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Cai H, Shan G, Wei Z, Zhao W, Xue G, Zhang C, Ye X. Guidelines for power and time variables for microwave ablation in porcine lung in vitro. J Cancer Res Ther 2024; 20:1150-1156. [PMID: 39206976 DOI: 10.4103/jcrt.jcrt_817_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/29/2023] [Indexed: 09/04/2024]
Abstract
PURPOSE Determination of the appropriate ablative parameters is the key to the success and safety of microwave ablation (MWA) of lung tumors. The purpose of this study was to provide guidelines and recommendations for the optimal time and power for lung tumor MWA. MATERIAL AND METHODS MWA using a 2450-MHz system was evaluated in a porcine lung. The independent variables were power (30, 40, 50, 60, 70, and 80 W) and time (2, 4, 6, 8, 10, and 12 min), and the outcome variable was the volume of ablation. Lung tissues were procured after MWA for measurement and histological evaluation. Analysis of variance was used for statistical analysis, followed by least significant difference (LSD) t-tests where appropriate. A P value of <0.05 was considered statistically significant. RESULTS The outcome variable (ablative volume) was significantly affected by time, power, and time/power interaction (P < 0.05). When the total output energy was kept constant, the combination of higher power and shorter time obtained a larger ablative volume, especially in the low- and medium-energy groups (P < 0.01). CONCLUSIONS We propose guidelines for ablative volume based on different time and power variables to provide a reference for clinical applications.
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Affiliation(s)
- Hongchao Cai
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, Shandong Province, China No. 16766, Jingshi Road, Jinan, Shandong Province, China
| | - Guanglian Shan
- Department of Oncology, People's Hospital of Xintai City, China No. 1329, Xinpu Road, Xintai, Shandong Province, China
| | - Zhigang Wei
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, Shandong Province, China No. 16766, Jingshi Road, Jinan, Shandong Province, China
| | - Wenhua Zhao
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, Shandong Province, China No. 16766, Jingshi Road, Jinan, Shandong Province, China
| | - Guoliang Xue
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, Shandong Province, China No. 16766, Jingshi Road, Jinan, Shandong Province, China
| | - Chao Zhang
- Department of Oncology, Affiliated Qujing Hospital of Kunming Medical University, Qujing, Yunnan Province, China
| | - Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, Shandong Province, China No. 16766, Jingshi Road, Jinan, Shandong Province, China
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Chang ATC, Ng CSH, Nezami N. Treatment strategies for malignant pulmonary nodule: beyond lobectomy. Point-counterpoint. Curr Opin Pulm Med 2024; 30:35-47. [PMID: 37916619 DOI: 10.1097/mcp.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW Technological advancement in low-dose computed tomography resulted in an increased incidental discovery of early-stage lung cancer and multifocal ground glass opacity. The demand for parenchyma-preserving treatment strategies is greater now than ever. Pulmonary ablative therapy is a groundbreaking technique to offer local ablative treatment in a lung-sparing manner. It has become a promising technique in lung cancer management with its diverse applicability. In this article, we will review the current development of ablative therapy in lung and look into the future of this innovative technique. RECENT FINDINGS Current literature suggests that ablative therapy offers comparable local disease control to other local therapies and stereotactic body radiation therapy (SBRT), with a low risk of complications. In particular, bronchoscopic microwave ablation (BMWA) has considerably fewer pleural-based complications due to the avoidance of pleural puncture. BMWA can be considered in the multidisciplinary treatment pathway as it allows re-ablation and allows SBRT after BMWA. SUMMARY With the benefits which ablative therapy offers and its ability to incorporate into the multidisciplinary management pathway, we foresee ablative therapy, especially BMWA gaining significance in lung cancer treatment. Future directions on developing novel automated navigation platforms and the latest form of ablative energy would further enhance clinical outcomes for our patients.
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Affiliation(s)
- Aliss Tsz Ching Chang
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore
- The Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, University of Maryland, Colleague Park, , Maryland, USA
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Shah IA, Seol HY, Cho Y, Ji W, Seo J, Lee C, Chon MK, Shin D, Kim JH, Choo KS, Park J, Kim J, Yoo H, Kim JH. Conversion of the bronchial tree into a conforming electrode to ablate the lung nodule in a porcine model. COMMUNICATIONS MEDICINE 2023; 3:129. [PMID: 37775526 PMCID: PMC10541426 DOI: 10.1038/s43856-023-00362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) is one of the treatment options for lung nodules. However, the need for exact delivery of the rigid metal electrode into the center of the target mass often leads to complications or suboptimal results. To overcome these limitations, a concept of conforming electrodes using a flexible material has been tested in this study. METHODS A bronchoscopy-guided RFA (CAROL) under a temperature-controlled mode was tested in in-vivo and ex-vivo porcine lungs. Gallium-based liquid metal was used for turning the bronchial tree into temporary RF electrodes. A customized bronchoscopy-guided balloon-tipped guiding catheter (CAROL catheter) was used to make the procedure feasible under fluoroscopy imaging guidance. The computer simulation was also performed to gain further insight into the ablation results. Safety was also assessed including the liquid metal remaining in the body. RESULTS The bronchial electrode injected from the CAROL catheter was able to turn the target site bronchial air pipe into a temporally multi-tined RF electrode. The mean volume of Gallium for each effective CAROL was 0.46 ± 0.47 ml. The ablation results showed highly efficacious and consistent results, especially in the peripheral lung. Most bronchial electrodes were also retrieved by either bronchoscopic suction immediately after the procedure or by natural expectoration thereafter. The liquid metal used in these experiments did not have any significant safety issues. Computer simulation also supports these results. CONCLUSION The CAROL ablation was very effective and safe in porcine lungs showing encouraging potential to overcome the conventional approaches.
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Affiliation(s)
- Izaz Ali Shah
- Department of Electronic Engineering, Hanyang University, Seoul, 04763, Republic of Korea
| | - Hee Yun Seol
- Department of Internal Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Republic of Korea
| | - Youngdae Cho
- Department of Electronic Engineering, Hanyang University, Seoul, 04763, Republic of Korea
| | - Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jaeyoung Seo
- Department of R&D Center, Tau Medical Inc, Busan, Republic of Korea
| | - Cheolmin Lee
- Department of R&D Center, Tau Medical Inc, Busan, Republic of Korea
| | - Min-Ku Chon
- Department of Cardiology, School of Medicine & Cardiovascular center, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Donghoon Shin
- Department of Pathology, School of Medicine, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Justin H Kim
- Department of R&D Center, Tau Medical Inc, Busan, Republic of Korea
| | - Ki-Seok Choo
- Department of Radiology, School of Medicine & Medical Research Institute, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Junhui Park
- Major of Human Bioconvergence, College of Information Technology and Convergence, Pukyong National University, Busan, Republic of Korea
| | - Juhyung Kim
- Department of Physiology, University of Toronto, Toronto, Canada
| | - Hyoungsuk Yoo
- Department of Electronic Engineering, Hanyang University, Seoul, 04763, Republic of Korea.
