Radiofrequency ablation of thoracic lesions: Part 2, initial clinical experience - Technical and multidisciplinary considerations in 30 patients

Eric VanSonnenberg, Sridhar Shankar, Paul R. Morrison, Rashmi T. Nair, Stuart G. Silverman, Michael T. Jaklitsch, Franklin Liu, Lawrence Cheung, Kemal Tuncali, Arthur T. Skarin, David J. Sugarbaker

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE. The purpose of our study was to report our initial experience with patients who underwent percutaneous imaging-guided radiofrequency ablation of thoracic lesions, and to emphasize technical and multidisciplinary issues and adjunctive procedures specific to thoracic tumor ablation. MATERIALS AND METHODS. Our cohort consisted of 30 patients with a spectrum of primary (n = 18) and secondary (n = 11) lung tumors, mesothelioma (n = 1), and five secondarily eroded, painful ribs who underwent ablation of 36 total lesions (one patient had two ablations). Patients either were nonsurgical candidates because of medical comorbidities or extent of disease, or had exhausted chemotherapy and radiation therapy options, or had refused surgery or undergone unsuccessful surgery. Patients were treated with radiofrequency ablation after agreement among oncologists, thoracic surgeons, and interventional radiologists. An array-style electrode under impedance control was used to treat 29 thoracic tumors and the adjacent rib metastases (n = 5). A cool-tip radiofrequency probe was used for two patients. CT guidance and general anesthetic were used for all but one patient. Sonographic guidance and IV conscious sedation were used in one patient. Pain (n = 11) and tumor cure or control (n= 19) were the primary indications for the procedures. Adjunctive procedures to the radiofrequency abla-tions included the creation of saline or water windows (n = 3); establishment of transosseous and transchondral routes (n = 4); use of intercostal and paravertebral nerve blocks (n = 15); and use of an intraprocedural catheter (n = 1), needle (n = 1), or sheath (n = 3) for treatment of pneumothoraces. Follow-up was from 2 to 26 months. RESULTS. All ablations were technically successful. No periprocedural mortality occurred. Necrosis of tumor was greater than 90% in 26 of 30 lesions based on short-term follow-up imaging (CT, PET, MRI). In the 11 patients who underwent ablation for pain, relief was complete in four and partial in the other seven. One patient developed a local skin burn, four patients had self-limited hemoptysis up to 4 days after ablation, one had transient atrial fibrillation, one developed hoarseness, and two patients were transiently reintubated after extubation. Eight pneumothoraces developed; one patient underwent placement of a chest tube. Four patients died within 1 year of ablation from extrathoracic 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, or PET. Various technical issues differentiate thoracic tumor ablation from standard abdominal ablations. Numerous other thoracic interventional radiology procedures are beneficial to assist the radiofrequency ablation. A multidisciplinary approach offers valuable expertise for patient care.

Original languageEnglish (US)
Pages (from-to)381-390
Number of pages10
JournalAmerican Journal of Roentgenology
Volume184
Issue number2
DOIs
StatePublished - Jan 1 2005

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Thorax
Neoplasms
Ribs
Pneumothorax
Pain
Intercostal Nerves
Conscious Sedation
Interventional Radiology
Hoarseness
Chest Tubes
General Anesthetics
Hemoptysis
Nerve Block
Mesothelioma
Electric Impedance
Atrial Fibrillation
Needles
Comorbidity
Patient Care
Electrodes

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Radiofrequency ablation of thoracic lesions : Part 2, initial clinical experience - Technical and multidisciplinary considerations in 30 patients. / VanSonnenberg, Eric; Shankar, Sridhar; Morrison, Paul R.; Nair, Rashmi T.; Silverman, Stuart G.; Jaklitsch, Michael T.; Liu, Franklin; Cheung, Lawrence; Tuncali, Kemal; Skarin, Arthur T.; Sugarbaker, David J.

In: American Journal of Roentgenology, Vol. 184, No. 2, 01.01.2005, p. 381-390.

