Dynamic Changes in the Immune Microenvironment in Tumor-Draining Lymph Nodes of a Lewis Lung Cancer Mouse Model After Microwave Ablation

Purpose

Microwave ablation (MWA) is a minimally invasive technique for treating lung cancer. It can induce immune response; however, its effect on the immune microenvironment in tumor-draining lymph nodes (TdLN) is not well understood. This study aims to identify changes in the immune microenvironment in TdLN following MWA in a Lewis lung cancer (LLC) mouse model.

Methods

LLC mouse model was established and followed by MWA. TdLN were collected at various time points, including pre-MWA and days 1, 2, 4, and 8 post-MWA. Flow cytometry was used to determine the frequencies of CD4+ T cells, CD8+ T cells, regulatory T (Treg) cells, natural killer (NK) cells, dendritic cells (DCs) and other immune cells in the TdLN. Certain cytokines were also detected.

Results

Compared with pre-MWA, the frequency of CD4+ T cells significantly increased from day 1 to day 8 post-MWA. The frequency of CD8+ T cells decreased significantly on days 2 and 4, but no significant changes occurred on days 1 and 8. Significant decreases in the frequencies of Treg cells and Klrg1+ Treg cells were observed from day 1 to day 4. On days 4 and 8, there was a significant increase in the frequency of NK cells. The frequency of resident cDC2 significantly increased on day 4, whereas CD11b+ migratory cDCs increased on day 1. Additionally, on day 4, a notable rise was observed in the frequency of NK cells secreting IFN-γ, while on day 8, there was a significant increase in the frequency of CD8+ T cells secreting both IFN-γ and TNF-α.

Conclusion

MWA of lung cancer can alter the immune microenvironment in the TdLN, triggering immune responses. These changes are particularly evident and intricate within the initial 4 days post-MWA. Treatment combined with MWA within a certain period may significantly enhance anti-tumor immunity.

Potential biomarkers for predicting immune response and outcomes in lung cancer patients undergoing thermal ablation

Thermal ablation is a promising alternative treatment for lung cancer. It disintegrates cancer cells and releases antigens, followed by the remodeling of local tumor immune microenvironment and the activation of anti-tumor immune responses, enhancing the overall effectiveness of the treatment. Biomarkers can offer insights into the patient's immune response and outcomes, such as local tumor control, recurrence, overall survival, and progression-free survival. Identifying and validating such biomarkers can significantly impact clinical decision-making, leading to personalized treatment strategies and improved patient outcomes. This review provides a comprehensive overview of the current state of research on potential biomarkers for predicting immune response and outcomes in lung cancer patients undergoing thermal ablation, including their potential role in lung cancer management, and the challenges and future directions.

A prognostic model for predicting progression-free survival in patients with advanced non-small cell lung cancer after image-guided microwave ablation plus chemotherapy

OBJECTIVES

This study aimed to build and validate a prediction model that can predict progression-free survival (PFS) in patients with advanced non-small cell lung cancer (NSCLC) after image-guided microwave ablation (MWA) plus chemotherapy.

METHODS

Data from a previous multi-center randomized controlled trial (RCT) was used and assigned to either the training data set or the external validation data set according to the location of the centers. Potential prognostic factors were identified by multivariable analysis in the training data set and used to construct a nomogram. After bootstraps internal and external validation, the predictive performance was evaluated by concordance index (C-index), Brier Score, and calibration curves. Risk group stratification was conducted using the score calculated by the nomogram. Then a simplified scoring system was built to make risk group stratification more convenient.

RESULTS

In total, 148 patients (training data set: n = 112; external validation data set: n = 36) were enrolled for analysis. Six potential predictors were identified and entered into the nomogram, including weight loss, histology, clinical TNM stage, clinical N category, tumor location, and tumor size. The C-indexes were 0.77 (95% CI, 0.65-0.88, internal validation) and 0.64 (95% CI, 0.43-0.85, external validation). The survival curves of different risk groups also displayed significant distinction (p < 0.0001).

CONCLUSIONS

We found weight loss, histology, clinical TNM stage, clinical N category, tumor location, and tumor size were prognostic factors of progression after receiving MWA plus chemotherapy and constructed a prediction model that can predict PFS.

CLINICAL RELEVANCE STATEMENT

The nomogram and scoring system will assist physicians to predict the individualized PFS of their patients and decide whether to perform or terminate MWA and chemotherapy according to the expected benefits.