| | - June-Hong Kim
- Department of Cardiology, School of Medicine & Cardiovascular center, Pusan National University & Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
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Nezami N, Khorshidi F, Mansur A, Habibollahi P, Camacho JC. Primary and Metastatic Lung Cancer: Rationale, Indications, and Outcomes of Thermal Ablation. Clin Lung Cancer 2023:S1525-7304(23)00055-4. [PMID: 37127487 DOI: 10.1016/j.cllc.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023]
Abstract
The widespread use of imaging as well as the efforts conducted through screening campaigns has dramatically increased the early detection rate of lung cancer. Historically, the management of lung cancer has heavily relied on surgery. However, the increased proportion of patients with comorbidities has given significance to less invasive therapeutic options like minimally invasive surgery and image-guided thermal ablation, which could precisely target the tumor without requiring general anesthesia or a thoracotomy. Thermal ablation is considered low-risk for lung tumors smaller than 3 cm that are located in peripheral lung and do not involve major blood vessels or airways. The rationale for ablative therapies relies on the fact that focused delivery of energy induces cell death and pathologic necrosis. Image-guided percutaneous thermal ablation therapies are established techniques in the local treatment of hepatic, renal, bone, thyroid and uterine lesions. In the lung, and specifically in the setting of metastatic disease, the 3 main indications for lung ablation are to serve as (1) curative intent, (2) as a strategy to achieve a chemo-holiday in oligometastatic disease, and (3) in oligoprogressive disease. Following these premises, the current paper aims to review the rationale, indications, and outcomes of thermal ablation as a form of local therapy in the treatment of primary and metastatic lung disease.
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Ghosn M, Elsakka AS, Petre EN, Cheleuitte-Nieves C, Tammela T, Monette S, Ziv E, Schachtschneider KM, Srimathveeravalli G, Yarmohammadi H, Edward Boas F, Solomon SB. Induction and preliminary characterization of neoplastic pulmonary nodules in a transgenic pig model. Lung Cancer 2023; 178:157-165. [PMID: 36868176 PMCID: PMC10538441 DOI: 10.1016/j.lungcan.2023.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/09/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES Lung cancer models in large animals are lacking. Oncopigs are transgenic pigs that carry both KRASG12D and TP53R167H Cre-inducible mutations. This study aimed to develop and histologically characterize a swine model of lung cancer that could serve for preclinical studies evaluating locoregional therapies. MATERIALS AND METHODS In two Oncopigs, an adenoviral vector encoding the Cre-recombinase gene (AdCre) was injected endovascularly through the pulmonary arteries or inferior vena cava. In two other Oncopigs, a lung biopsy was performed and incubated with AdCre, before reinjecting the mixture into the lungs percutaneously. Animals were clinically and biologically (complete blood count, liver enzymes and lipasemia) monitored. Obtained tumors were characterized on computed tomography (CT) and on pathology and immunohistochemistry (IHC). RESULTS Neoplastic lung nodules developed following 1 (1/10, 10%) endovascular inoculation, and 2 (2/6, 33%) percutaneous inoculations. All lung tumors were visible at the 1-week CT, and appeared as well-circumscribed solid nodules, with a median longest diameter of 14 mm (range: 5-27 mm). Only one complication occurred: an extravasation of the mixture into the thoracic wall during a percutaneous injection that resulted in a thoracic wall tumor. Pigs remained clinically healthy during the entire follow-up (14-21 days). On histology, tumors consisted of inflammatory undifferentiated neoplasms composed of atypical spindle and epithelioid cells and/or a fibrovascular stroma and abundant mixed leukocytic infiltrate. On IHC, atypical cells diffusely displayed expression of vimentin and some showed expression of CK WSS and CK 8/18. The tumor microenvironment contained abundant IBA1 + macrophages and giant cells, CD3 + T cells, and CD31 + blood vessels. CONCLUSION Tumors induced in the lungs of Oncopigs are fast growing poorly differentiated neoplasms associated with a marked inflammatory reaction that can be easily and safely induced at site specific locations. This large animal model might be suitable for interventional and surgical therapies of lung cancer.
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Affiliation(s)
- Mario Ghosn
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Ahmed S Elsakka
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Elena N Petre
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Christopher Cheleuitte-Nieves
- Center of Comparative Medicine and Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY, USA
| | - Tuomas Tammela
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sebastien Monette
- Laboratory of Comparative Pathology, Memorial Sloan Kettering Cancer Center, The Rockefeller University, Weill Cornell Medicine, New York, NY, USA
| | - Etay Ziv
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Kyle M Schachtschneider
- Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA; Department of Biochemistry and Molecular Genetics, University of Illinois at Chicago, Chicago, IL, USA; National Center for Supercomputing Applications, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Govind Srimathveeravalli
- Department of Mechanical Engineering, Institute for Applied Life Sciences, University of Massachusetts Amherst, Life Sciences Laboratories, 240 Thatcher Road Amherst, MA, USA
| | - Hooman Yarmohammadi
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - F Edward Boas
- Department of Radiology, City of Hope Cancer Center, 1500 East Duarte Rd., Duarte, CA, USA
| | - Stephen B Solomon
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA.
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De Leon H, Royalty K, Mingione L, Jaekel D, Periyasamy S, Wilson D, Laeseke P, Stoffregen WC, Muench T, Matonick JP, Kaluza GL, Cipolla G. Device safety assessment of bronchoscopic microwave ablation of normal swine peripheral lung using robotic-assisted bronchoscopy. Int J Hyperthermia 2023; 40:2187743. [PMID: 36944369 DOI: 10.1080/02656736.2023.2187743] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION The aim of this study was to assess the safety of bronchoscopic microwave ablation (MWA) of peripheral lung parenchyma using the NEUWAVE™ FLEX Microwave Ablation System, and robotic-assisted bronchoscopy (RAB) using the MONARCH™ Platform in a swine model. METHODS Computed tomography (CT)-guided RAB MWA was performed in the peripheral lung parenchyma of 17 Yorkshire swine (40-50 kg) and procedural adverse events (AEs) documented. The acute group (day 0, n = 5) received 4 MWAs at 100 W for 1, 3, 5, and 10 min in 4 different lung lobes. Subacute and chronic groups (days 3 and 30, n = 6 each) received one MWA (100 W, 10 min) per animal. RESULTS The study was completed without major procedural complications. No postprocedural AEs including death, pneumothorax, bronchopleural fistula, hemothorax, or pleural effusions were observed. No gross or histological findings suggestive of thromboembolism were found in any organ. One 3-Day and one 30-Day swine exhibited coughing that required no medication (minor AEs), and one 30-Day animal required antibiotic medication (major AE) for a suspected lower respiratory tract infection that subsided after two weeks. CT-based volumetric estimates of ablation zones in the acute group increased in an ablation time-dependent (1-10 min) manner, whereas macroscopy-based estimates showed an increasing trend in ablation zone size. CONCLUSION The NEUWAVE FLEX and MONARCH devices were safely used to perform single or multiple RAB MWAs. The preclinical procedural safety profile of RAB MWA supports clinical research of both devices to investigate efficacy in select patients with oligometastatic disease or primary NSCLC.
