Current status of thermal ablation treatments for lung malignancies - PubMed (original) (raw)

Current status of thermal ablation treatments for lung malignancies

Damian E Dupuy et al. Semin Intervent Radiol. 2010 Sep.

Abstract

About 75% of lung cancer patients are not surgical candidates, either due to advanced disease or medical comorbidities. Furthermore, conventional treatments that can be offered to these patients are beneficial only to a small percentage of them. Thermal ablation is a minimally invasive treatment that is commonly used in this group of patients, and which has shown promising results. Currently, the most widely used ablation techniques in the treatment of lung malignancies are radiofrequency ablation (RFA), microwave ablation, and cryoablation. Although the most studied technique is RFA, recent studies with microwave ablation and cryoablation have shown some advantages over RFA. This article reviews the application of thermal ablation in the thorax, including patient selection, basic aspects of procedure technique, imaging follow-up, treatment outcomes, and comparison of ablation techniques.

Keywords: Lung cancer; cryoablation; microwave ablation; radiofrequency ablation; thermal ablation.

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Figures

Figure 1

Figure 1

An 81-year-old man with right upper lobe nonsmall cell lung cancer felt to be poor candidate for lobectomy due to underlying heart disease. Axial positron emission tomography-computed tomography (PET-CT) image (A) shows intense avidity in right upper lobe mass (arrow) without evidence of regional or distant spread of disease. Axial CT (B) shows 2.2-cm mass (arrow) to have speculated margins and small pleural tail consistent with biopsy diagnosis of adenocarcinoma, stage T1b, N0, M0 (stage IA). Axial CT image (C) with patient prone during radiofrequency ablation (RFA) shows ground glass halo sign (arrows) after application of RF energy. Halo gives rough indication of energy penetration into aerated lung around mass. Axial contrast-enhanced CT images (D) in mediastinal (top) and lung (bottom) windows 3 months post-RFA shows lesion consolidation with peripheral and pleural reactive enhancement and central nonenhancement consistent with adequate treatment. Axial PET-CT image (E) shows intense uptake in mass (arrow), which is unusual given size and technical success of treatment. Therefore, repeat biopsy performed (F), which confirmed activity was due to underlying inflammatory reaction and not due to residual tumor. This is an example of false-positive PET examination due to reactionary inflammation, which is seen commonly along a pleural surface. Axial contrast-enhanced CT images (G) 9 months after RFA show contraction of mass (arrow) consistent with involution of thermal scar.

Figure 2

Figure 2

An 80-year-old man with cavitary squamous cell carcinoma. Axial computed tomography (CT) (A) one week after biopsy shows residual pneumothorax and cavitary mass in left upper lobe (arrow). (B) Three microwave antennae placed after instillation of fluid into air filled cavity. Note ground glass halo (arrows) after a single 10-minute treatment. Axial CT (C) 3 months after microwave ablation shows enlargement of mass with central cavitation.

Figure 3

Figure 3

A 75-year-old man with chest wall recurrence of nonsmall cell lung cancer after external beam radiotherapy presented with pain. Axial positron emission tomography-computed tomography (PET-CT) image (A) shows extensive metabolically active tumor invading chest wall. Axial CT image (B) after second freeze cycle from three cryoprobes shows expanding ice ball into chest wall (arrows). (C) 3-month follow-up (left) PET-CT shows cavitation and rim activity, which improved 6 months later (right).

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