KEY POINTS

• Build and validate a prognostic model using the data from a previous randomized controlled trial to predict progression-free survival after receiving MWA plus chemotherapy. • Weight loss, histology, clinical TNM stage, clinical N category, tumor location, and tumor size were prognostic factors. • The nomogram and scoring system published by the prediction model can be used to assist physicians to make clinical decisions.

Microwave ablation with a blunt-tip antenna for pulmonary ground-glass nodules: a retrospective, multicenter, case-control study

PURPOSE

A previous small-sample study verified that a blunt-tip antenna reduced hemorrhage during microwave ablation. We conducted this large-sample, multicenter, case-control study to further verify the efficacy and safety of microwave ablation with a blunt-tip antenna for ground-glass nodules.

MATERIALS AND METHODS

Patients with pulmonary ground-glass nodules were treated with either a sharp-tip (Group A) or blunt-tip antenna (Group B). A total of 147 and 150 patients were retrospectively allocated to Groups A and Group B, respectively. Group A patients underwent 151 procedures, and Group B patients underwent 153 procedures. We assessed the technical success, technique efficacy, and complications.

RESULTS

Technical success and overall technique efficacy were achieved in all patients (100%). Major complications of pneumothorax were more commonly observed in Group A than in Group B (19.7% vs. 2.0%, p < 0.001). Minor complications, such as intrapulmonary hemorrhage (2.0% vs. 9.5%, p = 0.005) and hemothorax (0.0% vs. 2.7%, p = 0.049), occurred less frequently in Group B compared to Group A.

CONCLUSION

In the treatment of ground-glass nodules, microwave ablation with a blunt-tip antenna had equal efficacy compared to microwave ablation with a sharp-tip antenna but had a decreased number of hemorrhage and hemothorax complications.

Microwave ablation for the treatment of peripheral ground-glass nodule-like lung cancer: Long-term results from a multi-center study

Introduction

Microwave ablation (MWA) is an effective and safe approach for the treatment of ground-glass nodule (GGN)-like lung cancer, but long-term follow-up is warranted. Therefore, this multi-center retrospective study aimed to evaluate the results of MWA for the treatment of peripheral GGN-like lung cancer with a long-term follow-up.

Materials and Methods

From June 2013 to January 2018, a total of 87 patients (47 males and 40 females, mean age 64.6 ± 10.2 years) with 87 peripheral lung cancer lesions showing GGN (mean long axis diameter, 17 ± 5 mm) underwent computed tomography (CT)-guided percutaneous MWA. All GGN-like lung cancers were histologically verified. The primary endpoints were local progression-free survival (LPFS) and overall survival (OS). The secondary endpoints were cancer-specific survival (CSS) and complications.

Results

During a median follow-up of 65 months, both the 3-year and 5-year LPFS rates were 96.6% and 96.6%. The OS rate was 94.3% at 3 years and 84.9% at 5 years, whereas the 3-year and 5-year CSS rates were 100% and 100%, respectively. No periprocedural deaths were observed. Complications were observed in 49 patients (51.6%). Grade 3 or higher complications included pneumothorax, pleural effusion, hemorrhage, and pulmonary infection, which were identified in ten (10.5%), two (2.1%), two (2.1%), and one (1.1%) patient, respectively.

Conclusions

CT-guided percutaneous MWA is an effective, safe, and potentially curative treatment regimen for GGN-like lung cancer.

Image-guided thermal ablation for patients with epidermal growth factor receptor-mutant nonsmall cell lung cancer

Nonsmall cell lung cancer (NSCLC) is treated by various therapies such as surgical intervention, radiotherapy, chemotherapy, molecular targeted therapy, and immunotherapy. Currently, molecular targeted therapy, including epidermal growth factor receptor (EGFR) inhibitors and Anaplastic Lymphoma Kinase (ALK) and Kirsten Rat Sarcoma viral Oncogene (KRAS) inhibitors, has received much attention and improved the prognosis of NSCLC. Nevertheless, the terminal point of molecular targeted drugs is resistance. Drug resistance has been classified into oligoprogression and extensive progression based on the tumor lesion progression after drug resistance. There is extensive research demonstrating that local therapy (surgical resection, radiotherapy, and thermal ablation) can prolong the survival of patients with drug resistance. This review is intended to determine the efficacy of image-guided thermal ablation in patients with NSCLC with EGFR mutation.