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Affiliation(s)
| | | | | | | | - Sarvesh Periyasamy
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - David Wilson
- Schneck Pulmonology, Schneck Medical Center, Seymour, IN, USA
| | - Paul Laeseke
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Study on the Microwave Ablation Effect of Inflated Porcine Lung. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12125916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
(1) Background: Microwave ablation (MWA) has an efficient killing effect on primary and metastatic lung cancer. However, the treatment effect will be affected by the air in the lung, which makes it very difficult to accurately predict and control the ablation area; (2) Methods: In this paper, in vitro experiments combined with simulations are used to study the microwave ablation area of inflated porcine lung. The in vitro experiment is divided into inflated group and deflated group, combined with different ablation power (40 W, 50 W, 60 W) and ablation time (100 s, 200 s, 300 s) for experiment, each power and time combination are repeated five times. A total of 90 ablation experiments were performed. The simulation experiment uses COMSOL Multiphysics software to simulate the microwave ablation area of the inflated lung; (3) Results and Conclusions: When the ablation power is 40 W, 50 W, and 60 W, the average long diameter of the deflated group are 20.8–30.9%, 7.6–22.6%, 10.4–19.8% larger than those of the inflated group, respectively; the average short diameter of the deflated group is 24.5–41.4%, 31.6–45.7%, 27.3–42.9% larger than that of the inflated group. The results show that the ablation area of inflated lung is smaller than deflated lung, which is mainly due to the smaller ablation short diameter.
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Comparison of Percutaneous Image-Guided Microwave and Cryoablation for Sarcoma Lung Metastases: 10-Year Experience. AJR Am J Roentgenol 2021; 218:494-504. [PMID: 34612679 DOI: 10.2214/ajr.21.26551] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Outcomes between percutaneous microwave (MWA) and cryoablation of sarcoma lung metastases have not been compared to our knowledge. Objective: To compare technical success, complications, local tumor control, and overall survival (OS) following MWA versus cryoablation of sarcoma lung metastases. Methods: This retrospective cohort study included 27 patients (16 women, 11 men; median age 64 years; Eastern Cooperative Oncology Group performance score 0-2) who underwent 39 percutaneous CT-guided ablation sessions (21 MWA, 18 cryoablation; 1-4 sessions per patient) to treat 65 sarcoma lung metastases (median 1 tumor per patient, range 1-12; median tumor diameter 11 mm, range 5-33 mm; 25% non-peripheral) from 2009 to 2021. We compared complications by ablation modality using generalized-estimating equations. We evaluated ablation modality, tumor size, and location (peripheral vs non-peripheral) in relation to local tumor progression using proportional Cox hazard models with death as competing risk. We estimated OS using the Kaplan-Meier method. Results: Primary technical success was 97% for both modalities. Median follow-up was 23 months (range: 1-102 months; interquartile range: 12, 44 months). A total of 7/61 (12%) tumors progressed. Estimated 1-year and 2-year local control rates were, for tumors >1 cm, 97% and 95% following MWA versus 99% and 98% following cryoablation, and for tumors ≤1 cm, 74% and 62% following MWA versus 86% and 79% following cryoablation. Tumor size ≤1 cm was associated with decreased cumulative incidence of local progression (p =.048); ablation modality and tumor location were not associated with progression (p =.86; p =.54). Complications (CTCAE grade ≤3) occurred in 17/39 sessions (44%), prompting chest tube placement in nine (23%). No complications with grade ≥4 occurred. OS at 1-, 2-, and 3-years was 100%, 89%, and 82%, respectively. Conclusion: High primary technical success, local control, and OS support MWA and cryoablation for treating sarcoma lung metastases. Ablation modality and tumor location did not affect local progression. Treatment failure was low, especially for small tumors. No life-threatening complications occurred. Clinical Impact: Percutaneous MWA and cryoablation are both suited for treatment of sarcoma lung metastases, especially for tumors ≤1 cm, whether peripheral or non-peripheral. Complications, if they occur, are not life-threatening.
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Imaging following thermal ablation of early lung cancers: expected post-treatment findings and tumour recurrence. Clin Radiol 2021; 76:864.e13-864.e23. [PMID: 34420686 DOI: 10.1016/j.crad.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/13/2021] [Indexed: 12/22/2022]
Abstract
Thermal ablation is a minimally invasive technique that is growing in acceptance and popularity in the management of early lung cancers. Although curative resection remains the optimal treatment strategy for stage I pulmonary malignancies, percutaneous ablative treatments may also be considered for selected patients. These techniques can additionally be used in the treatment of oligometastatic disease. Thermal ablation of early lung tumours can be achieved using several different techniques. For example, microwave ablation (MWA) and radiofrequency ablation (RFA) utilise extreme heat, whereas cryoablation uses extremely cold temperatures to cause necrosis and ultimately cell death. Typically, post-ablation imaging studies are performed within the first 1-3 months with subsequent imaging performed at regular intervals to ensure treatment response and to evaluate for signs of recurrent disease. Surveillance imaging is usually undertaken with computed tomography (CT) and integrated positron-emission tomography (PET)/CT. Typical imaging findings are usually seen on CT and PET/CT following thermal ablation of lung tumours, and it is vital that radiologists are familiar with these appearances. In addition, radiologists should be aware of the imaging findings that indicate local recurrence following ablation. The objective of this review is to provide an overview of the expected post-treatment findings on CT and PET/CT following thermal ablation of early primary lung malignancies, as well as describing the imaging appearances of local recurrence.
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Xu F, Song J, Lu Y, Wang J, Wang J, Xiao H, Li Z. Clinical efficacy of systemic chemotherapy combined with radiofrequency ablation and microwave ablation for lung cancer: a comparative study. Int J Hyperthermia 2021; 38:900-906. [PMID: 34148500 DOI: 10.1080/02656736.2021.1936214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Local thermal ablation, a minimally invasive technique, has been widely used in clinical treatment of lung cancer. This study aimed to discuss the clinical efficacy of systemic chemotherapy combined with radiofrequency ablation (RFA) versus systemic chemotherapy combined with microwave ablation (MWA) in treating lung cancer. METHODS A retrospective analysis involving 124 lung cancer patients, who received RFA (n = 68) and MWA (n = 56) combined with systemic chemotherapy in Cangzhou People's Hospital from August 2017 to December 2019, was conducted. Before comparative analysis for therapeutic efficacy, the two groups of patients were matched with propensity score matching method at a ratio of 1:1. Indicators including progression-free survival (PFS), overall survival (OS), short-term efficacy, tumor marker level, local tumor control rate, and postoperative complications were comparatively analyzed. RESULTS There was no statistical difference in disease control rate and objective response rate (90.6% and 78.1% vs 93.8% and 84.4%) between RFA group and MWA group. The incidence of complications was 12.5% in RFA group and 18.8% in MWA group with no statistically significant difference. In addition, the local tumor control rate in MWA group (90.6%) was significantly higher than that in RFA group (78.1%). Regarding survival, a statistically significant difference was observed in median PFS of RFA and MWA groups (9.2 months vs 10.4 months, p < 0.05), while OS in two groups slightly varied. CONCLUSION MWA was superior to RFA over local tumor control rate and PFS and showed great potential in lung cancer ablation treatment.