Research output: Contribution to journalArticle

VanSonnenberg, E, Shankar, S, Morrison, PR, Nair, RT, Silverman, SG, Jaklitsch, MT, Liu, F, Cheung, L, Tuncali, K, Skarin, AT & Sugarbaker, DJ 2005, 'Radiofrequency ablation of thoracic lesions: Part 2, initial clinical experience - Technical and multidisciplinary considerations in 30 patients', American Journal of Roentgenology, vol. 184, no. 2, pp. 381-390. https://doi.org/10.2214/ajr.184.2.01840381
VanSonnenberg, Eric ; Shankar, Sridhar ; Morrison, Paul R. ; Nair, Rashmi T. ; Silverman, Stuart G. ; Jaklitsch, Michael T. ; Liu, Franklin ; Cheung, Lawrence ; Tuncali, Kemal ; Skarin, Arthur T. ; Sugarbaker, David J. / Radiofrequency ablation of thoracic lesions : Part 2, initial clinical experience - Technical and multidisciplinary considerations in 30 patients. In: American Journal of Roentgenology. 2005 ; Vol. 184, No. 2. pp. 381-390.
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abstract = "OBJECTIVE. The purpose of our study was to report our initial experience with patients who underwent percutaneous imaging-guided radiofrequency ablation of thoracic lesions, and to emphasize technical and multidisciplinary issues and adjunctive procedures specific to thoracic tumor ablation. MATERIALS AND METHODS. Our cohort consisted of 30 patients with a spectrum of primary (n = 18) and secondary (n = 11) lung tumors, mesothelioma (n = 1), and five secondarily eroded, painful ribs who underwent ablation of 36 total lesions (one patient had two ablations). Patients either were nonsurgical candidates because of medical comorbidities or extent of disease, or had exhausted chemotherapy and radiation therapy options, or had refused surgery or undergone unsuccessful surgery. Patients were treated with radiofrequency ablation after agreement among oncologists, thoracic surgeons, and interventional radiologists. An array-style electrode under impedance control was used to treat 29 thoracic tumors and the adjacent rib metastases (n = 5). A cool-tip radiofrequency probe was used for two patients. CT guidance and general anesthetic were used for all but one patient. Sonographic guidance and IV conscious sedation were used in one patient. Pain (n = 11) and tumor cure or control (n= 19) were the primary indications for the procedures. Adjunctive procedures to the radiofrequency abla-tions included the creation of saline or water windows (n = 3); establishment of transosseous and transchondral routes (n = 4); use of intercostal and paravertebral nerve blocks (n = 15); and use of an intraprocedural catheter (n = 1), needle (n = 1), or sheath (n = 3) for treatment of pneumothoraces. Follow-up was from 2 to 26 months. RESULTS. All ablations were technically successful. No periprocedural mortality occurred. Necrosis of tumor was greater than 90{\%} in 26 of 30 lesions based on short-term follow-up imaging (CT, PET, MRI). In the 11 patients who underwent ablation for pain, relief was complete in four and partial in the other seven. One patient developed a local skin burn, four patients had self-limited hemoptysis up to 4 days after ablation, one had transient atrial fibrillation, one developed hoarseness, and two patients were transiently reintubated after extubation. Eight pneumothoraces developed; one patient underwent placement of a chest tube. Four patients died within 1 year of ablation from extrathoracic 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, or PET. Various technical issues differentiate thoracic tumor ablation from standard abdominal ablations. Numerous other thoracic interventional radiology procedures are beneficial to assist the radiofrequency ablation. A multidisciplinary approach offers valuable expertise for patient care.",
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AU - Morrison, Paul R.

AU - Nair, Rashmi T.

AU - Silverman, Stuart G.

AU - Jaklitsch, Michael T.

AU - Liu, Franklin

AU - Cheung, Lawrence

AU - Tuncali, Kemal

AU - Skarin, Arthur T.

AU - Sugarbaker, David J.