Immunotherapy for early-stage non-small cell lung cancer: A system review

With the addition of immunotherapy, lung cancer, one of the most common cancers with high mortality rates, has broadened the treatment landscape. Immune checkpoint inhibitors have demonstrated significant efficacy in the treatment of non-small cell lung cancer (NSCLC) and are now used as the first-line therapy for metastatic disease, consolidation therapy after radiotherapy for unresectable locally advanced disease, and adjuvant therapy after surgical resection and chemotherapy for resectable disease. The use of adjuvant and neoadjuvant immunotherapy in patients with early-stage NSCLC, however, is still debatable. We will address several aspects, namely the initial efficacy of monotherapy, the efficacy of combination chemotherapy, immunotherapy-related biomarkers, adverse effects, ongoing randomized controlled trials, and current issues and future directions for immunotherapy in early-stage NSCLC will be discussed here.

Significant response to transarterial chemoembolization combined with PD-1 inhibitor and apatinib for advanced intrahepatic cholangiocarcinoma: A case report and literature review

Intrahepatic cholangiocarcinoma (ICC) is a highly aggressive malignancy rising from the biliary tree with poor prognosis. We report the feasibility and efficacy of transarterial chemoembolization (TACE) combined with PD-1 inhibitor and apatinib for the treatment of a patient with unresectable ICC. A 70-year-old female presented with intermittent right upper abdominal distension, abdominal pain, and vomiting after eating for more than one month. Enhanced computed tomography (CT) and magnetic resonance imaging (MRI) scan revealed multiple intrahepatic lesions, retroperitoneal lymph node, and left lung metastasis. Based on the patient's medical history and pathology, the diagnosis was confirmed as locally advanced unresectable ICC. Multimodal therapy was applied to the ICC. The therapy comprised TACE every three months, and a combination regimen of the PD-1 inhibitor camrelizumab and the antiangiogenic agent apatinib. The patient underwent microwave ablation for a lesion on the left lung that had not responded to systemic therapies. Enhanced CT scan after every 2-3 months was performed. After several sessions, the primary lesion reduced dramatically in size. At 20 months from diagnosis, the patient was alive, in good condition, and stable. The patient experienced no critical complications and toxicity associated with the administered therapies. This case suggests that treatment with TACE combined with systemic therapy of camrelizumab combined with apatinib may be a safe and effective treatment option for patients with inoperable ICC.

Facilitating combined biopsy and percutaneous microwave ablation of pulmonary ground-glass opacities using lipiodol localisation

OBJECTIVES

Whether preoperative localisation is necessary and valuable for the microwave ablation (MWA) of small pulmonary lesions with ground-glass opacity (GGO) remains unclear. This study aimed to explore the role of the Chiba needle and lipiodol localisation techniques in facilitating MWA and biopsy.

METHODS

This retrospective before-after study included patients with GGOs who underwent conventional MWA and biopsy treatment in our hospital between January 2018 and December 2019 (group A) or who underwent the Chiba needle and lipiodol localisation treatment before MWA and biopsy between January 2020 and December 2020 (group B). The characteristics of each patient and GGO lesion were collected and analysed to evaluate the safety and effectiveness of the localisation technique.

RESULTS

A total of 122 patients with 152 GGOs and 131 patients with 156 GGOs underwent MWA and biopsy in groups A and B, respectively. The primary technique efficacy rate of MWA differed significantly between the two groups (A vs. B: 94.1% vs. 99.4%; p = 0.009). The positive biopsy rate in the two groups was determined by the difference (A vs. B: 93.4% vs. 98.1%; p = 0.042). The incidence of complications did not increase in group B.

CONCLUSIONS

Compared with the unmarked group, the Chiba needle and lipiodol localisation technique improved the positive rate of biopsy and the initial effective rate of MWA, without significantly increasing the complication rate.

KEY POINTS

• The localisation of the Chiba needle and lipiodol could improve the positive biopsy rate and the initial effective rate of MWA. • The localisation of the Chiba needle and lipiodol does not affect the subsequent MWA and biopsy and does not increase the incidence of pneumothorax and haemorrhage.

Progress in the knowledge on the transformation of lung adenocarcinoma to small-cell lung cancer

Lung cancer is a common type of carcinoma and is the leading cause of cancer-related deaths worldwide. The two broad histological subtypes of lung cancer are non-small-cell lung cancer (NSCLC), which accounts for 85% of cases and includes adenocarcinoma and squamous cell carcinoma, and small-cell lung cancer (SCLC), which accounts for 15% of cases. Substantial improvements in treatment have led to remarkable progress and changed outcomes for many patients in the past two decades. However, with prolonged survival time and awareness of repeat biopsy, more and more patients with lung cancer have been found to undergo a histological transformation during treatment, with lung adenocarcinoma (LAdC) to SCLC transformation being the most frequent. In this article, we summarized findings on the mechanism, clinical characteristics, therapeutic strategies, and predictors of the transformation of LAdC to SCLC. A non-systematic narrative review was performed using the Pubmed/MEDLINE (US National Library of Medicine National Institutes of Health) database with the following keywords: "transformation from NSCLC to SCLC," "transformation from lung adenocarcinoma to small-cell lung cancer," "NSCLC transformation in SCLC," and "NSCLC and transformation and SCLC." Articles published until June 2022 were analyzed. Search results were limited to human studies without restriction for language.