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Affiliation(s)
- Feng Xu
- Department of Pulmonary and Critical Care Medicine, Cangzhou People's Hospital, Cangzhou, China
| | - Jian Song
- Department of Pulmonary and Critical Care Medicine, Cangzhou People's Hospital, Cangzhou, China
| | | | - Jiang Wang
- Department of Pulmonary and Critical Care Medicine, Cangzhou People's Hospital, Cangzhou, China
| | - Jing Wang
- Department of Pulmonary and Critical Care Medicine, Cangzhou People's Hospital, Cangzhou, China
| | - Haiyan Xiao
- Department of Pulmonary and Critical Care Medicine, Cangzhou People's Hospital, Cangzhou, China
| | - Zhenzhen Li
- Department of Pulmonary and Critical Care Medicine, Cangzhou People's Hospital, Cangzhou, China
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García Vázquez A, Rodríguez-Luna MR, Verde J, Piantanida E, Alonci G, Palermo M, Serra E, De Cola L, Giménez ME. Image-Guided Surgical Simulation in Minimally Invasive Liver Procedures: Development of a Liver Tumor Porcine Model Using a Multimodality Imaging Assessment. J Laparoendosc Adv Surg Tech A 2021; 31:1097-1103. [PMID: 34171972 DOI: 10.1089/lap.2021.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Image-guided liver surgery and interventions are growing as part of the current trend to translate liver procedures into minimally invasive approaches. Hands-on surgical training in such techniques is required. Consequently, a meaningful and realistic liver tumor model using multi-imaging modalities, such as ultrasound (US), computed tomography (CT), magnetic resonance (MR), cone beam-CT (CBCT), is mandatory. The first aim of this study is to develop a novel tumor-mimic model and assess it with multi-imaging modalities. The second aim is to evaluate the usefulness of the model during image-guided liver procedures. Materials and Methods: The tumor-mimic model is made of a composition of hydrogel, smashed muscle, and gadolinium contrast solution. Five ex vivo livers and three pigs were included in the study. Procedures were performed in an experimental hybrid operating room. Under general anesthesia, US guidance was required to inject the biotumor formula into the pig's liver. US, CT, CBCT, and MR acquisitions were then performed after the initial injection. In vivo models were then used to perform liver procedures, including US-guided biopsy, radiofrequency ablation, and laparoscopic resection. Results: The formula developed is easily injected generating a tissue-like material. Visualization using multi-imaging modalities was appropriate, thereby allowing to perform image-guided techniques. Conclusion: A novel design of an in vivo and ex vivo tissue-like tumor liver model is presented. Due to the multimodality imaging appraisal, it may provide a realistic and meaningful model allowing to perform image-guided liver procedures.
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Affiliation(s)
| | | | - Juan Verde
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Etienne Piantanida
- Institut de Sciences et Ingénierie Supramoléculaire, Université de Strasbourg, Strasbourg, France
| | - Giuseppe Alonci
- Institut de Sciences et Ingénierie Supramoléculaire, Université de Strasbourg, Strasbourg, France
| | - Mariano Palermo
- Daicim Foundation, Training, Research, and Clinical Activity in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - Edgardo Serra
- Daicim Foundation, Training, Research, and Clinical Activity in Minimally Invasive Surgery, Buenos Aires, Argentina
| | - Luisa De Cola
- Institut de Sciences et Ingénierie Supramoléculaire, Université de Strasbourg, Strasbourg, France
| | - Mariano Eduardo Giménez
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute against Digestive Cancer, Strasbourg, Strasbourg, France
- Daicim Foundation, Training, Research, and Clinical Activity in Minimally Invasive Surgery, Buenos Aires, Argentina
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12
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Prud'homme C, Teriitehau C, Adam J, Kyaw Tun J, Roux C, Hakime A, Delpla A, Deschamps F, de Baere T, Tselikas L. Lung microwave ablation - an in vivo swine tumor model experiment to evaluate ablation zones. Int J Hyperthermia 2021; 37:879-886. [PMID: 32689829 DOI: 10.1080/02656736.2020.1787530] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
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 [Formula: see text] 0.3 × 2.2 [Formula: see text] 0.3 cm; 4.1 [Formula: see text] 0.5 × 2.6 [Formula: see text] 0.3 cm and 4.8 [Formula: see text] 0.3 × 3.2 [Formula: see text] 0.3 cm respectively using CM; And, 3.0 [Formula: see text] 0.2 × 2.1 [Formula: see text] 0.2 cm; 4.0 [Formula: see text] 0.4 × 2.7 [Formula: see text] 0.4 cm and 4.6 [Formula: see text] 0.4 × 3.2 [Formula: see text] 0.4 cm respectively for PM, without any significant difference except for 1 cm TMLs treated by PM ablation which were significantly smaller (p = 0.009) The sphericity index was 1.6, 1.6, 1.5 and 1.4, 1.5, 1.4 at 1, 2 and 3 cm for CM and PM respectively, p = 0.07, 0.14 and 0.13 for 1, 2 and 3 cm tumors mimics. CONCLUSION Microwave ablation for 1-3 cm lung tumors were successfully realized but with a moderate reproducibility rate, using either CM or PM. Immediate post ablation CBCT can accurately evaluate ablation zones.
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Affiliation(s)
- Clara Prud'homme
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Christophe Teriitehau
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Julien Adam
- Department of Pathology, Gustave Roussy, Villejuif, France
| | - Jimmy Kyaw Tun
- Interventional Radiology Department, Barts Health NHS Trust, London, UK
| | - Charles Roux
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Antoine Hakime
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Alexandre Delpla
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Fréderic Deschamps
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Thierry de Baere
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Saint-Aubin, France
| | - Lambros Tselikas
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
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13
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Páez-Carpio A, Gómez FM, Isus Olivé G, Paredes P, Baetens T, Carrero E, Sánchez M, Vollmer I. Image-guided percutaneous ablation for the treatment of lung malignancies: current state of the art. Insights Imaging 2021; 12:57. [PMID: 33914187 PMCID: PMC8085189 DOI: 10.1186/s13244-021-00997-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/09/2021] [Indexed: 12/25/2022] Open
Abstract
Image-guided percutaneous lung ablation has proven to be a valid treatment alternative in patients with early-stage non-small cell lung carcinoma or oligometastatic lung disease. Available ablative modalities include radiofrequency ablation, microwave ablation, and cryoablation. Currently, there are no sufficiently representative studies to determine significant differences between the results of these techniques. However, a common feature among them is their excellent tolerance with very few complications. For optimal treatment, radiologists must carefully select the patients to be treated, perform a refined ablative technique, and have a detailed knowledge of the radiological features following lung ablation. Although no randomized studies comparing image-guided percutaneous lung ablation with surgery or stereotactic radiation therapy are available, the current literature demonstrates equivalent survival rates. This review will discuss image-guided percutaneous lung ablation features, including available modalities, approved indications, possible complications, published results, and future applications.
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Affiliation(s)
- Alfredo Páez-Carpio
- Department of Radiology, CDI, Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - Fernando M Gómez
- Department of Radiology, CDI, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gemma Isus Olivé
- Department of Radiology, CDI, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pilar Paredes
- Department of Nuclear Medicine, CDI, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Tarik Baetens
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Enrique Carrero
- Department of Anesthesiology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Marcelo Sánchez
- Department of Radiology, CDI, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ivan Vollmer
- Department of Radiology, CDI, Hospital Clínic, University of Barcelona, Barcelona, Spain
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14
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Székely R, Suhai FI, Karlinger K, Baksa G, Szabaczki B, Bárány L, Pölöskei G, Rácz G, Wagner Ö, Merkely B, Ruttkay T. Human Cadaveric Artificial Lung Tumor-Mimic Training Model. Pathol Oncol Res 2021; 27:630459. [PMID: 34257596 PMCID: PMC8262143 DOI: 10.3389/pore.2021.630459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/01/2021] [Indexed: 12/11/2022]
Abstract
Introduction: An important phase in surgical training is gaining experience in real human anatomical situations. When a cadaver is available it may complement the various artificial practice models. However, it is often necessary to supplement the characteristics of the cadavers with a simulation of a tumor. Our objective was to develop an easy-to-create, realistic artificial tumor-mimic model for peripheral lung tumor resection practice. Methods: In our work we injected barium sulphate enriched silicone suspension into 10 isolated, non-fixed lungs of human cadavers, through the puncture of the visceral pleura. Four lesions–apical, hilar and two peripheral–were created in each of ten specimens. After fixation CT scans were obtained and analyzed. The implanted tumor-mimics were examined after anatomical preparation and slicing. Also performed CT-guided percutaneous puncture was also performed to create the lesions in situ in two lungs of human cadavers. Results: Analyzing the CT data of 10 isolated lungs, out of 40 lesions, 34 were nodular (85.0%) and in the nodular group five were spiculated (12.5%). Satellite lesions were formed in two cases (5.0%). Relevant outflow into vessels or airway occurred in five lesions (12.5%). Reaching the surface of the lung occured in 11 lesions (27.5%). The tumor-mimics were elastic and adhered well to the surrounding tissue. The two lesions, implanted via percutaneous puncture, both were nodular and one also showed lobulated features. Conclusion: Our artificial tumor-mimics were easy to create, varied in shape and size, and with percutaneous implantation the lesions provide a model for teaching every step of a surgical procedure.
