Thermal ablation of malignant lung tumours]

In Germany in about 50,000 patients lung cancer is diagnosed per year - actually it is the tumour most likely to result in death. Furthermore, the lung is the second most common site of distant metastases of extrathoracic tumours. In recent years image-guided thermo-ablative techniques are increasingly being used in patients unable to undergo surgery. Radiofrequency ablation (RFA) is the most frequently used technique, cryoablation, microwave-ablation and laser-induced thermoablation are new and promising techniques. Actually there is only a small evidence base, only retrospective and prospective case series have been published as yet. Randomised controlled trials have not been conducted up to now. RFA results in a local control of tumour growth in about 90%. Long-term results indicate 5-year survival rates of 20-61% in patients with lung cancer or lung metastases. Pneumothorax is the most common morbidity - requiring drainage in about 10% after the intervention. In the long term no loss of pulmonary function results after the ablation of peripheral lesions. Peripherally localised tumours <3 cm in diameter are the most promising targets, the treatment of centrally localised tumours is subtle due to the "heat-loss" effect. The current evidence is insufficient to develop a procedure for differential indication of ablative techniques versus stereotactic radiotherapy. Tumour ablation always should be indicated on the basis of interdisciplinary consensus (including pulmonologists, oncologists, thoracic surgeons, radiotherapists). Inoperability should be assigned by the thoracic surgeon himself. Actually it cannot be considered an alternative to surgery for the treatment of malignant lung tumours with curative intent, however thermal ablation broadens the range of treatment options for patients being no candidates for surgery.