Local thermal ablative therapies for extracranial oligometastatic disease of non-small-cell lung cancer

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Clinically, 40-50% of patients with NSCLC are found to have systemic metastasis at the initial diagnosis. Meanwhile, 30-75% of patients with lung cancer who have undergone radical surgical resection have local recurrence and distant metastases. However, not all distant metastases are multiple, and some are potentially curable. In this study, among the patients with NSCLC having distant organ metastasis, approximately 7% showed extrapulmonary solitary metastasis and remained in this relatively stable state for a long time. This form of metastasis is known as NSCLC oligometastases. This review describes the concept and classification of oligometastases, as well as the local treatment and prognosis of extracranial oligometastases.

Crosstalk between microwave ablation and ferroptosis: The next hot topic?

Microwave ablation has been one form of thermal ablation in treatments for many tumors, which can locally control unresectable tumors. Ferroptosis is iron-dependent cell death caused by the cumulative reactive oxygen species and lipid peroxidation products. Recently, increasing evidence has shown that ferroptosis might play a vital role in MWA-induced tumor suppression. In this article, we briefly illustrate the concept of ferroptosis, the related signal pathways and inducers, the basic principle of microwave ablation in killing tumors, and the key molecules released after microwave ablation. Then, we describe the cross-talking molecules between microwave ablation and ferroptosis, and discussed the potential mechanism of microwave ablation-induced ferroptosis. This review explores the therapeutic target of ferroptosis in enhancing the systemic antitumor effect after microwave ablation, providing theoretical support in combinational microwave ablation with pro-ferroptosis therapy.

The safety and feasibility of three-dimensional visualization planning system for CT-guided microwave ablation of stage I NSCLC (diameter ≤2.5 cm): A pilot study

Background

Microwave ablation (MWA) of lung tumors is a technique that is dependent on the ablationist's level of expertise. The selection of the optimum puncture path and determination of appropriate ablative parameters is the key to the success and safe of the procedure. The objective of this study was to describe the clinical use of a novel three-dimensional visualization ablation planning system (3D-VAPS) for aided MWA of stage I non-small cell lung cancer (NSCLC).

Methods

This was a single-arm, single-center, retrospective study. From May 2020 to July 2022, 113 consented patients with stage I NSCLC received MWA treatment in 120 MWA sessions. The 3D-VAPS was used to determine that: (1) the overlap between the gross tumor region and simulated ablation; (2) the proper posture and appropriate puncture site on the surface of the body; (3) the puncture path; and (4) presetting preliminarily ablative parameters. Patients were monitored with contrast-enhanced CT scans at 1, 3, and 6 months, as well as every 6 months following that. The primary endpoints were technical success and a complete ablation rate. Local progression-free survival (LPFS), overall survival (OS), and comorbidities were secondary study objectives.

Results

The mean diameter of tumors was 1.9 ± 0.4 cm (range 0.9-2.5 cm). The mean duration was 5.34 ± 1.28 min (range 3.0-10.0 min). The mean power output was 42.58 ± 4.23 (range 30.0-50.0W). The median follow-up time was 19.0 months (6.0-26.0 months). The technical success rate was 100%. Three-month after the procedure, the complete ablation rate was 97.35%. 6, 9, 12, and 24 months LPFS rates were 100%, 98.23%, 98.23%, and 96.46%, respectively. One-year and 2-year OS rates were 100% and 100%. There were no patients who died both during the procedure and after the MWA of 30 days. The complications after MWA included pneumothorax (38.33%), pleural effusion (26.67%), intrapulmonary hemorrhage (31.67%), and pulmonary infection (2.50%).

Conclusions

This research describes and confirms that 3D-VAPS is a feasibility and safe method for MWA of stage I NSCLC treatment. 3D-VAPS may be helpful to optimize the puncture path, assess reasonable ablative parameters, and minimize complications.

