Indications for CT-guided radiofrequency ablation for lung tumors

Radiofrequency ablation for lung cancer is a well-established method that has been included in the recognized and authoritative clinical guidelines for lung cancer treatment for several years —- NCCN Clinical Guidelines for the Treatment of Non-Small Cell Lung Cancer (since 2007); it is used as a first-line option for patients who are unable to tolerate surgery or do not agree with surgical treatment. At the 88th Annual Meeting of American Thoracic Surgeons held in San Diego, California in May 2008, Prof. Michael Lanuti introduced the preliminary experience of percutaneous lung puncture radiofrequency ablation for inoperable lung cancer at Massachusetts General Hospital in Boston, U.S.A., which showed that the survival rates of 2 years and 4 years were 60% and 30%, and local recurrence was found in only 13% of the patients without fatal complications. Only 13% of patients experienced local recurrence, no fatal complications occurred, and there was no significant difference in the lung function of patients 6 months after radiofrequency ablation compared with that before treatment. This has aroused great interest from thoracic surgeons all over the world. In June 2008, Lancet Oncology, a top international medical journal, published online the results of a prospective multicenter clinical study on percutaneous lung puncture radiofrequency ablation for the treatment of lung cancer, in which 99% of the patients were able to complete the operation successfully without treatment-related deaths. The 1-year and 2-year survival rates after radiofrequency ablation for non-small cell lung cancer were 92% and 73%, respectively, with a 92% 2-year survival rate for stage I non-small cell lung cancer. In addition, for lung metastatic cancer, radiofrequency ablation has also achieved very good therapeutic effect: the 1-year and 2-year survival rates of colorectal cancer lung metastasis are 91% and 68% respectively; the 1-year and 2-year survival rates of other malignant tumors lung metastasis are 93% and 67% respectively. Radiofrequency ablation therapy opens a new window for lung cancer treatment, which is applicable to patients with early stage lung cancer or lung metastasis who cannot tolerate surgery, and can also be used as a remedial therapeutic measure for open thoracic surgical exploration of lung cancer as well as a tumor reduction therapy for patients with locally advanced and metastatic cancers, which can provide a condition for comprehensive treatment. Through CT-guided three-dimensional reconstruction, it is possible to make the radiofrequency ablation therapy electrodes evenly distributed in the lung tumors to maximize the completion of radiofrequency ablation therapy. This is an advantage incomparable to open thoracic surgery or thoracoscopic radiofrequency ablation treatment, and it is also the preferred radiofrequency ablation treatment in the field of global thoracic surgery and lung cancer treatment, which can maximize the ablation of tumors as well as minimally invasive treatment. Radiofrequency ablation treatment for lung cancer is generally used in two cases: first, early lung cancer and elderly lung cancer patients who cannot tolerate surgery, or primary or metastatic lung cancer patients who have surgical indications but the patient refuses to undergo surgery; and second, local tumor reduction treatment. The second one is local tumor reduction therapy, which is the physical radiofrequency ablation treatment for lung cancer, and after tumor reduction therapy, it creates conditions for systemic comprehensive treatment, combining with local radiotherapy, systemic chemotherapy or molecular targeting therapy. Strict indications have not been established, and the reported indications are: 1. Early stage (stage I or IIa) NSCLC patients who are not suitable for surgery, such as patients with peripheral early lung cancer who are old or have poor cardiopulmonary function and cannot tolerate surgery; 2. Stage IIIb (satellite nodules in the same lobe of the lung) or stage IV (nodules in other lobes of the lung or in the other lung) NSCLC patients who are not suitable for surgery; or stage IIIa or IV lung cancer Isolated nodules remaining after standard treatment; 3. Patients with peripheral early lung cancer who are not willing to receive surgery or radiotherapy; 4. Lung metastases: the number of lesions on each side of the lung is ≤3, and the number of lesions on both sides of the lung is <6 or the total diameter is <10cm; both sides should be divided into two parts, and the diameter of the lesions is ≤3.5cm; 5. Lung metastasis which has been or can be controlled by the primary disease, and is unsuitable for surgery, chemotherapy or radiotherapy; 6. Tumor reduction therapy for multiple metastases; 7, target lesion less than 5cm, tumor distance from large blood vessels or large bronchial tubes is more than 1.0 cm; 8, pleural effusion should be aspirated before ablation; 9, platelet count ≥100 × 109/ L, INR ≤1.5. Contraindications: Serious failure of important organs; hilar lesion with large cavities; central lung cancer combined with severe obstructive pneumonia; lung cancer with metastases to cervical or thoracic vertebrae; lung cancer with metastases to cervical or thoracic vertebrae; lung cancer with metastases to cervical or thoracic vertebrae. Those with metastasis to cervical or thoracic vertebrae and serious vertebral destruction with the risk of paraplegia; those with diffuse metastatic lesions in the lungs. Tumor immediately adjacent to hilar or large pulmonary vessels at a distance of <1.0 cm; pulmonary arterial hypertension, pneumonia, atelectasis; number of tumors >3 in the same lung, diffuse; target lesion >5 cm.