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Affiliation(s)
- Réka Székely
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| | | | - Kinga Karlinger
- Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Gábor Baksa
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| | - Bence Szabaczki
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| | - László Bárány
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
| | - Gergely Pölöskei
- Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Gergely Rácz
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Ödön Wagner
- Department of Inorganic and Analytical Chemistry, Budapest University of Technology and Economics, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Tamás Ruttkay
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
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15
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Leppelmann KS, Levesque VM, Bunck AC, Cahalane AM, Lanuti M, Silverman SG, Shyn PB, Fintelmann FJ. Outcomes Following Percutaneous Microwave and Cryoablation of Lung Metastases from Adenoid Cystic Carcinoma of the Head and Neck: A Bi-Institutional Retrospective Cohort Study. Ann Surg Oncol 2021; 28:5829-5839. [PMID: 33620616 DOI: 10.1245/s10434-021-09714-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/27/2021] [Indexed: 02/06/2023]
Abstract
OBECTIVE The aim of this study was to report outcomes following percutaneous microwave and cryoablation of lung metastases from adenoid cystic carcinoma (ACC) of the head and neck. MATERIAL AND METHODS This bi-institutional retrospective cohort study included 10 patients (6 females, median age 59 years [range 28-81]) who underwent 32 percutaneous ablation sessions (21 cryoablation, 11 microwave) of 60 lung metastases (median 3.5 tumors per patient [range 1-16]) from 2007 to 2019. Median tumor diameter was 16 mm [range 7-40], significantly larger for cryoablation (22 mm, p = 0.002). A median of two tumors were treated per session [range 1-7]. Technical success, local control, complications, and overall survival were assessed. RESULTS Primary technical success was achieved for 55/60 tumors (91.7%). Median follow-up was 40.6 months (clinical) and 32.5 months (imaging, per tumor). Local control at 1, 2, and 3 years was 94.7%, 80.8%, and 76.4%, respectively, and did not differ between ablation modalities. Five of fifteen recurrent tumors underwent repeat ablation, and secondary technical success was achieved in four (80%). Assisted local tumor control at 1, 2, and 3 years was 96.2%, 89.8%, and 84.9%, respectively. Complications occurred following 24/32 sessions (75.0%) and 57.2% Common Terminology Criteria for Adverse Events (CTCAE) lower than grade 3. Of 13 pneumothoraces, 7 required chest tube placements. Hemoptysis occurred after 7/21 cryoablation sessions, and bronchopleural fistula developed more frequently with microwave (p = 0.037). Median length of hospital stay was 1 day [range 0-10], and median overall survival was 81.5 months (IQR 40.4-93.1). CONCLUSION Percutaneous computed tomography-guided microwave and cryoablation can treat lung metastases from ACC of the head and neck. Complications are common but manageable, with full recovery expected.
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Affiliation(s)
- Konstantin S Leppelmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Alexander C Bunck
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Alexis M Cahalane
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael Lanuti
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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16
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Sebek J, Kramer S, Rocha R, Yu KC, Bortel R, Beard WL, Biller DS, Hodgson DS, Ganta CK, Wibowo H, Yee J, Myers R, Lam S, Prakash P. Bronchoscopically delivered microwave ablation in an in vivo porcine lung model. ERJ Open Res 2020; 6:00146-2020. [PMID: 33083442 PMCID: PMC7553114 DOI: 10.1183/23120541.00146-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
Background Percutaneous microwave ablation is clinically used for inoperable lung tumour treatment. Delivery of microwave ablation applicators to tumour sites within lung parenchyma under virtual bronchoscopy guidance may enable ablation with reduced risk of pneumothorax, providing a minimally invasive treatment of early-stage tumours, which are increasingly detected with computed tomography (CT) screening. The objective of this study was to integrate a custom microwave ablation platform, incorporating a flexible applicator, with a clinically established virtual bronchoscopy guidance system, and to assess technical feasibility for safely creating localised thermal ablations in porcine lungs in vivo. Methods Pre-ablation CTs of normal pigs were acquired to create a virtual model of the lungs, including airways and significant blood vessels. Virtual bronchoscopy-guided microwave ablation procedures were performed with 24–32 W power (at the applicator distal tip) delivered for 5–10 mins. A total of eight ablations were performed in three pigs. Post-treatment CT images were acquired to assess the extent of damage and ablation zones were further evaluated with viability stains and histopathologic analysis. Results The flexible microwave applicators were delivered to ablation sites within lung parenchyma 5–24 mm from the airway wall via a tunnel created under virtual bronchoscopy guidance. No pneumothorax or significant airway bleeding was observed. The ablation short axis observed on gross pathology ranged 16.5–23.5 mm and 14–26 mm on CT imaging. Conclusion We have demonstrated the technical feasibility for safely delivering microwave ablation in the lung parenchyma under virtual bronchoscopic guidance in an in vivo porcine lung model. This paper demonstrates the technical feasibility of safely delivering microwave ablation in the lung parenchyma under virtual bronchoscopic guidance in an in vivo porcine lung modelhttps://bit.ly/32aruLf
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Affiliation(s)
- Jan Sebek
- Dept of Electrical and Computer Engineering, Kansas State University Manhattan, Manhattan, KS, USA.,Dept of Circuit Theory, Czech Technical University in Prague, Prague, Czech Republic
| | | | - Rob Rocha
- Broncus Medical, Inc., San Jose, CA, USA
| | | | - Radoslav Bortel
- Dept of Circuit Theory, Czech Technical University in Prague, Prague, Czech Republic
| | - Warren L Beard
- Dept of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - David S Biller
- Dept of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - David S Hodgson
- Dept of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - Charan K Ganta
- Dept of Diagnostic Medicine/Pathobiology, Kansas State University, Manhattan, KS, USA
| | | | - John Yee
- Dept of Thoracic Surgery, Vancouver General Hospital and the University of British Columbia, Vancouver, Canada
| | - Renelle Myers
- Dept of Thoracic Surgery, Vancouver General Hospital and the University of British Columbia, Vancouver, Canada.,Dept of Integrative Oncology, BC Cancer Research Center and the University of British Columbia, Vancouver, Canada
| | - Stephen Lam
- Dept of Integrative Oncology, BC Cancer Research Center and the University of British Columbia, Vancouver, Canada
| | - Punit Prakash
- Dept of Electrical and Computer Engineering, Kansas State University Manhattan, Manhattan, KS, USA
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17
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Ni Y, Xu H, Ye X. Image-guided percutaneous microwave ablation of early-stage non-small cell lung cancer. Asia Pac J Clin Oncol 2020; 16:320-325. [PMID: 32969192 DOI: 10.1111/ajco.13419] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 06/07/2020] [Indexed: 12/24/2022]
Abstract
Although surgical lobectomy with systematic mediastinal lymph node evaluation is considered as the "gold standard" for management of early stage non-small cell lung cancer (NSCLC), image-guided percutaneous thermal ablation has been increasingly used for medically inoperable patients. Radiofrequency ablation (RFA) is a research-based technique that has the most studies for medically inoperable early-stage NSCLC. Other thermal ablation techniques used to treat pulmonary tumors include microwave ablation (MWA), cryoablation and laser ablation. MWA has several advantages over RFA including reduced procedural time, reduced heat-sink effect, large ablation zones, decreased susceptibility to tissue impedance, and simultaneous use of multiple antennae. This review article highlights the most relevant updates of MWA for the treatment of early-stage NSCLC, including mechanism of action, clinical outcomes, potential complications, the existing technique problems and future directions.