Microwave ablation induces abscopal effect via enhanced systemic antitumor immunity in colorectal cancer

Background

Thermal ablation is the primary procedure for the local treatment of lung metastases. It is known that radiotherapy and cryoablation can stimulate an abscopal effect, while the occurrence of abscopal effect induced by microwave ablation is less; the cellular and molecular mechanisms involved in the abscopal effect after microwave ablation should be further elucidated.

Methods

CT26 tumor-bearing Balb/c mice were treated with microwave ablation with several combinations of ablation power and time duration. The growth of primary or abscopal tumors and the survival of mice were both monitored; moreover, immune profiles in abscopal tumors, spleens, and lymph nodes were examined by flow cytometry.

Results

Microwave ablation suppressed tumor growth in both primary and abscopal tumors. Both local and systemic T-cell responses were induced by microwave ablation. Furthermore, the mice exhibiting significant abscopal effect after microwave ablation markedly elevated Th1 cell proportion both in the abscopal tumors and spleens.

Conclusions

Microwave ablation at 3 w-3 min not only suppressed tumor growth in the primary tumors but also stimulated an abscopal effect in the CT26-bearing mice via the improvement of systemic and intratumoral antitumor immunity.

SPACES: Our team's experience in lung tumor microwave ablation

The standard treatment of stage I nonsmall cell lung cancer is lobectomy with systematic mediastinal lymph node evaluation. Unfortunately, up to 25% of patients with stage I nonsmall cell lung cancer are not candidates for surgery due to severe medical comorbidities (poor cardiopulmonary function). Image-guided thermal ablation is an alternative for those patients, includes radiofrequency ablation, microwave ablation (MWA), cryoablation, and laser ablation. Compared to them, MWA is a relatively new technique with some potential advantages, such as faster heating times, higher intralesional temperatures, larger ablation zones, less procedural pain, relative insensitivity to "heat sinks," and less sensitivity to tissue types. However, some advantages of MWA mentioned above (such as higher intralesional temperatures, larger ablation zones) also have potential risks and problems, and an innovative and standardized guidance system is needed to avoid and solve these risks and problems. This article combs our team's clinical experience over the past decade, summarizes a systematic and standardized guidance system, and names it SPACES (Selection, Procedure, Assessment, Complication, Evaluation, Systemic therapy). Both primary and metastatic pulmonary tumors can be efficiently treated with image-guided thermal ablation in selected candidates. The selection and use of ablation techniques should consider the size and location of the target tumor, the risk of complications, and the expertise and skills of the professionals, among which the size of the target tumor (<3 mm) is a major factor determining the success of ablation.

Early enlarging cavitation after percutaneous microwave ablation of primary lung cancer

PURPOSE

This retrospective study assessed the incidence rate, risk factors, and clinical course of early enlarging cavitation after percutaneous microwave ablation (MWA) of primary lung cancer (PLC).

METHODS

This study included 557 lesions of 514 patients with PLC who underwent CT-guided percutaneous MWA between 1 January 2018 and 31 December 2021. Of these patients, 29 developed early enlarging cavitation and were enrolled in the cavity group, and 173 were randomly enrolled in the control group. Early enlarging cavitation of the lung was defined as the development of a cavity ≥30 mm within 7 days after MWA.

RESULTS

Overall, 31 (5.57%, 31/557 tumors) early enlarging cavitations occurred at an average of 5.83 ± 1.55 d after MWA. The risk factors were lesion contact with a large vessel (diameter ≥3 mm), lesion contact with the bronchus (diameter ≥2 mm), and a large ablated parenchymal volume. The cavity group had a higher incidence rate of delayed hydropneumothorax (12.9%) and bronchopleural fistula (9.68%) than the control group, resulting in a longer hospitalization (9.09 ± 5.26 days). Until Dec 31, 2022, 27 cavities disappeared after a mean of 217.88 ± 78.57 d (range, 111-510 d), two persisted, and two were lost to follow-up.

CONCLUSIONS

Early enlarging cavitation occurred in 5.57% PLC cases that underwent MWA, causing serve complications and longer hospitalization. The risk factors were ablated lesion contact with large vessels and bronchi, as well as a larger ablated parenchymal volume.

Synchronous computed tomography-guided percutaneous biopsy and microwave ablation for highly suspicious malignant lung ground-glass opacities adjacent to mediastinum

BACKGROUND

This retrospective study aimed to assess the safety and efficacy of synchronous biopsy and microwave ablation (MWA) for highly suspected malignant lung ground-glass opacities (GGOs) adjacent to the mediastinum (distance ≤10 mm).

