Lung Cancer Radiofrequency Ablation: Process, Risks and Recovery

Lung cancer radiofrequency ablation (RFA) is a procedure in which a thin needle electrode is passed through the skin into the centre of a lung tumour under CT guidance, and heat generated by radiofrequency current destroys the tumour. It is mainly used for early lung cancers of around 3 cm or smaller in people who cannot easily have surgery, and for a small number of lung metastases. The UK National Institute for Health and Care Excellence (NICE) recognises lung RFA as a procedure that can be offered in routine care.

Drawing on UK hospital patient leaflets, NICE guidance and multicentre trials from the US and France, this guide explains who is suitable, what happens on the day, how side effects such as pneumothorax are managed, and how long recovery takes, including when it is safe to fly. It is a basic guide for patients and families looking into treatment abroad.

What lung RFA is: principle and other ablation methods

Radiofrequency ablation takes place in the CT scanning room rather than an operating theatre. An interventional radiologist watches the CT images while advancing a needle-shaped electrode into the centre of the tumour, then heats the surrounding tissue with radiofrequency energy from the electrode tip. The heated tumour tissue is destroyed where it lies and slowly shrinks into scar tissue over time. Because the chest is not opened and no part of the lung is removed, recovery is quick, and the same area can be treated again if needed. See our RFA guide and IVR guide for more on how it works.

There are two other needle-based ways to treat lung tumours. The patient leaflet from Royal Brompton and Harefield Hospitals in the UK explains that the doctor chooses one of the three methods below according to the type and location of the tumour.

All three are performed through the skin under CT guidance. The choice depends on the hospital and the tumour.

Who is suitable

Taken together, UK hospital leaflets and NICE guidance describe lung RFA as an option in the following situations.

• Early lung cancer when surgery is difficult: early non-small cell lung cancer in people for whom lung surgery carries a high burden because of age, heart or lung function, or other illnesses
• A small number of lung metastases: cancer that has spread to the lungs from another organ, such as the bowel, with only a few deposits
• Hard-to-operate locations: tumours whose surgical removal would sacrifice a lot of healthy lung
• Combined with other treatment: used alongside surgery, radiotherapy or chemotherapy, or repeated in stages when there are several tumours

Size matters. In studies reviewed by NICE, tumours of 3 cm or smaller did clearly better than larger ones, so many hospitals use about 3 cm as a guide. NICE also recommends that patients are selected by a multidisciplinary team including thoracic surgery, oncology and radiology, and that the procedure is done by radiologists who regularly perform similar procedures. Stereotactic body radiotherapy (SBRT) is another option for early lung cancer when surgery is difficult, so it is worth comparing both at consultation.

Tests and preparation before the procedure

Preparation varies by hospital, but the following items appear in the leaflets from both the Royal Devon and Harefield hospitals.

The stopping times are examples from the Royal Devon leaflet. Whether and when to stop is decided by your doctors.

On the day and length of stay

Before the procedure, you go over the steps and risks with the doctor again and sign a consent form. The procedure then follows these steps.

1. Anaesthesia: usually general anaesthesia; local anaesthesia with sedation may be possible depending on the hospital and patient.
2. Planning: CT images are used to locate the tumour and choose the entry point, and the skin is cleaned.
3. Placing the electrode: the electrode is passed through the skin into the centre of the tumour and its position is rechecked on CT.
4. Heating: radiofrequency energy heats the tumour and a margin around it.
5. Finishing: the electrode is removed and a dressing is applied.

Time in the scanning department is usually 1–3 hours. Afterwards, pulse and blood pressure are checked in recovery and you rest in bed on the ward for a few hours. To check for an air leak, chest X-rays are taken 3–4 hours after the procedure and the next morning, and if all is well most people go home the next day. In the French phase II trial, the median hospital stay was 3 days.

Side effects and how they are managed

Because a needle passes into the lung, the most common side effect is pneumothorax, where air leaks out around the lung. It often causes no symptoms or settles by itself; if a lot of air collects, a thin tube (chest drain) is used to remove it. UK leaflets explain that this usually does not delay discharge.

Frequencies are taken directly from the Royal Devon leaflet and the NICE IPG372 evidence review.

In the US Z4033 trial, grade 3 or higher adverse events attributable to RFA occurred in 11.8%, and no grade 4–5 events were attributed to RFA. Importantly, lung function measures (FEV1, DLCO) did not fall significantly over 24 months, showing that people with weak lungs can be treated while preserving their remaining lung function.