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Affiliation(s)
- Yang Ni
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Hui Xu
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong Province, China
| | - Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong Province, China
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18
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Abstract
Conventional approaches to the treatment of early-stage lung cancer have focused on the use of surgical methods to remove the tumor. Recent progress in radiation therapy techniques and in the field of interventional oncology has seen the development of several novel ablative therapies that have gained widespread acceptance as alternatives to conventional surgical options in appropriately selected patients. Local control rates with stereotactic body radiation therapy for early-stage lung cancer now approach those of surgical resection, while percutaneous ablation is in widespread use for the treatment of lung cancer and oligometastatic disease for selected other malignancies. Tumors treated with targeted medical and ablative therapies can respond to treatment differently when compared with conventional therapies. For example, after stereotactic body radiation therapy, radiologic patterns of posttreatment change can mimic disease progression, and, following percutaneous ablation, the expected initial increase in the size of a treated lesion limits the utility of conventional size-based response assessment criteria. In addition, numerous treatment-related side effects have been described that are important to recognize, both to ensure appropriate treatment and to avoid misclassification as worsening tumor. Imaging plays a vital role in the assessment of patients receiving targeted ablative therapy, and it is essential that thoracic radiologists become familiar with these findings.
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19
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Tafti BA, Genshaft S, Suh R, Abtin F. Lung Ablation: Indications and Techniques. Semin Intervent Radiol 2019; 36:163-175. [PMID: 31435124 DOI: 10.1055/s-0039-1693981] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Lung ablation is ever more recognized since its initial report and use almost two decades ago. With technological advancements in thermal modalities, particularly microwave ablation and cryoablation, better identification of the cohort of patients who best benefit from ablation, and understanding the role of imaging after ablation, image-guided thermal ablation for primary and secondary pulmonary malignancies is increasingly recognized and accepted as a cogent form of local therapy.
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Affiliation(s)
- Bashir Akhavan Tafti
- Divisions of Interventional Radiology, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Scott Genshaft
- Thoracic Imaging at the Department of Radiological Sciences, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Robert Suh
- Divisions of Interventional Radiology, David Geffen School of Medicine, UCLA Health System, Los Angeles, California.,Thoracic Imaging at the Department of Radiological Sciences, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Fereidoun Abtin
- Divisions of Interventional Radiology, David Geffen School of Medicine, UCLA Health System, Los Angeles, California.,Thoracic Imaging at the Department of Radiological Sciences, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
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20
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Aufranc V, Farouil G, Abdel-Rehim M, Smadja P, Tardieu M, Aptel S, Guibal A. Percutaneous thermal ablation of primary and secondary lung tumors: Comparison between microwave and radiofrequency ablation. Diagn Interv Imaging 2019; 100:781-791. [PMID: 31402333 DOI: 10.1016/j.diii.2019.07.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE 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: 4-27mm) than in MWA group (17.1±8.3 [SD] mm; range: 5-36mm) (P<0.001). Ablation volumes at one month were 24.1±21.7 (SD) cm3 (range: 2-97.8 cm3) in RFA group and 30.2±35.9 (SD) cm3 (range: 1.9-243.8 cm3) 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). CONCLUSIONS MWA favorably compares with RFA and can be considered as an effective and safe thermal ablation technique for lung tumors, especially in situations where RFA has limited efficacy.
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Affiliation(s)
- V Aufranc
- Department of Medical Imaging, CHU Montpellier-Lapeyronie, 371 Avenue du Doyen Gaston-Giraud, 34295 Montpellier cedex 5, France.
| | - G Farouil
- Department of Medical Imaging, Hôpital Saint-Jean, 66000 Perpignan, France
| | - M Abdel-Rehim
- Department of Medical Imaging, Hôpital Saint-Jean, 66000 Perpignan, France
| | - P Smadja
- Department of Medical Imaging, Hôpital Saint-Jean, 66000 Perpignan, France
| | - M Tardieu
- Department of Medical Imaging, Hôpital Saint-Jean, 66000 Perpignan, France
| | - S Aptel
- Department of Medical Imaging, Hôpital Saint-Jean, 66000 Perpignan, France
| | - A Guibal
- Department of Medical Imaging, Hôpital Saint-Jean, 66000 Perpignan, France
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21
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22
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Temporal evaluation of the microwave ablation zone and comparison of CT and gross sizes during the first month post-ablation in swine lung. Diagn Interv Imaging 2019; 100:279-285. [DOI: 10.1016/j.diii.2018.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 12/22/2022]
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23
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Palussière J, Chomy F, Savina M, Deschamps F, Gaubert JY, Renault A, Bonnefoy O, Laurent F, Meunier C, Bellera C, Mathoulin-Pelissier S, de Baere T. Radiofrequency ablation of stage IA non-small cell lung cancer in patients ineligible for surgery: results of a prospective multicenter phase II trial. J Cardiothorac Surg 2018; 13:91. [PMID: 30143031 PMCID: PMC6109264 DOI: 10.1186/s13019-018-0773-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/26/2018] [Indexed: 12/19/2022] Open
Abstract
Background A prospective multicenter phase II trial to evaluate the survival outcomes of percutaneous radiofrequency ablation (RFA) for patients with stage IA non-small cell lung cancer (NSCLC), ineligible for surgery. Methods Patients with a biopsy-proven stage IA NSCLC, staging established by a positron emission tomography-computed tomography (PET-CT), were eligible. The primary objective was to evaluate the local control of RFA at 1-year. Secondary objectives were 1- and 3-year overall survival (OS), 3-year local control, lung function (prior to and 3 months after RFA) and quality of life (prior to and 1 month after RFA). Results Of the 42 patients (mean age 71.7 y) that were enrolled at six French cancer centers, 32 were eligible and assessable. Twenty-seven patients did not recur at 1 year corresponding to a local control rate of 84.38% (95% CI, [67.21–95.72]). The local control rate at 3 years was 81.25% (95% CI, [54.35–95.95]). The OS rate was 91.67% (95% CI, [77.53–98.25]) at 1 year and 58.33% (95% CI, [40.76–74.49]) at 3 years. The forced expiratory volume was stable in most patients apart from two, in whom we observed a 10% decrease. There was no significant change in the global health status or in the quality of life following RFA. Conclusion RFA is an efficient treatment for medically inoperable stage IA NSCLC patients. RFA is well tolerated, does not adversely affect pulmonary function and the 3-year OS rate is comparable to that of stereotactic body radiotherapy, in similar patients. Trial registration ClinicalTrials.gov Identifier NCT01841060 registered in November 2008.
