Clinical Applications of Radio-Frequency Tumor Ablation in the Thorax1
Damian E. Dupuy, MD,
William W. Mayo-Smith, MD,
Gerald F. Abbott, MD and
Thomas DiPetrillo, MD
1 From the Departments of Diagnostic Imaging (D.E.D., W.W.M.S., G.F.A.) and Radiation Oncology (T.D.), Brown Medical School, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903. Presented as an education exhibit at the 2001 RSNA scientific assembly. Received January 28, 2002; revision requested March 18 and received April 12; accepted April 26. Address correspondence to D.E.D. (e-mail: ddupuy@lifespan.org).
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Figure 1. Photograph shows an RF generator, which monitors impedance, current, power, and temperature during the ablation procedure.
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Figure 2. Photograph shows intercostal insertion of a cool-tip cluster electrode for chest wall ablation.
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Figure 3a. Results of RF ablation in a 78-year-old woman with emphysema and a right suprahilar mass. Results of biopsy showed squamous cell carcinoma. The patient was a poor surgical candidate due to comorbid conditions (heart disease, emphysema). (a) CT scan obtained prior to external-beam radiation therapy shows an electrode inserted into the mass for percutaneous RF ablation. (b) CT scan obtained 3 months after RF ablation (6 weeks after radiation therapy) shows the mass with adjacent parenchymal stranding but no retraction. (c) CT scan obtained 27 months after RF ablation demonstrates shrinkage of the tumor with parenchymal fibrosis and contraction medially. This dramatic response in such a large tumor would be unusual in a patient treated with irradiation alone. Tissues treated with RF ablation become cicatricial, and the lesions may still be apparent at imaging.
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Figure 3b. Results of RF ablation in a 78-year-old woman with emphysema and a right suprahilar mass. Results of biopsy showed squamous cell carcinoma. The patient was a poor surgical candidate due to comorbid conditions (heart disease, emphysema). (a) CT scan obtained prior to external-beam radiation therapy shows an electrode inserted into the mass for percutaneous RF ablation. (b) CT scan obtained 3 months after RF ablation (6 weeks after radiation therapy) shows the mass with adjacent parenchymal stranding but no retraction. (c) CT scan obtained 27 months after RF ablation demonstrates shrinkage of the tumor with parenchymal fibrosis and contraction medially. This dramatic response in such a large tumor would be unusual in a patient treated with irradiation alone. Tissues treated with RF ablation become cicatricial, and the lesions may still be apparent at imaging.
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Figure 3c. Results of RF ablation in a 78-year-old woman with emphysema and a right suprahilar mass. Results of biopsy showed squamous cell carcinoma. The patient was a poor surgical candidate due to comorbid conditions (heart disease, emphysema). (a) CT scan obtained prior to external-beam radiation therapy shows an electrode inserted into the mass for percutaneous RF ablation. (b) CT scan obtained 3 months after RF ablation (6 weeks after radiation therapy) shows the mass with adjacent parenchymal stranding but no retraction. (c) CT scan obtained 27 months after RF ablation demonstrates shrinkage of the tumor with parenchymal fibrosis and contraction medially. This dramatic response in such a large tumor would be unusual in a patient treated with irradiation alone. Tissues treated with RF ablation become cicatricial, and the lesions may still be apparent at imaging.
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Figure 4a. Biopsy-proved metachronous primary tumor of the left lung in a 75-year-old man who had undergone right pneumonectomy for bronchogenic carcinoma several years earlier. Owing to the size of the lesion, RF ablation and brachytherapy implantation were performed during one session. (a) CT scan obtained with the patient prone shows the RF electrode inserted into the lesion. Four overlapping ablations were performed. (b) CT scan obtained after RF ablation shows a brachytherapy catheter being used to place radioactive iodine seeds around the periphery of the mass. (c) Chest radiograph obtained 2 hours after RF ablation shows the lesion with the brachytherapy seeds in place. (d) Follow-up CT scan obtained 11 months later shows retraction of the soft tissue in the area of treatment with brachytherapy and RF ablation.