MATERIALS AND METHODS

Ninety patients with 98 GGOs (diameter range, 6-30 mm), located within 10 mm of the mediastinum, underwent synchronous biopsy and MWA at a single institution from 1 May 2020, to 31 October 2021 and were enrolled in this study. Synchronous biopsy and MWA involving the completion of the biopsy and MWA in a single procedure was performed. Safety, technical success rate, and local progression-free survival (LPFS) were evaluated. The risk factors for local progression were calculated using the Mann-Whitney U test.

RESULTS

The technical success rate was 97.96% (96/98 patients). The LPFS rates at 3, 6, and 12 months were 95.0%, 90.0%, and 82.0%, respectively. The diagnostic rate of biopsy-proven malignancy was 72.45% (n = 71/98). Invasion of lesions into the mediastinum was a risk factor for local progression (p = 0.0077). The 30-day mortality rate was 0. The major complications were pneumothorax (13.27%), ventricular arrhythmias (3.06%), pleural effusion (1.02%), hemoptysis (1.02%), and infection (1.02%). Minor complications included pneumothorax (30.61%), pleural effusion (24.49%), hemoptysis (18.37%), ventricular arrhythmias (11.22%), structural changes in adjacent organs (3.06%), and infection (3.06%).

CONCLUSIONS

Synchronous biopsy and MWA was effective for treating GGOs adjacent to the mediastinum without severe complications (Society of Interventional Radiology classification E or F). Invasion of lesions into the mediastinum was identified as a risk factor for local progression.

Issues and prospects of image-guided thermal ablation in the treatment of primary and metastatic lung tumors

The precise local minimally invasive or noninvasive treatment represents the important orientation for advancing the treatment of pulmonary malignant tumors. New local treatment methods have emerged as solutions to the shortcomings of minimally invasive or local treatment methods. Image-guided thermal ablation (IGTA) comes with the characteristics such as more accurate localization, less trauma, more definite efficacy, higher safety, stronger repeatability, fewer complications, and lower cost in treating lung tumors. This paper investigates the existing problems of IGTA in the treatment of lung tumors and puts forward the orientation of studies.

Pancreatic intra-arterial infusion chemotherapy for the treatment of patients with advanced pancreatic carcinoma: A pilot study

Objective

To preliminarily evaluate the efficacy and safety of pancreatic intra-arterial infusion chemotherapy (PAIC) with nab-paclitaxel in patients with advanced pancreatic carcinoma.

Methods

Fifteen patients with advanced pancreatic carcinoma received monthly, inpatient, 3-h, continuous PAIC of nab-paclitaxel at 180 mg/m², combined with 60 mg oral tegafur gimeracil oteracil potassium capsule for 2 weeks. The therapeutic courses were repeated every 4 weeks. All patients had a preliminary diagnosis based on clinical symptoms, imaging data (computed tomography or magnetic resonance imaging or positron emission tomography/computed tomography), and tumor markers. The adverse effects, clinical benefit response (CBR), objective response rate (ORR), median progression free survival (mPFS), and median overall survival (mOS) were monitored.

Results

Fifteen patients with advanced pancreatic carcinoma were enrolled in this study, including 10 male and 5 female patients. The mean age at the time of treatment was 66.3 years (53-84 years). A total of 49 cycles of PAIC (mean = 3.27 cycles/patient) were performed. The most common treatment-related toxicities were alopecia, diarrhea, and nausea/vomiting. No procedure-related complications were observed. The longest overall survival observed was 22 months and the maximum number of treatments for the same patient was six cycles. PAIC contributed a high rate (13/15 [86.67%]) and fast (10/15 [66.67%]) easement of pain, with apparent symptom relief within 24 h, especially local pain symptom. The pain anesis rate was 13 (86.67%). CBR was achieved in 13 (86.67%) patients (95%CI [59.54,98.34]). ORR was achieved in four (26.67%) patients (95%CI [7.79,55.10]). Disease Control Rate was achieved in 14 (93.33%) patients. The mPFS was 5.22 months (interquartile range [IQR], 4.27-7.85 months). The mOS was 8.97 months (IQR, 5.65-13.70 months).

Conclusions

In this study, the dose of the chemotherapeutics and the schedule of the transcatheter pancreatic arterial chemotherapy perfusion were shown to be safe, well-tolerated, and effective for the relief of clinical symptoms and CBR. These advantages can quickly establish the treatment belief and improve patient quality of life. This regimen requires further investigation in patients with advanced pancreatic carcinoma.