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Affiliation(s)
- J Palussière
- Department of Interventional Radiology, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France.
| | - F Chomy
- Department of Medical Oncology, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - M Savina
- Department of Clinical and Epidemiological Research, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - F Deschamps
- Department of Interventional Imaging, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, Paris, France
| | - J Y Gaubert
- Department of Imaging, CHU Timone, 264 Rue Saint-Pierre, 13385, Marseille, France
| | - A Renault
- Department of Imaging, CHU Pau, 4 Boulevard Hauterive, 64000, Pau, France
| | - O Bonnefoy
- Department of Imaging, CHU Pau, 4 Boulevard Hauterive, 64000, Pau, France
| | - F Laurent
- Department of Imaging, CHU Haut Lévêque, Avenue Magellan, 33600, Pessac, France
| | - C Meunier
- Department of Imaging, CHU Rennes, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - C Bellera
- Department of Clinical and Epidemiological Research, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - S Mathoulin-Pelissier
- Department of Clinical and Epidemiological Research, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - T de Baere
- Department of Interventional Imaging, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, Paris, France
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Chi J, Ding M, Shi Y, Wang T, Cui D, Tang X, Li P, Zhai B. Comparison study of computed tomography-guided radiofrequency and microwave ablation for pulmonary tumors: A retrospective, case-controlled observational study. Thorac Cancer 2018; 9:1241-1248. [PMID: 30070054 PMCID: PMC6166065 DOI: 10.1111/1759-7714.12822] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the safety, efficacy, and prognostic value of radiofrequency ablation (RFA) and microwave ablation (MWA) for lung tumors. METHODS Between March 2012 and January 2018, 238 patients with lung cancer were treated with MWA (139, 58.4%) or RFA (99, 41.6%) in our center. Patient and tumor characteristics, complications, complete ablation (CA) rate, and prognosis were compared between the groups. Meta-analysis was used to systematically compare the outcomes of RFA and MWA for the treatment of lung tumors. RESULTS Ablation was successfully completed in all patients and no procedure-related death occurred. The total complication rates in the RFA and MWA groups were 24.2% (24/99) and 16.5% (23/139), respectively, and there was no statistically significant difference (P = 0.142). The initial and total CA rates were similar at P > 0.05 (RFA vs. MWA: initial CA, 97.0% vs. 96.4%; total CA, 99.0% vs. 98.6%, respectively). During follow-up, there was no significant difference in median progression-free (RFA vs. MWA: 12.5 months, 95% confidence interval [CI] 5.002-19.998 vs. 9.5 months, 95% CI 6.623-12.377; P = 0.673) or overall survival (RFA vs. MWA: 33 months, 95% CI 27.070-38.930 vs. 30 months, 95% CI, 18.482-41.518; P = 0.410) between the groups. Combined with the results of published comparison studies, meta-analysis further confirmed that the outcomes of these two treatments were similar. CONCLUSION Both RFA and MWA are safe and effective treatments with a survival benefit for selected patients with primary and metastatic lung tumors.
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Affiliation(s)
- Jiachang Chi
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Min Ding
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yaoping Shi
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Tao Wang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dan Cui
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiaoyin Tang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ping Li
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Ji J, Weng Q, Zhang F, Xiong F, Jin Y, Hui J, Song J, Gao J, Chen M, Li Q, Shin D, Yang X. Non-Small-Cell Lung Cancer: Feasibility of Intratumoral Radiofrequency Hyperthermia-enhanced Herpes Simplex Virus Thymidine Kinase Gene Therapy. Radiology 2018; 288:612-620. [PMID: 29893649 DOI: 10.1148/radiol.2018172148] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose To validate the feasibility and efficacy of intratumoral radiofrequency hyperthermia (RFH)-enhanced herpes simplex virus (HSV) thymidine kinase (TK) and ganciclovir (GCV) (hereafter, HSV-TK/GCV) gene therapy for non-small-cell lung cancer (NSCLC). Materials and Methods This study was performed from November 11, 2015, to April 14, 2017, and included (a) in vitro experiments with human NSCLC cells to establish the proof of principle, (b) in vivo experiments using mice with subcutaneous NSCLC to further demonstrate the principle, and (c) in vivo experiments using rats with orthotopic NSCLC to validate the technical feasibility. Cells, nude mice, and nude rats were randomly divided into four groups (six animals per group): (a) combination therapy (HSV-TK/GCV combined with RFH), (b) RFH, (c) HSV-TK/GCV, and (d) phosphate-buffered saline. Data were analyzed by using the Dunnett t test or Kruskal-Wallis test. Results For in vitro experiments, the cell proliferation assay showed significantly diminished viable cells with combination therapy (mean, 0.56; 95% confidence interval [CI]: 0.44, 0.68) versus RFH (mean, 0.89; 95% CI: 0.82, 0.97), HSV-TK/GCV (mean, 0.71; 95% CI: 0.56, 0.86), and phosphate-buffered saline (mean, 1; 95% CI: 1, 1) (P < .05 for all). For in vivo experiments, optical imaging showed significantly decreased relative bioluminescence signal with combination therapy (mean, 0.71 [95% CI: 0.03, 1.39] in mice; 1.29 [95% CI: 0.51, 2.06] in rats) compared with RFH (mean, 2.66 [95% CI: 1.73, 3.59] in mice; 2.26 [95% CI: 1.51, 3.01] in rats), HSV-TK/GCV (mean, 1.37 [95% CI: 0.65, 2.08] in mice; 1.76 [95% CI: 1.20, 2.31] in rats), and phosphate-buffered saline (mean, 3.07 [95% CI: 2.50, 3.65] in mice; 2.94 [95% CI: 2.29, 3.58] in rats) (P < .001 for all). US showed that the smallest relative tumor volumes occurred with combination therapy (mean, 0.60; 95% CI: 0.15, 1.05) versus RFH (mean, 2.43; 95% CI: 1.80, 3.06), HSV-TK/GCV (mean, 1.32; 95% CI: 0.75, 1.89), and phosphate-buffered saline (mean, 2.56; 95% CI: 1.75, 3.38) (P < .05 for all) in the mouse subcutaneous model. Conclusion Intratumoral radiofrequency hyperthermia-enhanced herpes simplex virus thymidine kinase and ganciclovir gene therapy for non-small-cell lung cancer is feasible and can be guided by molecular imaging. © RSNA, 2018.
