Recently, two large studies evaluating the addition of chemotherapy to surgery for stage I and II NSCLC showed a 12–15% improvement in survival in the chemotherapy group compared with surgery alone. Clearly, even in earlystage disease, systemic failures can be problematic.

The fact that many patients are not candidates for resection or radiation has led to alternative modalities that could accomplish tumor destruction. Percutaneous image-guided thermal ablation with radiofrequency (RF) energy has been used as a minimally invasive approach for a variety of solid tumors, including liver, kidney, bone, and adrenal gland. The technique for thermal ablation utilizing RF was first reported in human lungs in 2000.12,13 Since 2000 the worldwide experience of RF ablation (RFA) of lung neoplasms has grown (see Table 1) as a minimally invasive option for non-surgical candidates, not only for local control but also for symptom palliation.

Clinical Applications of RFA for Primary Lung Neoplasms
RFA of lung neoplasms is a technique, the clinical applications of which are just beginning to be developed. It has some advantages over traditional RT and chemotherapy. Its safety profile is similar to percutaneous image-guided lung biopsy.Almost all RF procedures can be performed in an out-patient setting, mostly with conscious sedation. Multiple applications can be performed in a single session or over several sessions.

RFA of lung malignancies is performed with two basic rationales. In the first group it is used with an intention of achieving definitive therapy. These are patients who are not candidates for surgery because of co-morbid medical conditions. This cohort could potentially derive significant benefit from a minimally invasive alternative therapy. In the second group it is used as a palliative measure:

• to achieve tumor reduction before chemotherapy;
• to palliate local symptoms related to aggressive tumor growth, such as chest pain, chest wall pain or dyspnea;
• for hematogenous painful bony metastatic disease; and
• tumor recurrence in patients who are not suitable for repeat radiotherapy or surgery.