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N2 - OBJECTIVE. The purpose of our study was to report our initial experience with patients who underwent percutaneous imaging-guided radiofrequency ablation of thoracic lesions, and to emphasize technical and multidisciplinary issues and adjunctive procedures specific to thoracic tumor ablation. MATERIALS AND METHODS. Our cohort consisted of 30 patients with a spectrum of primary (n = 18) and secondary (n = 11) lung tumors, mesothelioma (n = 1), and five secondarily eroded, painful ribs who underwent ablation of 36 total lesions (one patient had two ablations). Patients either were nonsurgical candidates because of medical comorbidities or extent of disease, or had exhausted chemotherapy and radiation therapy options, or had refused surgery or undergone unsuccessful surgery. Patients were treated with radiofrequency ablation after agreement among oncologists, thoracic surgeons, and interventional radiologists. An array-style electrode under impedance control was used to treat 29 thoracic tumors and the adjacent rib metastases (n = 5). A cool-tip radiofrequency probe was used for two patients. CT guidance and general anesthetic were used for all but one patient. Sonographic guidance and IV conscious sedation were used in one patient. Pain (n = 11) and tumor cure or control (n= 19) were the primary indications for the procedures. Adjunctive procedures to the radiofrequency abla-tions included the creation of saline or water windows (n = 3); establishment of transosseous and transchondral routes (n = 4); use of intercostal and paravertebral nerve blocks (n = 15); and use of an intraprocedural catheter (n = 1), needle (n = 1), or sheath (n = 3) for treatment of pneumothoraces. Follow-up was from 2 to 26 months. RESULTS. All ablations were technically successful. No periprocedural mortality occurred. Necrosis of tumor was greater than 90% in 26 of 30 lesions based on short-term follow-up imaging (CT, PET, MRI). In the 11 patients who underwent ablation for pain, relief was complete in four and partial in the other seven. One patient developed a local skin burn, four patients had self-limited hemoptysis up to 4 days after ablation, one had transient atrial fibrillation, one developed hoarseness, and two patients were transiently reintubated after extubation. Eight pneumothoraces developed; one patient underwent placement of a chest tube. Four patients died within 1 year of ablation from extrathoracic 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, or PET. Various technical issues differentiate thoracic tumor ablation from standard abdominal ablations. Numerous other thoracic interventional radiology procedures are beneficial to assist the radiofrequency ablation. A multidisciplinary approach offers valuable expertise for patient care.

AB - OBJECTIVE. The purpose of our study was to report our initial experience with patients who underwent percutaneous imaging-guided radiofrequency ablation of thoracic lesions, and to emphasize technical and multidisciplinary issues and adjunctive procedures specific to thoracic tumor ablation. MATERIALS AND METHODS. Our cohort consisted of 30 patients with a spectrum of primary (n = 18) and secondary (n = 11) lung tumors, mesothelioma (n = 1), and five secondarily eroded, painful ribs who underwent ablation of 36 total lesions (one patient had two ablations). Patients either were nonsurgical candidates because of medical comorbidities or extent of disease, or had exhausted chemotherapy and radiation therapy options, or had refused surgery or undergone unsuccessful surgery. Patients were treated with radiofrequency ablation after agreement among oncologists, thoracic surgeons, and interventional radiologists. An array-style electrode under impedance control was used to treat 29 thoracic tumors and the adjacent rib metastases (n = 5). A cool-tip radiofrequency probe was used for two patients. CT guidance and general anesthetic were used for all but one patient. Sonographic guidance and IV conscious sedation were used in one patient. Pain (n = 11) and tumor cure or control (n= 19) were the primary indications for the procedures. Adjunctive procedures to the radiofrequency abla-tions included the creation of saline or water windows (n = 3); establishment of transosseous and transchondral routes (n = 4); use of intercostal and paravertebral nerve blocks (n = 15); and use of an intraprocedural catheter (n = 1), needle (n = 1), or sheath (n = 3) for treatment of pneumothoraces. Follow-up was from 2 to 26 months. RESULTS. All ablations were technically successful. No periprocedural mortality occurred. Necrosis of tumor was greater than 90% in 26 of 30 lesions based on short-term follow-up imaging (CT, PET, MRI). In the 11 patients who underwent ablation for pain, relief was complete in four and partial in the other seven. One patient developed a local skin burn, four patients had self-limited hemoptysis up to 4 days after ablation, one had transient atrial fibrillation, one developed hoarseness, and two patients were transiently reintubated after extubation. Eight pneumothoraces developed; one patient underwent placement of a chest tube. Four patients died within 1 year of ablation from extrathoracic 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, or PET. Various technical issues differentiate thoracic tumor ablation from standard abdominal ablations. Numerous other thoracic interventional radiology procedures are beneficial to assist the radiofrequency ablation. A multidisciplinary approach offers valuable expertise for patient care.

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