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Figure 4b. Biopsy-proved metachronous primary tumor of the left lung in a 75-year-old man who had undergone right pneumonectomy for bronchogenic carcinoma several years earlier. Owing to the size of the lesion, RF ablation and brachytherapy implantation were performed during one session. (a) CT scan obtained with the patient prone shows the RF electrode inserted into the lesion. Four overlapping ablations were performed. (b) CT scan obtained after RF ablation shows a brachytherapy catheter being used to place radioactive iodine seeds around the periphery of the mass. (c) Chest radiograph obtained 2 hours after RF ablation shows the lesion with the brachytherapy seeds in place. (d) Follow-up CT scan obtained 11 months later shows retraction of the soft tissue in the area of treatment with brachytherapy and RF ablation.
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Figure 4c. Biopsy-proved metachronous primary tumor of the left lung in a 75-year-old man who had undergone right pneumonectomy for bronchogenic carcinoma several years earlier. Owing to the size of the lesion, RF ablation and brachytherapy implantation were performed during one session. (a) CT scan obtained with the patient prone shows the RF electrode inserted into the lesion. Four overlapping ablations were performed. (b) CT scan obtained after RF ablation shows a brachytherapy catheter being used to place radioactive iodine seeds around the periphery of the mass. (c) Chest radiograph obtained 2 hours after RF ablation shows the lesion with the brachytherapy seeds in place. (d) Follow-up CT scan obtained 11 months later shows retraction of the soft tissue in the area of treatment with brachytherapy and RF ablation.
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Figure 4d. Biopsy-proved metachronous primary tumor of the left lung in a 75-year-old man who had undergone right pneumonectomy for bronchogenic carcinoma several years earlier. Owing to the size of the lesion, RF ablation and brachytherapy implantation were performed during one session. (a) CT scan obtained with the patient prone shows the RF electrode inserted into the lesion. Four overlapping ablations were performed. (b) CT scan obtained after RF ablation shows a brachytherapy catheter being used to place radioactive iodine seeds around the periphery of the mass. (c) Chest radiograph obtained 2 hours after RF ablation shows the lesion with the brachytherapy seeds in place. (d) Follow-up CT scan obtained 11 months later shows retraction of the soft tissue in the area of treatment with brachytherapy and RF ablation.
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Figure 5a. Two-centimeter-long, poorly differentiated squamous cell carcinoma (stage 1) of the right lower lobe in a 69-year-old woman with emphysema, which precluded surgery or external-beam radiation therapy. (a) CT scan shows an electrode inserted for percutaneous RF ablation, which seemed to be a reasonable treatment option in this case. (b) CT scan obtained 14 months after RF ablation shows no interval growth of the tumor and peritumoral pleural and parenchymal stranding. The treated tumor continued to show lack of growth 2 years after RF ablation.
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Figure 5b. Two-centimeter-long, poorly differentiated squamous cell carcinoma (stage 1) of the right lower lobe in a 69-year-old woman with emphysema, which precluded surgery or external-beam radiation therapy. (a) CT scan shows an electrode inserted for percutaneous RF ablation, which seemed to be a reasonable treatment option in this case. (b) CT scan obtained 14 months after RF ablation shows no interval growth of the tumor and peritumoral pleural and parenchymal stranding. The treated tumor continued to show lack of growth 2 years after RF ablation.
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Figure 6a. Single small pulmonary metastasis in the right lower lobe in a 54-year-old woman who had undergone right mastectomy for breast carcinoma. (a) Axial CT scan shows metastasis in the right lower lobe. (b) CT scan shows an RF electrode within the metastasis. (c) Follow-up CT scan obtained 6 months later shows the mass abutting the pleural surface with surrounding retraction of adjacent parenchyma, but with no significant increase in size.
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Figure 6b. Single small pulmonary metastasis in the right lower lobe in a 54-year-old woman who had undergone right mastectomy for breast carcinoma. (a) Axial CT scan shows metastasis in the right lower lobe. (b) CT scan shows an RF electrode within the metastasis. (c) Follow-up CT scan obtained 6 months later shows the mass abutting the pleural surface with surrounding retraction of adjacent parenchyma, but with no significant increase in size.
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Figure 6c. Single small pulmonary metastasis in the right lower lobe in a 54-year-old woman who had undergone right mastectomy for breast carcinoma. (a) Axial CT scan shows metastasis in the right lower lobe. (b) CT scan shows an RF electrode within the metastasis. (c) Follow-up CT scan obtained 6 months later shows the mass abutting the pleural surface with surrounding retraction of adjacent parenchyma, but with no significant increase in size.
