title: Long-term results of percutaneous radiofrequency ablation of pulmonary metastases: a single institution experience.
abstract: Surgical resection of pulmonary metastases is considered as a therapeutic procedure in selected cases. However, many patients are unable to tolerate surgical intervention due to comorbidities and/or poor pulmonary reserve, also related to repeated parenchymal resections. Considering this scenario, we decided to investigate the role of radiofrequency ablation (RFA).
  
  
  
  The outcomes of all patients that underwent RFA for lung metastases, during the period 2003-2013, were analysed. The primary end-points were overall survival (OS) and local progression-free survival (LPFS). Secondary end-point was the analysis of possible risk factors affecting OS and LPFS.
  
  
  
  Ninety-nine RFAs were performed on 61 patients (38 men, 23 women, median age of 74 years). Fourteen patients were treated for two or more lesions, for a total of 86 lesions. Twelve lesions were treated up to three times. The median lesion diameter was 2 cm. The majority of patients were affected by lung metastases from colorectal cancer (47.5%). All procedures were successfully completed. One death occurred, whereas the morbidity rate was 11% (8% pneumothorax requiring chest drainage). At a median follow-up of 28 months, the 1-, 3-, 5-year OS (LPFS) rates were 94.8% (86.3%), 49.0% (70.3%) and 44.5% (68.3%), respectively. No significant correlation was found, using univariate and multivariate analysis, between OS and age, gender, histology of primary cancer (colon versus others), type of approach (computed tomography versus ultrasonography guidance), number of treated lesions (1 vs >1), disease-free interval (from primary tumour to first lung metastases) (1-35 vs >35 months), previous lung resections (yes versus no), whereas a tendency towards better OS was observed, by applying univariate analysis, for a lesion of <3 cm (P = 0.051) and for the presence of local disease 1 month after treatment (P = 0.056), however, without a statistically significant difference. With regard to LPFS, lesion dimensions (P = 0.005) and the presence of local disease 1 month after treatment (P < 0.001) were found to be significant risk factors, in both univariate and multivariate analyses.
  
  
  
  RFA appears as a feasible and safe procedure, with an acceptable morbidity, offering the possibility to safely repeat the treatment on the same lesion. RFA can be considered a valid option for the local control of lung metastases, in patients not eligible for surgery, especially those with lesions smaller than 3 cm.
authors.affiliation: Division of Thoracic Surgery, Cardio-Thoracic and Vascular Department, Cisanello University Hospital, Pisa, Italy olivia.fanucchi@for.unipi.it.
authors.forename: Olivia
authors.initials: O
authors.lastname: Fanucchi
authors.affiliation: Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy.
authors.forename: Marcello Carlo
authors.initials: MC
authors.lastname: Ambrogi
authors.affiliation: Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Aprile
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Vascular and Interventional Radiology, and Nuclear Medicine, Cisanello University Hospital, Pisa, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cioni
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Vascular and Interventional Radiology, and Nuclear Medicine, Cisanello University Hospital, Pisa, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Cappelli
authors.affiliation: Division of Thoracic Surgery, Multidisciplinary Robotic Centre, Cisanello University Hospital, Pisa, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Melfi
authors.affiliation: Division of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Gabrilele
authors.initials: G
authors.lastname: Massimetti
authors.affiliation: Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mussi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
keywords: High-risk patients; Lung metastases; Minimally invasive therapy; Non-surgical patients; Percutaneous ablation; Radiofrequency ablation