C. Gadaleta, A. Catino; Bari/IT

Conclusion
Lung RFA has demonstrated to be safe and feasible; the percutaneous approach and imaging guidance make this procedure suitable for patients considered unfit for standard surgical resection. The usually short hospital stay and the good tolerability contribute to RFA being well accepted by patients, resulting in a favourable impact on quality of life. The most serious complication of lung RFA is pneumothorax, requiring pleural drainage in 12.6 % of sessions in this group of patients. In agreement with other Authors, it has to be taken into consideration that in case of lesions larger than 3.5 cm it could be difficult to achieve complete necrosis ; nevertheless, when the subdivision of the lesion in overlapped sectors is required, the use of repeated CT scan during the procedure could improve the technical results, due to the capability of monitoring even the slightest repositioning of the electrode-needle. Lung RFA produces a typical radiological appearance which resembles a “cockade”, so-called due to the formation of concentric layers surrounding the ablated lesion, most likely corresponding to histopathological changes and related to thermal gradients between the tumoral nodule and the surrounding parenchyma. CT scan is the most widely used imaging technique to evaluate lung tumors treated with RFA, able to detect changes in contrast-enhancement as well as the presence of cavitation; in addition, NMR with gadolinium could provide information about tumoral density and composition. Nothwithstanding the need for more standardized methods, CT scan and NMR with gadolinium could be considered reliable techniques for radiologic assessment of treatment efficacy and follow-up of lung neoplasms submitted to RFA. In conclusion, lung RFA could represent an important tool in the multidisciplinary approach of unresectable lung tumors. Further well-designed and long-term studies are warranted to identify which subgroups of patients are ideal candidates to this procedure and to determine its optimal combination with other antineoplastic therapies