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Figure 7a. Metastatic colon carcinoma and a painful pleura-based mass in a 59-year-old woman. (a) CT scan obtained with the patient prone shows a large, pleura-based lesion in the right lung. A cluster RF electrode was inserted into the mass, and thermocoagulation was performed in five overlapping areas. (b) Follow-up gadolinium-enhanced magnetic resonance (MR) image obtained 18 months later shows a thick, enhanced soft-tissue rind around the lesion, a finding that is consistent with residual tumor tissue. A central area of low signal intensity indicating necrosis is also seen.
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Figure 7b. Metastatic colon carcinoma and a painful pleura-based mass in a 59-year-old woman. (a) CT scan obtained with the patient prone shows a large, pleura-based lesion in the right lung. A cluster RF electrode was inserted into the mass, and thermocoagulation was performed in five overlapping areas. (b) Follow-up gadolinium-enhanced magnetic resonance (MR) image obtained 18 months later shows a thick, enhanced soft-tissue rind around the lesion, a finding that is consistent with residual tumor tissue. A central area of low signal intensity indicating necrosis is also seen.
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Figure 8a. Nasopharyngeal carcinoma metastatic to the mediastinum in a 52-year-old man. The patient refused additional radiation therapy and chemotherapy. RF ablation was performed to retard tumor growth and prevent involvement of the left hilum. CT scan obtained prior to RF ablation showed a safe window for ablation adjacent to the manubrium of the sternum. (a) CT fluoroscopic image shows a mass into which a cluster RF electrode has been inserted. The untreated tumor grew, and a second RF ablation procedure was performed 7 months later. (b, c) Follow-up CT scans show a large tumor cavity that communicates with the left upper lobe bronchus. Note also the peripheral contrast-enhanced tumor tissue.
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Figure 8b. Nasopharyngeal carcinoma metastatic to the mediastinum in a 52-year-old man. The patient refused additional radiation therapy and chemotherapy. RF ablation was performed to retard tumor growth and prevent involvement of the left hilum. CT scan obtained prior to RF ablation showed a safe window for ablation adjacent to the manubrium of the sternum. (a) CT fluoroscopic image shows a mass into which a cluster RF electrode has been inserted. The untreated tumor grew, and a second RF ablation procedure was performed 7 months later. (b, c) Follow-up CT scans show a large tumor cavity that communicates with the left upper lobe bronchus. Note also the peripheral contrast-enhanced tumor tissue.
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Figure 8c. Nasopharyngeal carcinoma metastatic to the mediastinum in a 52-year-old man. The patient refused additional radiation therapy and chemotherapy. RF ablation was performed to retard tumor growth and prevent involvement of the left hilum. CT scan obtained prior to RF ablation showed a safe window for ablation adjacent to the manubrium of the sternum. (a) CT fluoroscopic image shows a mass into which a cluster RF electrode has been inserted. The untreated tumor grew, and a second RF ablation procedure was performed 7 months later. (b, c) Follow-up CT scans show a large tumor cavity that communicates with the left upper lobe bronchus. Note also the peripheral contrast-enhanced tumor tissue.
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Figure 9a. Recurrent synovial sarcoma of the pleura in a 47-year-old woman. A 9-cm mass developed in the right pulmonary apex after surgery and radiation therapy. RF ablation was performed with a cool-tip cluster RF ablation probe. (a, b) CT scans show that multiple placements of the probe were required to thermocoagulate the mass. (c) Sagittal gadolinium-enhanced MR image obtained after RF ablation shows extensive central thermocoagulation of the tumor, which demonstrates a thin rim of enhancement. Residual tumor tissue extends between the ribs.
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Figure 9b. Recurrent synovial sarcoma of the pleura in a 47-year-old woman. A 9-cm mass developed in the right pulmonary apex after surgery and radiation therapy. RF ablation was performed with a cool-tip cluster RF ablation probe. (a, b) CT scans show that multiple placements of the probe were required to thermocoagulate the mass. (c) Sagittal gadolinium-enhanced MR image obtained after RF ablation shows extensive central thermocoagulation of the tumor, which demonstrates a thin rim of enhancement. Residual tumor tissue extends between the ribs.