Computed tomography findings, associated factors, and management of pulmonary nodules in 54,326 healthy individuals

Introduction

To investigate the pulmonary nodules detected by low-dose computed tomography (LDCT), identified factors affecting the size and number of pulmonary nodules (single or multiple), and the pulmonary nodules diagnosed and management as lung cancer in healthy individuals.

Methods

A retrospective analysis was conducted on 54,326 healthy individuals who received chest LDCT screening. According to the results of screening, the detection rates of pulmonary nodules, grouped according to the size and number of pulmonary nodules (single or multiple), and the patients' gender, age, history of smoking, hypertension, and diabetes were statistically analyzed to determine the correlation between each factor and the characteristics of the nodules. The pulmonary nodules in healthy individuals diagnosed with lung cancer were managed with differently protocols.

Results

The detection rate of pulmonary nodules was 38.8% (21,055/54,326). The baseline demographic characteristics of patients with pulmonary nodules were: 58% male and 42% female patients, 25.7% smoking and 74.3% nonsmoking individuals, 40-60 years old accounted for 49%, 54.8% multiple nodules, and 45.2% single nodules, and ≤5-mm size accounted for 80.4%, 6-10 mm for 18.2%, and 11-30 mm for 1.4%. Multiple pulmonary nodules were more common in hypertensive patients. Diabetes is not an independent risk factor for several pulmonary nodules. Of all patients with lung nodules, 26 were diagnosed with lung cancer, accounting for 0.1% of all patients with pulmonary nodules, 0.6% with nodules ≥5 mm, and 2.2% with nodules ≥8 mm, respectively. Twenty-six patients with lung cancer were treated with surgical resection (57.7%), microwave ablation (MWA, 38.5%), and follow-up (3.8%).

Conclusions

LDCT was suitable for large-scale pulmonary nodules screening in healthy individuals, which was helpful for the early detection of suspicious lesions in the lung. In addition to surgical resection, MWA is an option for early lung cancer treatment.

Microwave ablation of the lung: Comparison of 19G with 14G and 16G microwave antennas in ex vivo porcine lung

Background

Percutaneous image-guided thermal ablation has an increasing role in the treatment of primary and metastatic lung tumors. Although microwave ablation (MWA) has emerged advantageous as a new ablation technology, more research is needed to improve it. This study aims to investigate the ablation zone of three microwave antennas in ex vivo porcine lung.

Materials and Methods

In the ex vivo standard model and porcine lung model, MWA was performed in three power output settings (50 W, 60 W, and 70 W) for 3, 6, 9, and 12 min using three microwave antennas, with outer diameter of 1.03 mm (19G), 1.6 mm (16G), and 2.0 mm (14G). A total of 108 and 216 sessions were performed (3 or 6 sessions per time setting with the 14G, 16G, and 19G microwave antennas). After the MWA was complete, we evaluated the shape and extent of the coagulation zone and measured the maximum long-axis (along the needle axis; length [L]) and maximum short-axis (perpendicular to the needle; diameter [D]) of the ablation zones using a ruler; subsequently, the sphericity index (L/D) was calculated. The sphericity index can be simplified as long-axis/short-axis.

Results

In the ex vivo standard model study, the long- and short-axis diameters and sphericity indices were not statistically different between the 14G, 16G, and 19G groups. In the ex vivo porcine lung study, the long- and short-axis diameters did not differ statistically between the 14G, 16G, and 19G groups (P < 0.05 each). The sphericity index for the 19G microwave antenna was higher than the sphericity indices for the 14G and 16G microwave antennas (P < 0.05); however, the index for the 14G microwave antenna was not statistically different than that for the 16G microwave antenna (P > 0.05).

Conclusions

The ablation zone of the 19G antenna was the same as those of the 14G and 16G antennas in vitro. Thus, the 19G antenna may reduce the incidence of complications in lung tumor ablation.

Cost and effectiveness of microwave ablation versus video-assisted thoracoscopic surgical resection for ground-glass nodule lung adenocarcinoma

Purpose

To retrospectively evaluate the cost and effectiveness in consecutive patients with ground-glass nodules (GGNs) treated with video-assisted thoracoscopic surgery (VATS; i.e., wedge resection or segmentectomy) or microwave ablation (MWA).

Materials and methods

From May 2017 to April 2019, 204 patients who met our study inclusion criteria were treated with VATS (n = 103) and MWA (n = 101). We calculated the rate of 3-year overall survival (OS), local progression-free survival (LPFS), and cancer−specific survival (CSS), as well as the cost during hospitalization and the length of hospital stay.

