State of The Art in Alternative Treatments for Lung Cancer: Thermal Ablation Therapy (original) (raw)
Related papers
Thermal ablation in the treatment of lung cancer: present and future
European Journal of Cardio-Thoracic Surgery, 2013
Surgery is considered the best choice for stage I non-small cell lung cancer and also in treatment of selected patients with lung metastasis. However, surgery is often a high-risk procedure because of severe medical comorbidities affecting this cohort of patients. Thermal ablation (TA) has recently been proposed to achieve destruction of lung tumours whilst avoiding the use of general anaesthesia, thereby limiting the invasiveness of the procedure. For pulmonary malignancies, there are two methods of TA based on tissue heating: radio frequency ablation (RFA) and microwave ablation (MWA). Both are mini-invasive procedures, delivering energy to the tumour through single or multiple percutaneous needles introduced under guidance of computed tomography. The procedure may be performed under conscious sedation or general anaesthesia to avoid pain caused by needle insertion and tissue heating. Local efficacy is directly correlated to tumour target size: for RFA, tumours smaller than 2 cm can be completed ablated in 78-96% of cases; for MWA -according to the largest available study-95% of initial ablations are reported to be successful for tumours smaller than 5 cm. Very few series provide survival data beyond 3 years. For nodules smaller than 3 cm, the registered survival rate is higher: 50% at five years. The data collected in the last 10 years allow us to conclude that TA is an established alternative treatment for patients who cannot undergo surgery because of their compromised general condition. In the case of pulmonary metastasis, most authors agree to offer TA only if lesions are smaller than 5 cm.
Thermal ablation of lung tumors
2011
Lung cancer remains the leading cause of cancer death in the United States, accounting for an estimated 29% of cancer deaths in 2009. 1 Pneumonectomy or lobectomy with hilar and mediastinal lymph node sampling is the gold standard treatment and offers the best option for cure of stage 1/2 nonsmall cell lung cancer (NSCLC). 2 Unfortunately, only 15% of patients present with stage 1/2 disease, and many of these patients do not meet the pulmonary physiologic guidelines for lobar resection. 3 In addition to lung cancer, pulmonary metastases are present in 25% to 30% of patients dying from all types of cancer. 4 For some patients with oligometastatic pulmonary disease, metastectomy is associated with an improvement in survival. 5 External beam radiation traditionally has been offered as the alternative to surgical resection for NSCLC or pulmonary metastatic disease. Unfortunately, the 5-year survival following radiation for stage 1 and 2 NSCLC remains low at 15% to 20%, with local recurrence being the most common mode of failure. 6,7 Thermal ablation offers an intriguing therapeutic option to increase local tumor control and survival in patients with early stage NSCLC or with limited metastatic disease from nonlung primaries who are not surgical candidates because of poor cardiopulmonary reserve, anatomic constraints limiting resection, failure of traditional therapies, or refusal of operative approaches. Thermal ablation has been shown to be effective in treating tumors in bone, kidney, and liver. 8-11 Most preclinical and clinical trials have focused on demonstrating the feasibility of three modalities for pulmonary thermal ablation, namely radiofrequency (RF) ablation, microwave (MW) ablation, and cryoablation. This article discusses the unique challenges of performing thermal ablation in lung tissue and reviews the current literature regarding RF, MW, and cryoablation in the lung.
Radiofrequency Ablation for the Treatment of Pulmonary Metastases
The Annals of Thoracic Surgery, 2009
Objectives-Surgical resection is the preferred treatment in selected patients with pulmonary metastases. In high-risk patients, radiofrequency ablation (RFA) may offer an alternative option. RFA may be used either alone or in combination with surgical resection as a lung parenchymalsparing approach. Our objectives were to evaluate the intermediate term outcomes after RFA and to determine the prognostic variables associated with outcome in patients with pulmonary metastases Methods-Thoracic surgeons evaluated and performed RFA under computed-tomography (CT) guidance or in combination with surgical resection as a lung parenchymal-sparing modality. Patients were monitored in the thoracic surgery clinic for recurrence and survival.
Repeat thermal ablation for local progression of lung tumours: how safe and efficacious is it
Mini-invasive Surgery , 2018
Aim: To retrospectively evaluate the safety and efficacy of repeat thermal ablation for local progression of lung tumours after prior ablation(s)., 13 patients underwent repeat ablation [11 repeat microwave ablations and 2 repeat radiofrequency ablations] of a lung tumour [9 non-small cell lung carcinomas, 3 metastatic colorectal adenocarcinomas, 1 metastatic pelvic sarcoma] for local progression after prior ablation(s). Safety of the procedure was assessed by presence or absence of adverse events. Efficacy of the procedure was assessed by local tumour response to ablation and survival time. Results: Repeat ablation procedures were safe, without major adverse events. Median length of hospital stay was 2 days (interquartile range 1-2). Pneumothorax was the most common complication [5 (38%) of 13 repeat ablation procedures]. There was one death within 30 days of ablation, but the cause of death and its relation to the procedure were unknown. Of the 12 patients with imaging follow-up [median follow-up 26 months (range 3-62)], 10 (83%) had complete ablation and 2 (17%) had local progression. Of all 13 patients, 8 (62%) were alive and 5 (38%) had died with a median overall survival of 43 months (95% confidence interval 36-49 months). Conclusion: Repeat ablation in locally progressing tumours after prior ablation attempt(s) is a safe therapeutic option and often achieves local tumour control.
