Haemopthysis due to unresectable lung cancer successfully treated with radiofrequency ablation

Background: Percutaneous radiofrequency ablation (RFA) is a minimally invasive therapeutic option recently achieving a meaningful role for lung cancer treatment. We report the case of an advanced lung cancer determining severe and recurring haemoptysis treated successfully with RFA. Methods: In a 80-year-old woman a right lung cancer was complicated by severe and recurring haemoptysis. The tumour was 6x6 cm sized, in the peripheral parenchyma of the lower lobe, with pathological hilar and mediastinal lymph nodes. Three months before she was excluded from both surgery and medical treatment because of the tumour stage (IIIB) and the respiratory and cardiac co-morbidities. In the last two months, the clinical course was complicated by a serious haemoptysis, inducing progressive anaemia and requiring several blood transfusions. Three bronchoscopies were performed showing blood in the airways without any evident endobronchial source of the bleeding. It was the neoplastic involvement of the distal bronchial tree determining a diffuse bleeding. Endobronchial cauterization by argon-plasma was therefore excluded. At arteriography no bronchial or pulmonary vessels supplying the mass were identified and embolization was also impossible. In the hope of controlling the bleeding by sclerosing the tumor we attempted a percutaneous RFA, despite the size of the mass and the tumor stage. The CT-guided procedure was performed by a multitined expandable array, starting from 30 up to 160 W and repeated from 30 to 120 W. Results: A minimal pleural effusion without pneumothorax occurred. The haemoptysis was successfully controlled immediately after the procedure up to a six months follow-up. At a three months control by CT-scan the lesion was reduced to 5x5 cm and stable at six months. Conclusions: Our experience shows that RFA can be helpful in the management of haemoptysis complicating lung cancer and not suitable for other treatments like endobronchial coagulation or embolitazion.