Lung cancer is one of the leading causes of death worldwide, while surgery is the treatment of choice for localized tumors and early-stage disease. Systemic treatment (with or without radiotherapy) is indicated for patients with advanced disease. Obviously, each patient should be evaluated with a multidisciplinary approach to define the most appropriate treatment for each case, which in many situations consists of a combination of all the options previously mentioned.

As we know, the current state of the disease and the patient’s general condition are the two aspects considered when defining treatment. Therefore, it is essential to know patients’ lung function because its reduction, a relatively common situation in lung cancer which is highly related to smoking, is a major limitation to perform lung resections. In this context, radiofrequency ablation (RFA) has demonstrated its value by providing an effective and less invasive alternative for the treatment of lung tumors.

Radiofrequency ablation, which uses heat made by radio waves to destroy cancer cells, involves inserting a probe directly into the tumor, guided by accurate imaging tests. This technique selectively destroys the neoplastic cells by applying controlled heat while sparing the surrounding healthy tissues.

An outstanding advantage is its ability to treat inoperable lung tumors (due to poor lung reserve) or patients ineligible for surgery due to other medical or personal reasons. It also offers significant benefits in terms of time to recovery. Patients undergoing radiofrequency ablation experience faster recovery and shorter length of hospital stay compared to traditional methods. This not only has a positive impact on patient’s quality of life, but also reduces the economic burden associated with prolonged treatments.

Nevertheless, there are also some disadvantages related to the method. The limitations of RFA to consider include:

▪ Tumor size and location: efficacy may vary depending on tumor size and location. Larger tumors or those located near vital structures may be more difficult to accurately treat using this technique.

▪ Tumor recurrence: although RFA can destroy cancer cells at the initial treatment site, there is risk of locoregional or distant recurrence. This is because RFA may find it difficult to reach smaller neoplastic cells or those scattered in surrounding areas, either by lymphatic, vascular or air embolisms (STAS).

▪ Multiple tumors: when a patient has multiple lung lesions, RFA may not be the most appropriate option. The technique may be limited in terms of treating simultaneous lesions, which would require additional therapeutic approaches.

▪ Side effects and complications: although it is a less invasive procedure compared to surgery, it may still present some side effects and complications. These can include pain (primarily in lesions near the pleura), bleeding, pneumothorax, infection or injury to nearby structures, such as bronchi.

▪ Limitations in advanced stages: in cases of advanced or metastatic lung cancer, the role of RFA is more limited. The technique focuses on localized treatment and is not effective in controlling cancer spreading to other distant organs.

▪ Staging and current treatments: since there is no reliable information on lymph node involvement, the right stage of the disease is not known. It is also worth asking ourselves if it is necessary to first perform needle biopsy of the lesion to treat to confirm the histology and analyze possible mutations or protein expressions in the tumor cells (EGFR, ALK, PDL-1, etc.), so necessary nowadays to determine cancer treatments either with chemotherapy, tyrosine kinase inhibitors or immunotherapy (several studies are currently underway because of the encouraging results in certain groups of patients). Therefore, without these fundamental data, the comparison between methods and/or patients is limited.

In the study by Patricio Méndez, Cristian A. Angeramo and Eduardo P. Eyeheremendy¹, the authors mention most of the situations previously described and also the advent of SBRT (Stereotactic Body Radiation Therapy), currently used in similar conditions. They provide detailed information on how patients are stratified and how radiofrequency ablation is implemented, demonstrating that the procedure is appropriate, and the morbidity is low. Nevertheless, it would be interesting to count with more data on the population analyzed, including the origin in those secondary cases, the number of tumors treated (in case of multiple lesions) and to know, in the future, the outcome after medium-term follow-up.

In conclusion, I reiterate what I said in the first paragraph: to avoid “under-treatment” of the disease or over-indication of a procedure (be it radiotherapy, radiofrequency ablation or surgery), it is necessary to carefully evaluate each individual case; in addition, the intervening physicians and the patient must discuss the options thoroughly.

This less invasive and highly targeted technique (RFA) has proved to be a viable option for inoperable patients or for those seeking alternatives to conventional surgery, although it is important to recognize that it is still under development and that its efficacy may vary according to tumor size, histology and location. Further studies and clinical trials are needed to evaluate its long-term efficacy and safety.