Results

The rates of 3-year OS, LPFS, and CSS were 100%, 98.9%, and 100%, respectively, in the VATS group and 100%, 100% (p = 0.423), and 100%, respectively, in the MWA group. The median cost of VATS vs. MWA was RMB 54,314.36 vs. RMB 21,464.98 (p < 0.001). The length of hospital stay in the VATS vs. MWA group was 10.0 vs. 6.0 d (p < 0.001).

Conclusions

MWA had similar rates of 3-year OS, LPFS, and CSS for patients with GGNs and a dramatically lower cost and shorter hospital stay compared with VATS. Based on efficacy and cost, MWA provides an alternative treatment option for patients with GGNs.

Microwave ablation plus camrelizumab monotherapy or combination therapy in non-small cell lung cancer

Purpose

Immunotherapy has become widely applied in non-small cell lung cancer (NSCLC) patients. However, the relatively low response rate of immunotherapy monotherapy restricts its application. Combination therapy improves the response rate and prolongs patient survival; however, adverse events (AEs) associated with immunotherapies increase with combination therapy. Therefore, exploring combination regimens with equal efficacy and fewer AEs is urgently required. The aim of this study was to evaluate the efficacy and safety of microwave ablation (MWA) plus camrelizumab monotherapy or combination therapy in NSCLC.

Materials and methods

Patients with pathologically confirmed, epidermal growth factor receptor/anaplastic lymphoma kinase-wild-type NSCLC were retrospectively enrolled in this study. Patients underwent MWA to the pulmonary lesions first, followed by camrelizumab monotherapy or combination therapy 5–7 days later. Camrelizumab was administered with the dose of 200 mg every 2 to 3 weeks. Treatment was continued until disease progression or intolerable toxicities. The technical success and technique efficacy of ablation, objective response rate (ORR), progression-free survival (PFS), overall survival (OS), complications of ablation, and AEs were recorded.

Results

From January 1, 2019 to December 31, 2021, a total of 77 patients underwent MWA and camrelizumab monotherapy or combination therapy. Technical success was achieved in all patients (100%), and the technique efficacy was 97.4%. The ORR was 29.9%. The PFS and OS were 11.8 months (95% confidence interval, 9.5–14.1) and not reached, respectively. Smoking history and response to camrelizumab were correlated with PFS, and response to camrelizumab was correlated with OS in both the univariate and multivariate analyses. No periprocedural deaths due to ablation were observed. Complications were observed in 33 patients (42.9%). Major complications included pneumothorax (18.2%), pleural effusion (11.7%), pneumonia (5.2%), bronchopleural fistula (2.6%), and hemoptysis (1.3%). Grade 3 or higher AEs of camrelizumab, including reactive capillary endothelial proliferation, fatigue, pneumonia, edema, and fever, were observed in 10.4%, 6.5%, 5.2%, 2.6%, and 2.6% of patients, respectively.

Conclusion

MWA combined with camrelizumab monotherapy or combination therapy is effective and safe for the treatment of NSCLC.

Safety and efficacy of microwave ablation for lung cancer adjacent to the interlobar fissure

Background

This retrospective study aimed to assess the safety and efficacy of microwave ablation for lung tumors adjacent to the interlobar fissures.

Methods

From May 2020 to April 2021, 59 patients with 66 lung tumors (mean diameter, 16.9 ± 7.7 mm; range, 6–30 mm) adjacent to the interlobar fissures who underwent microwave ablation at our institution were identified and included in this study. Based on the relationship between the tumor and the interlobar fissure, tumors can be categorized into close to the fissure, causing the fissure, and involving the fissure. The complete ablation rate, local progression‐free survival, complications, and associated factors were analyzed.

Results

All 66 histologically proven tumors were treated using computed tomography‐guided microwave ablation. The complete ablation rate was 95.5%. Local progression‐free survival at 3, 6, 9, and 12 months were 89.4%, 83.3%, 74.2%, and 63.6%, respectively. The complications included pneumothorax (34.8%), pleural effusion (24.2%), cavity (18.2%), and pulmonary infection (7.6%). There were statistical differences in the incidence of pneumothorax, cavity, and delayed complications between the groups with and without antenna punctures through the fissure.

Conclusions

Microwave ablation is a safe and effective treatment for lung tumor adjacent to the interlobar fissure. Antenna puncturing though the interlobar fissure may be a potential risk factor for pneumothorax, cavity, and delayed complications.