Percutaneous Radiofrequency Ablation of Pulmonary Malignancies: Combined Treatment with Brachytherapy
Sapna K. Jain1,
Damian E. Dupuy1,
Gene A. Cardarelli2,
Zhen Zheng2 and
Thomas A. DiPetrillo2
1 Department of Diagnostic Imaging, Rhode Island Hospital, Brown Medical School,
593 Eddy St., Providence, RI 02903
2 Department of Radiation Oncology, Rhode Island Hospital, Brown Medical School,
Providence, RI 02903.
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Fig. 1A. —78-year-old man with biopsy-proven recurrent non-small cell
lung cancer in left upper lobe after undergoing chemotherapy and external beam
radiation therapy for treatment of T4 N1 M0 poorly differentiated squamous
cell carcinoma of lung. CT image of area before patient underwent therapy
shows mass (arrow) in left upper lobe is abutting aortic arch and
great vessels.
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Fig. 1B. —78-year-old man with biopsy-proven recurrent non-small cell
lung cancer in left upper lobe after undergoing chemotherapy and external beam
radiation therapy for treatment of T4 N1 M0 poorly differentiated squamous
cell carcinoma of lung. CT image with patient prone obtained to check
placement of brachytherapy catheter shows mass and internal dummy seeds
(arrows).
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Fig. 1C. —78-year-old man with biopsy-proven recurrent non-small cell
lung cancer in left upper lobe after undergoing chemotherapy and external beam
radiation therapy for treatment of T4 N1 M0 poorly differentiated squamous
cell carcinoma of lung. Photograph shows patient in prone position with
inserted brachytherapy catheters.
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Fig. 1D. —78-year-old man with biopsy-proven recurrent non-small cell
lung cancer in left upper lobe after undergoing chemotherapy and external beam
radiation therapy for treatment of T4 N1 M0 poorly differentiated squamous
cell carcinoma of lung. Axial CT image obtained after contrast administration
at 1-month follow-up reveals nonenhancing mass (arrow) in left upper
lobe.
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Fig. 1E. —78-year-old man with biopsy-proven recurrent non-small cell
lung cancer in left upper lobe after undergoing chemotherapy and external beam
radiation therapy for treatment of T4 N1 M0 poorly differentiated squamous
cell carcinoma of lung. Axial CT image shows persistent catheter tract
(long arrow) and adjacent radiation fibrosis (short arrow)
from previous external beam radiation therapy.
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Fig. 1F. —78-year-old man with biopsy-proven recurrent non-small cell
lung cancer in left upper lobe after undergoing chemotherapy and external beam
radiation therapy for treatment of T4 N1 M0 poorly differentiated squamous
cell carcinoma of lung. Diagram of three-dimensionally reconstructed
brachytherapy dosimetry plan using iridium-192 high-dose-rate afterloading.
Dose distribution of radiation is according to isodoses in right upper corner
of figure. Arrow indicates radiation dose of 16 Gy.
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Fig. 2A. —61-year-old man with new metastatic lesion in right lower
lobe after undergoing bilateral pulmonary wedge resections and chemotherapy
for treatment of metastatic renal cell carcinoma. Axial CT image with patient
prone shows 3.5 x 2.5 x 2.0 cm mass (arrow) in medial
portion of right lower lobe.
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Fig. 2B. —61-year-old man with new metastatic lesion in right lower
lobe after undergoing bilateral pulmonary wedge resections and chemotherapy
for treatment of metastatic renal cell carcinoma. Axial CT image obtained
after radiofrequency ablation with patient prone shows iodine-125 seeds were
deposited in tumor periphery (arrows) and brachytherapy catheter has
been repositioned posteromedially for placement of additional seeds.
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Fig. 2C. —61-year-old man with new metastatic lesion in right lower
lobe after undergoing bilateral pulmonary wedge resections and chemotherapy
for treatment of metastatic renal cell carcinoma. Axial CT image obtained at
12-month follow-up with patient supine shows tumor has contracted and seeds
(arrows) are now placed more peripherally than at baseline (not
shown).
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Fig. 3A. —65-year-old man with new mass in superior segment of left
lower lobe after undergoing right pneumonectomy and adjuvant chemotherapy for
treatment of locally advanced non-small cell lung cancer. Axial CT image shows
3.0 x 2.0 cm mass (arrow) in superior segment of left lower
lobe.
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Fig. 3B. —65-year-old man with new mass in superior segment of left
lower lobe after undergoing right pneumonectomy and adjuvant chemotherapy for
treatment of locally advanced non-small cell lung cancer. CT fluoroscopy image
with patient prone shows radiofrequency electrode (arrow) in
mass.
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Fig. 3C. —65-year-old man with new mass in superior segment of left
lower lobe after undergoing right pneumonectomy and adjuvant chemotherapy for
treatment of locally advanced non-small cell lung cancer. Axial CT image after
radiofrequency ablation with patient prone shows placement of seeds
(arrows).
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Fig. 3D. —65-year-old man with new mass in superior segment of left
lower lobe after undergoing right pneumonectomy and adjuvant chemotherapy for
treatment of locally advanced non-small cell lung cancer. Axial CT image with
patient supine at 9-month follow-up shows tumor in treated area has shrunk
compared with A. Note seed (arrow) located in aerated lung
that previously was in tumor.
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Copyright © 2003 by the American Roentgen Ray Society.
