CIRSE Standards of Practice on Thermal Ablation of Primary and Secondary Lung Tumours (original) (raw)
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Thermal Ablation of Lung Tumors: Focus on Microwave Ablation
RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, 2017
Background Image-guided thermal ablation can be used for the treatment of medically inoperable primary and metastatic lung cancer. These techniques are based on the heating up or freezing (cryoablation) of a volume of tissue around a percutaneous applicator that induces necrosis of the tumor. Method The English-language literature concerning thermal ablation of the lung was reviewed. Radiofrequency ablation (RFA) is the most widely performed and investigated of these techniques. Microwave ablation (MWA) represents a relatively new alternative that shares the same indications and is conducted in a very similar fashion as RFA. It has been experimentally and clinically shown that MWA produces larger, more spherical ablation zones over shorter periods of time compared to RFA. Seven different MWA systems are available in Europe and the USA with significant differences in the size and shape of the produced ablation zones. Results The types of complications caused by MWA and their rates of...
Journal of Thoracic Disease, 2021
Background: Percutaneous image-guided thermal ablation has an increasing role in the treatment of primary and metastatic lung tumors. Achieving acceptable clinical outcomes requires better tools for preprocedure prediction of ablation zone size and shape. Methods: This was a prospective, non-randomized, single-arm, multicenter study conducted by Medtronic (ClinicalTrials.gov ID: NCT02323854). Subjects scheduled for resection of metastatic or primary lung nodules underwent preoperative percutaneous microwave ablation. Ablation zones as measured via CT imaging following ablation immediately and before resection surgically versus predicted ablation zones as prescribed by the investigational system software were compared. This CT scan occurred after the ablation was finished but the antenna still in position. Time (minutes) from antenna placement to removal was 23.7±13.1 (n=14); median: 21.0 (range, 6.0 to 48.0). The definition of the secondary endpoint of complete ablation was 100% non-viable tumor cells based on nicotinamide adenine dinucleotide hydrogen (NADH) staining. Safety endpoints were type, incidence, and severity of adverse events. Results: Fifteen patients (mean age 58.9 years; 67% male; 33% female) were enrolled in the study, 33.3% (5/15) with previous thoracic surgery, 73% (11/15) with metastasis, and 27% (4/15) with primary lung tumors. All underwent percutaneous microwave ablation followed by surgical resection the same day. Complete ablation was detected in 54.4% (6/11), incomplete ablation in 36.4% (4/11), and delayed necrosis in 9.1% (1/11). There were no device-related adverse events. Ablation zone volume was overestimated in all patients. Conclusions: Histological complete ablation was observed in 55% of subjects. CT scanning less than an hour after ablation and tissue shrinkage may account for the smaller zone of ablation observed compared to predicted by the investigational system software.
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.
Thermal Ablation of Lung Tissue: In Vivo Experimental Comparison of Microwave and Radiofrequency
CardioVascular and Interventional Radiology, 2010
This study was designed to compare feasibility, safety, and effectiveness of microwave (MW) ablation versus radiofrequency (RF) ablation of lung tissue in a rabbit model. Twenty New Zealand White rabbits were submitted to MW (n = 10, group A) or RF ablation (n = 10, group B). The procedures were performed with a prototype MW ablation device with a 1.6-cm radiating section antenna (Valleylab MW Ablation System) and with a 2-cm exposed-tip RF electrode (Cool-tip RF Ablation System). At immediate computed tomography increase in density, maximum diameters (D1-D3) of ablation zones were measured and ablation volume was calculated. Histopathologic assessment was performed 3 and 7 days after the procedure. Technical success was achieved in nine of 10 rabbits in each group. One death occurred in group B. Complications included pneumothorax (group A, n = 4; group B, n = 4), abscess (group A, n = 1; group B, n = 1), and thoracic wall burn (group A, n = 4). No significant differences were demonstrated in attenuation increase (P = 0.73), dimensions (P = 0.28, 0.86, 0.06, respectively, comparing D1-D3) and volume (P = 0.17). At histopathology, ablation zones were similar, with septal necrosis, edema, hemorrhage, and peripheral lymphocytic infiltrate. Complete thrombosis of more than 90% of vessels up to 2 mm in diameter was depicted at the periphery of the ablation zone in group A specimens. In group B specimens, complete thrombosis was depicted in 20% of vessels. Feasibility and safety of MW and RF ablation are similar in a lung rabbit model. MW ablation produces a greater damage to peripheral small vessels inducing thrombosis.