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Figure 9c. Recurrent synovial sarcoma of the pleura in a 47-year-old woman. A 9-cm mass developed in the right pulmonary apex after surgery and radiation therapy. RF ablation was performed with a cool-tip cluster RF ablation probe. (a, b) CT scans show that multiple placements of the probe were required to thermocoagulate the mass. (c) Sagittal gadolinium-enhanced MR image obtained after RF ablation shows extensive central thermocoagulation of the tumor, which demonstrates a thin rim of enhancement. Residual tumor tissue extends between the ribs.
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Figure 10a. Lung cancer metastatic to the sternum in a 49-year-old man. The patient had undergone external-beam radiation therapy but had persistent pain. (a) Axial CT scan shows a destructive mass within the midsternum. (b) CT fluoroscopic image shows placement of a single RF electrode into the mass. Two overlapping treatments were performed. The patient experienced relief of symptoms after undergoing ablation.
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Figure 10b. Lung cancer metastatic to the sternum in a 49-year-old man. The patient had undergone external-beam radiation therapy but had persistent pain. (a) Axial CT scan shows a destructive mass within the midsternum. (b) CT fluoroscopic image shows placement of a single RF electrode into the mass. Two overlapping treatments were performed. The patient experienced relief of symptoms after undergoing ablation.
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Figure 11a. Large, expansile mass at the left first rib in a 65-year-old man who had undergone nephrectomy for renal cell carcinoma 12 years earlier. (a) Follow-up CT scan shows that the mass had continued to grow despite external-beam radiation therapy. (b) CT fluoroscopic image used to guide RF ablation shows the RF electrode inserted into the mass. Because of the size of the mass, nine overlapping treatments were performed. (c) Follow-up coronal gadolinium-enhanced MR image obtained 5 months after RF ablation shows the mass with lack of enhancement centrally, a finding that is consistent with adequate thermocoagulation. The surrounding peripheral enhancement represents granulation tissue or residual tumor tissue. The tumor near the spine was not treated for fear of neural toxicity.
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Figure 11b. Large, expansile mass at the left first rib in a 65-year-old man who had undergone nephrectomy for renal cell carcinoma 12 years earlier. (a) Follow-up CT scan shows that the mass had continued to grow despite external-beam radiation therapy. (b) CT fluoroscopic image used to guide RF ablation shows the RF electrode inserted into the mass. Because of the size of the mass, nine overlapping treatments were performed. (c) Follow-up coronal gadolinium-enhanced MR image obtained 5 months after RF ablation shows the mass with lack of enhancement centrally, a finding that is consistent with adequate thermocoagulation. The surrounding peripheral enhancement represents granulation tissue or residual tumor tissue. The tumor near the spine was not treated for fear of neural toxicity.
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Figure 11c. Large, expansile mass at the left first rib in a 65-year-old man who had undergone nephrectomy for renal cell carcinoma 12 years earlier. (a) Follow-up CT scan shows that the mass had continued to grow despite external-beam radiation therapy. (b) CT fluoroscopic image used to guide RF ablation shows the RF electrode inserted into the mass. Because of the size of the mass, nine overlapping treatments were performed. (c) Follow-up coronal gadolinium-enhanced MR image obtained 5 months after RF ablation shows the mass with lack of enhancement centrally, a finding that is consistent with adequate thermocoagulation. The surrounding peripheral enhancement represents granulation tissue or residual tumor tissue. The tumor near the spine was not treated for fear of neural toxicity.
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Figure 12a. Small squamous cell lung cancer of the right upper lobe in a 78-year-old man. The patient was undergoing home oxygen therapy and was a poor candidate for surgery or irradiation. (a) CT scan obtained with the patient prone shows a mass into which a single RF electrode has been inserted. (b) Conventional radiograph shows a chest tube that was required because of development of a pneumothorax. The patient underwent 1 week of chest tube treatment. Extensive subcutaneous emphysema is also noted.
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Figure 12b. Small squamous cell lung cancer of the right upper lobe in a 78-year-old man. The patient was undergoing home oxygen therapy and was a poor candidate for surgery or irradiation. (a) CT scan obtained with the patient prone shows a mass into which a single RF electrode has been inserted. (b) Conventional radiograph shows a chest tube that was required because of development of a pneumothorax. The patient underwent 1 week of chest tube treatment. Extensive subcutaneous emphysema is also noted.
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Copyright © 2002 by the Radiological Society of North America.