Recovery, returning to normal life and flying

• Pain: there may be pain at the needle site, but it is rarely severe and usually settles within a few days with simple painkillers.
• Dressing: remove after 24 hours. Any bruising around the site fades within 2–3 days.
• Daily life and work: most people return to normal activities within a few days, and about a week off work is common.
• Flying and scuba diving: Royal Devon advises avoiding both for at least 6 weeks, because a pneumothorax can still develop later. If you are treated abroad, plan your flight home with the medical team in advance.

Contact the hospital straight away if you have breathlessness or pain when breathing in, pain not controlled by painkillers, a fever or pain 1–2 weeks after treatment, or coughing up blood that starts or continues more than 24 hours after the procedure.

The result is checked with CT. At Royal Devon, the first CT is done 3 months after the procedure, then every 3 months for the first year and every 6 months the following year. If tumour remains or regrows at the treated site, the procedure can be repeated, and PET-CT may also be used.

Outcomes reported in clinical trials

Key results from multicentre trials in patients unable to have surgery and from the NICE evidence review are shown below.

Single-arm results without a comparison group. Figures are taken directly from each source.

Most participants in Z4033 were older people whose heart and lung function ruled out surgery. About 7 in 10 of them were alive two years later, and smaller tumours did even better. In the French trial, more than 80% of treated tumours had not regrown at the treated site after three years. Finding tumours while they are small and discussing them early with a multidisciplinary team makes it easier to benefit from RFA.

Where it is available

Coverage and costs vary by country, hospital and insurance. International patients are often not covered by the host country's public insurance, so check in advance.

University hospitals and cancer centres in Japan and other countries also perform lung tumour ablation in their interventional radiology departments, but availability and eligibility differ by hospital. When contacting a hospital abroad, start by asking how many procedures they do each year, whether they use radiofrequency, microwave or cryoablation, and whether decisions are made at a multidisciplinary meeting.

What to check and questions for your doctor

• Compare options: hear the pros and cons for your case compared with surgery and stereotactic radiotherapy.
• Size and location: tumours over 3 cm or close to large vessels, airways or the chest wall may need a different approach.
• Lung function: if you have only one lung or very reduced lung function, ask for a careful explanation of the risks.
• Travel plans: if treated abroad, agree in advance when you can fly and where follow-up CT will be done after you return.

Questions to ask your medical team:

• Given the size and location of my tumour, which is most suitable: radiofrequency, microwave or cryoablation?
• How does it compare with surgery or stereotactic radiotherapy for me?
• Will it be under general anaesthesia, and how many nights will I stay?
• How is a pneumothorax treated, and which symptoms after discharge should I report?
• When can I fly, and when and how often will follow-up CT be done?

For consultation tips see five questions before an RFA consultation, for reading research numbers see how to check a study's phase, and to compare with liver tumour treatment see liver cancer RFA procedure and recovery.

Related: for the same needle-based treatments in other organs, see long-term results of kidney cancer cryoablation (up to 13 years) and thyroid nodule RFA vs microwave ablation at one year. Freezing small breast cancers is covered in breast cancer cryoablation: FDA criteria and recurrence rates.

Frequently asked questions

How long does lung cancer RFA take, and how long is the hospital stay?

Time in the scanning department is usually 1–3 hours, mostly under general anaesthesia. Chest X-rays 3–4 hours afterwards and the next morning check for pneumothorax, and most people go home the next day. The stay may be a little longer if a chest drain is needed.

What happens if a pneumothorax occurs?

Pneumothorax is the most common side effect; a chest drain is needed in about 1 in 7 patients at a UK hospital. Removing the air through a thin tube usually resolves it, and often discharge is not delayed. After going home, contact the hospital straight away if you become breathless or it hurts to breathe.

When can I fly after the procedure?

Royal Devon in the UK advises avoiding flying and scuba diving for at least 6 weeks because a pneumothorax can develop later. Advice may differ between hospitals, so if you are treated abroad, discuss your return flight with the medical team before the procedure.

How do I choose between RFA, surgery and radiotherapy?

Surgery is the standard for early lung cancer when it is possible; when it is not, RFA or stereotactic radiotherapy is considered. In the US Z4033 trial, 2-year survival in medically inoperable stage IA lung cancer was 69.8% with lung function preserved. The choice is best made with a multidisciplinary team based on tumour size, location and lung function.

Related: relieving pain from cancer that has spread to bone with RFA or cryoablation is covered in ablation for painful bone metastases.

This article summarises official sources and published studies as general information, not medical advice. Please discuss treatment choices with doctors who have examined you.