Microwave ablation therapy for treating primary and secondary lung tumours: technical note
La Radiologia Medica, 2010
Purpose. The purpose of our study was to retrospectively evaluate the feasibility, safety and effectiveness of microwave ablation (MWA) in nine patients with unresectable lung tumour. Materials and methods. Ten lesions were treated in ten ablation sessions in nine patients. The treatments were performed with a microwave generator with 45 W and 915 MHz connected to a 14.5-gauge antenna for 10 min. Antenna placement was performed with computed tomography (CT) fluoroscopy guidance or XperGuide. All patients underwent CT follow-up at 1, 3 and 6 months from the procedure. Results. Technical success was obtained in all cases; mortality at 30 days was 0%.
Lung microwave ablation – an in vivo swine tumor model experiment to evaluate ablation zones
2020
Purpose To evaluate microwave ablation (MWA) algorithms, comparing pulsed and continuous mode in an in vivo lung tumor mimic model Materials and methods A total of 43 lung tumor-mimic models of 1, 2 or 3 cm were created in 11 pigs through an intra-pulmonary injection of contrast-enriched minced muscle. Tumors were ablated under fluoroscopic and 3D-CBCT-guidance using a single microwave antenna. Continuous (CM) and pulsed mode (PM) were used. According to tumor size, 3 different algorithms for both continuous and pulsed mode were used. The ablation zones were measured using post-procedural 3D-CBCT and on pathologic specimens. Results Two radiologists measured the ablation zones on CBCT and they significantly correlated with macroscopic and microscopic pathological findings: r = 0.75 and 0.74 respectively (p < 0.0001) (inter-observer correlation r = 0.9). For 1, 2 and 3 cm tumors mimics lesions (TMLs), mean maximal and transverse ablation diameters were 3.6 0.3 × 2.2 0.3 cm; 4....
Image guided thermal ablation in lung cancer treatment
Journal of Thoracic Disease, 2020
Lung ablation has been introduced into lung cancer treatment for about two decades. Currently, 3 main choices of thermal energy for lung ablation are radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation. As a mostly palliative, occasionally curative intent local treatment, the feasibility and safety of lung ablation have been validated in small size lung cancer treatment, especially in lung tumor ≤3 cm. Improved techniques and experience in recent years help render outcomes much better than before for lung cancer patients who are medically inoperable with early stage primary lung cancer, and patients with oligometastasis or local recurrence. For stage IA non-small cell lung cancer (NSCLC) patients underwent RFA, 1-and 2-year overall survival rate were reported as 86.3% and 69.8%. And 1and 2-year local recurrence rate were reported as 68.9% and 59.8%. Limitations, including heat sink, skin burn, and inconsistent heat conduction, are observed in the first applied ablation technique, RFA. MWA and cryoablation are developed to overcome these limitations and achieve the goal of less morbidity. Generally, imaged guided thermal ablation has a good safety profile, with pneumothorax as the most common morbidity. This article will mainly discuss the current features and application of these ablation techniques in lung cancer treatment.
State of The Art in Alternative Treatments for Lung Cancer : Thermal Ablation Therapy
2016
Surgery is considered the best choice for stage I non-small cell lung cancer therapy and for selected patients with lung metastasis. However, surgery is often a high-risk procedure because of severe medical co-morbidities affecting this cohort of patients. Thermal Ablation (TA) has been recently proposed to achieve destruction of lung tumors whilst avoiding the use of general anesthesia and parenchyma resection, thereby limiting the invasiveness of the procedure. Two technique of TA based on tissue heating have been described: Radio Frequency Ablation (RFA) and Microwave Ablation (MWA). Both are mini-invasive procedures, delivering energy to the tumor through single or multiple percutaneous needles introduced under guidance of computed tomography. The procedure may be performed under conscious sedation or general anesthesia to avoid pain caused by needle insertion and tissue heating. We have reviewed the literature and Federico Raveglia1*, Alessandro Rizzi1, Matilde De Simone3, Ugo ...