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Radiofrequency ablation (RFA) uses an electromagnetic wave with a frequency band and is a new treatment offered as a minimally invasive treatment.RFA is most commonly used to treat patients with liver tumors, kidney cancer,breast cancer or lung cancer.Since RFA for lung cancer has been more widely used by percutaneous imaging-guided therapy, the complications from this method include pain, pneumothorax, hemothorax, and pleural effusion.We have developed a new internal cooled electrode for RFA (Japan Application No.2006-88228) suitable for forceps channel bronchoscopy.We had previously demonstrated that the increased necrotic area by RFA was obtained by with the improvement of RFA catheter tips and prolongation of ablation time in animal and human study (Eur Respir J 29;1193,2007, Chest 137;8990, 2010).Now, we have advanced this method for a clinical application for patients with lung cancer.This study was undertaken with the approval of our institutional human studies committee, and written informed consent was obtained from patients.Patients with pathologically diagnosed with NSCLC, who had no lymph node involvement and distant metastases (T1-2N0M0), but not indication for surgery because of other complications for example;synchronous multiple nodules, advanced age, cardiovascular diseases, poor pulmonary function et al, were enrolled in the present study.RFA output power in the generator and temperature were setted to be 20-30 W and 60-70 ℃, respectively.A peristaltic pump was used to infuse cold water (4℃) into the internal lumen of the catheter electrode at 50ml/minute.Computed tomography (CT) guided bronchoscopy-guided cooled RFA were performed in these patients and followed CT.Results;19 patients, mean age of 73.5 (62-87) yrs were enrolled and total 29 RFA were performed.Almost targeted lesions ablated by RFA were changed to be scarred or decreased after bronchoscopy-guided cooled RFA.During follow up (median 32 months, 2.5-73 months) after bronchoscopy-guided cooled RFA, local progression occurred in 4 patients and RFA was repeated.The other lesions maintained stable after RFA.Four patients died because of progressive disease in one and other causes in three.There were no adverse events and complications in the present study.Conclusion;Bronchoscopy-guided internal cooled-RFA was safe and feasible procedure that could become a potential therapeutic tool in local control in medically inoperable patients with stage Ⅰ non-small cell lung cancer.