Oncology Letters, 2019
The aim of the present study was to compare the safety and efficacy of cryoablation (CA) and microwave ablation (MWA) as treatments for non-small cell lung cancer (NSCLC). Patients with stage IIIB or IV NSCLC treated with CA (n=45) or MWA (n=56) were enrolled in the present study. The primary endpoint was progression-free survival (PFS); the secondary endpoints included overall survival (OS) time and adverse events (AEs). The median PFS times between the two groups were not significantly different (P=0.36): CA, 10 months [95% confidence interval (CI), 7.5-12.4] vs. MWA, 11 months (95% CI, 9.5-12.4). The OS times between the two groups were also not significantly different (P= 0.07): CA, 27.5 months (95% CI, 22.8-31.2 months) vs. MWA, 18 months (95% CI, 12.5-23.5). For larger tumors (>3 cm), patients treated with MWA had significantly longer median PFS (P=0.04; MWA, 10.5 months vs. CA, 7.0 months) and OS times (P=0.04; MWA, 24.5 months vs. CA, 14.5 months) compared patients treated with CA. However, for smaller tumors (≤3 cm), median PFS (P= 0.79; MWA, 11.0 months vs. CA, 13.0 months) and OS times (P=0.39; MWA, 30.0 months vs. CA, 26.5 months) between the two groups did not differ significantly. The incidence rates of AEs were similar in the two groups (P>0.05). The number of applicators, tumor size and length of the lung traversed by applicators were associated with a higher risk of pneumothorax and intra-pulmonary hemorrhage in the two groups. Treatment with CA resulted in significantly less intraprocedural pain compared with treatment with MWA (P=0.001). Overall, the present study demonstrated that CA and MWA were comparably safe and effective procedures for the treatment of small tumors. However, treatment with MWA was superior compared with CA for the treatment of large tumors.
Image-guided lung metastasis ablation: a literature review
International Journal of Hyperthermia, 2019
Purpose: To review the available options of percutaneous ablation of lung metastasis. Methods: General indications, prognostic factors, and image guidance of percutaneous lung ablations were reviewed. Specificities, technical aspects, advantages and limitations of each technic were highlighted. Complications and follow up where also reviewed. Results: Image-guided, percutaneous ablation is of interest for patients with a limit number (<3-5) small metastases (<2-3 cm). Other predictive factors have been reported such as the disease-free interval, the primary tumor, or the proximity with large vessels or bronchus. Radiofrequency ablation (RFA) is the most reported technic, with local control rate >90% for small tumors, and a very low complication rate. Microwave (MWA) and cryoablation are alternative technics developed in the last 15 years to overcome RFA limitations, with encouraging results. Larger ablations zones and less heat sink effect have been described with MWA. On the other hand, cryoablation allows painless treatments under conscious sedation and/or local anesthesia, high accessibility of difficult locations and promising results on prospective multicenter series. Although irreversible electroporation (IRE) could be used for lesions close to main blood vessels as it is not limited by the heat sink effect and does not have significant effects on connective tissue, allowing to treat lesions near to vital organs, preliminary results for lung metastasis are disappointing. Conclusion: Percutaneous ablation of lung metastases, whatever technic is used, is feasible, with high local control rate, and acceptable complication rate. Although indications seem clear enough, validation through controlled trials is mandatory.
Diagnostic and Interventional Imaging, 2019
The purpose of this study was to retrospectively compare microwave (MWA) and radiofrequency (RFA) ablation in the percutaneous treatment of primary and secondary lung tumors. Material and methods: A total of 115 patients with a total of 160 lung tumors (primary, n = 41; secondary, n = 119) were retrospectively included. There were 56 men and 59 women with a mean age of 67.8 ± 12.7 (SD) years (range: 42-89 years) who underwent either MWA (61 patients; 79 tumors) or RFA (54 patients; 81 tumors). The primary study endpoints were local recurrence during follow-up and the incidence of complications during and following thermal ablation. The MWA and RFA groups were compared in terms of treatment efficacy and complication rates. Results: Demographics were similar in the two groups. Mean tumor diameter was smaller in RFA group (13.1 ± 5.1 [SD] mm; range: 4-27 mm) than in MWA group (17.1 ± 8.3 [SD] mm; range: 5-36 mm) (P < 0.001). Ablation volumes at one month were 24.1 ± 21.7 (SD) cm 3 (range: 2-97.8 cm 3) in RFA group and 30.2 ± 35.9 (SD) cm 3 (range: 1.9-243.8 cm 3) in MWA group (P = 0.195). During a mean overall follow-up duration of 488 ± 407 (SD) days (range: 30-1508 days), 9/160 tumors (5.6%) developed local recurrence: six (6/79; 7.6%) in the RFA group and three (3/81; 3.7%) in the MWA group (P = 0.32). Pneumothoraces were more frequent in the RFA group (32/79; 40.5%) than in the MWA group (20/81; 24.7%) (P = 0.049). The mean length of hospital stay was 4.5 ± 3.7 (SD) days (range: 1-25 days) in the RFA group and 4.7 ± 4.6 (SD) days (range: 2-25 days) in the MWA group (P = 0.76).