7 male/8 female). Median age was 75 (range 58-86) years. Prior treatments included pulmonary resection (3) or chemoradiation (2). Stages were I (7), II (2),III( 3) and IV (3). Stage IV patients included 2 with recurrence following prior lobectomies and 1 with a synchronous liver metastasis also treated with RFA. Tumor histologies were squamous (8), adenocarcinoma (5), bronchiolar (1) and undifferentiated (1). Thoracotomy was performed in 2 and a CT-guided percutaneous approach in 13. Follow-up CT and PET scans were used to evaluate response.
RESULTS:
One post-operative death occurred from pneumonia after open RFA. In the CT-guided group median hospital stay was 2 days; a chest tube was required in 6 (46%) for procedural related pneumothoraces. At a median follow-up of 7 months; 13 (92.3%) of 14 hospital survivors were alive, with local recurrence occurring in 4 and distal recurrence in 1. Follow-up scans demonstrated regression or stable disease in 10 (59%) of 17 evaluable nodules.
CONCLUSIONS:
RFA is feasible for selected high-risk patients with small peripheral NSCLC. Response rates and survival were acceptable at intermediate follow-up. Further prospective studies will be necessary to determine optimal patient selection and long-term outcomes.

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