Ablation for treating small pulmonary nodules: radiologic and surgical approach and perspectives
Damian E. Dupuy, Janine Zuromski, Arjun Pennathur
Abstract
Abstract: Lung cancer is the most common cause of cancer-related mortality in the United States. While surgical resection is the standard therapy for resectable early-stage non-small cell lung cancer (NSCLC), a significant proportion of patients may have comorbidities that preclude resection. In addition, in patients who have previously undergone successful lung resection for cancer, recurrent disease is the most common cause of cancer-related mortality. Ablative techniques, such as radiofrequency ablation (RFA) may be applicable in high-risk patients with lung cancer. Further, ablative modalities may be applicable in selected patients with limited pulmonary metastases. In this review, the potential indications for ablative therapies in selected high-risk medically inoperable patients with early-stage NSCLC, patients with limited pulmonary metastases, and patients with recurrent lung cancer are discussed. Ablative therapies include RFA, microwave ablation (MWA) and cryoablation (CA). RFA is a thermal ablative modality, which uses an energy delivery system that applies an alternating current supplied by a radiofrequency energy generator, delivered through a needle electrode. RFA is the most well-studied percutaneous ablative modality and will be the focus of this review. The principles of RFA, the technique for RFA, potential indications for RFA, and clinical experiences with RFA in the treatment of lung neoplasm are reviewed.