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Affiliation(s)
- Jiansong Ji
- From the Image-Guided Bio-Molecular Interventions Research and Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican St, S470, Seattle, WA 98109 (J.J., Q.W., F.Z., F.X., Y.J., J.S., J.G., M.C., Q.L., D.S., X.Y.); Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, Zhejiang, China (J.J., Q.W., J.H., J.S., M.C., Q.L.); and Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (Y.J., X.Y.)
| | - Qiaoyou Weng
- From the Image-Guided Bio-Molecular Interventions Research and Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican St, S470, Seattle, WA 98109 (J.J., Q.W., F.Z., F.X., Y.J., J.S., J.G., M.C., Q.L., D.S., X.Y.); Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, Zhejiang, China (J.J., Q.W., J.H., J.S., M.C., Q.L.); and Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (Y.J., X.Y.)
| | - Feng Zhang
- From the Image-Guided Bio-Molecular Interventions Research and Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican St, S470, Seattle, WA 98109 (J.J., Q.W., F.Z., F.X., Y.J., J.S., J.G., M.C., Q.L., D.S., X.Y.); Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, Zhejiang, China (J.J., Q.W., J.H., J.S., M.C., Q.L.); and Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (Y.J., X.Y.)
| | - Fu Xiong
- From the Image-Guided Bio-Molecular Interventions Research and Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican St, S470, Seattle, WA 98109 (J.J., Q.W., F.Z., F.X., Y.J., J.S., J.G., M.C., Q.L., D.S., X.Y.); Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, Zhejiang, China (J.J., Q.W., J.H., J.S., M.C., Q.L.); and Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (Y.J., X.Y.)
| | - Yin Jin
- From the Image-Guided Bio-Molecular Interventions Research and Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican St, S470, Seattle, WA 98109 (J.J., Q.W., F.Z., F.X., Y.J., J.S., J.G., M.C., Q.L., D.S., X.Y.); Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, Zhejiang, China (J.J., Q.W., J.H., J.S., M.C., Q.L.); and Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (Y.J., X.Y.)
| | - Junguo Hui
- From the Image-Guided Bio-Molecular Interventions Research and Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican St, S470, Seattle, WA 98109 (J.J., Q.W., F.Z., F.X., Y.J., J.S., J.G., M.C., Q.L., D.S., X.Y.); Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, Zhejiang, China (J.J., Q.W., J.H., J.S., M.C., Q.L.); and Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (Y.J., X.Y.)
| | - Jingjing Song
- From the Image-Guided Bio-Molecular Interventions Research and Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican St, S470, Seattle, WA 98109 (J.J., Q.W., F.Z., F.X., Y.J., J.S., J.G., M.C., Q.L., D.S., X.Y.); Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, Zhejiang, China (J.J., Q.W., J.H., J.S., M.C., Q.L.); and Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (Y.J., X.Y.)
| | - Jun Gao
- From the Image-Guided Bio-Molecular Interventions Research and Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican St, S470, Seattle, WA 98109 (J.J., Q.W., F.Z., F.X., Y.J., J.S., J.G., M.C., Q.L., D.S., X.Y.); Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, Zhejiang, China (J.J., Q.W., J.H., J.S., M.C., Q.L.); and Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (Y.J., X.Y.)
| | - Minjiang Chen
- From the Image-Guided Bio-Molecular Interventions Research and Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican St, S470, Seattle, WA 98109 (J.J., Q.W., F.Z., F.X., Y.J., J.S., J.G., M.C., Q.L., D.S., X.Y.); Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, Zhejiang, China (J.J., Q.W., J.H., J.S., M.C., Q.L.); and Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (Y.J., X.Y.)
| | - Qiang Li
- From the Image-Guided Bio-Molecular Interventions Research and Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican St, S470, Seattle, WA 98109 (J.J., Q.W., F.Z., F.X., Y.J., J.S., J.G., M.C., Q.L., D.S., X.Y.); Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, Zhejiang, China (J.J., Q.W., J.H., J.S., M.C., Q.L.); and Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (Y.J., X.Y.)
| | - David Shin
- From the Image-Guided Bio-Molecular Interventions Research and Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican St, S470, Seattle, WA 98109 (J.J., Q.W., F.Z., F.X., Y.J., J.S., J.G., M.C., Q.L., D.S., X.Y.); Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, Zhejiang, China (J.J., Q.W., J.H., J.S., M.C., Q.L.); and Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (Y.J., X.Y.)
| | - Xiaoming Yang
- From the Image-Guided Bio-Molecular Interventions Research and Division of Interventional Radiology, Department of Radiology, University of Washington School of Medicine, 850 Republican St, S470, Seattle, WA 98109 (J.J., Q.W., F.Z., F.X., Y.J., J.S., J.G., M.C., Q.L., D.S., X.Y.); Key Laboratory of Imaging Diagnosis and Minimally Invasive Interventional Research of Zhejiang Province, Department of Radiology, Zhejiang University Lishui Hospital, Lishui, Zhejiang, China (J.J., Q.W., J.H., J.S., M.C., Q.L.); and Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (Y.J., X.Y.)
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Yang X, Ye X, Zhang L, Geng D, Du Z, Yu G, Ren H, Wang J, Huang G, Wei Z, Ni Y, Li W, Han X. Microwave ablation for lung cancer patients with a single lung: Clinical evaluation of 11 cases. Thorac Cancer 2018. [PMID: 29527825 PMCID: PMC5928380 DOI: 10.1111/1759-7714.12611] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The study was conducted to retrospectively evaluate the safety and effectiveness of computed tomography (CT)‐guided percutaneous microwave ablation (MWA) for peripheral non‐small cell lung cancer (NSCLC) in 11 patients with a single lung after pneumonectomy. Methods From May 2011 to March 2015, 11 single‐lung patients (8 men and 3 women; mean age 60.3 years, range 46–71) with peripheral NSCLC underwent 12 sessions of MWA. Eleven tumors measuring 13–52 mm (mean 30.2 mm) were treated. Follow‐up was performed via CT scan at 1, 3, 6, 12, 18, and 24 months after the procedure and annually thereafter. Clinical outcomes were evaluated and complications after MWA were summarized. Results At a median follow‐up period of 20 months (range 6–38), four patients showed evidence of local recurrence at a rate of 36.4% (4/11). Median overall survival was 20 months. The overall survival rates at one, two, and three years after MWA were 88.7%, 63.6%, and 42.3%, respectively. Complications after MWA included pneumothorax (33.3%), hemoptysis (33.3%), intrapulmonary bleeding (25%), pleural effusion (16.7%), and pulmonary infection (8.3%). None of the patients died during the procedure or in the 30 days after MWA. Conclusion CT‐guided percutaneous MWA is safe and effective for the treatment of peripheral NSCLC in patients with a single lung after prior pneumonectomy.
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Affiliation(s)
- Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan City, China
| | - Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan City, China
| | - Licheng Zhang
- Department of Oncology, The 88th Hospital of Chinese People's Liberation Army, Taian, China
| | - Dianzhong Geng
- Department of Oncology, Hospital Affiliated to Binzhou Medical College, Binzhou, China
| | - Zhenli Du
- Department of Oncology, The Second People's Hospital of Dezhou, Dezhou, China
| | - Guohua Yu
- Department of Oncology, Weifang People's Hospital Affiliated to Weifang Medical College, Weifang, China
| | - Haipeng Ren
- Department of Oncology, Weifang People's Hospital Affiliated to Weifang Medical College, Weifang, China
| | - Jiao Wang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan City, China
| | - Guanghui Huang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan City, China
| | - Zhigang Wei
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan City, China
| | - Yang Ni
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan City, China
| | - Wenhong Li
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan City, China
| | - Xiaoying Han
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan City, China
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The Role of Percutaneous Image-Guided Thermal Ablation for the Treatment of Pulmonary Malignancies. AJR Am J Roentgenol 2017; 209:740-751. [DOI: 10.2214/ajr.17.18368] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Lung ablation: Best practice/results/response assessment/role alongside other ablative therapies. Clin Radiol 2017; 72:657-664. [DOI: 10.1016/j.crad.2017.01.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/26/2016] [Accepted: 01/12/2017] [Indexed: 02/06/2023]
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Palussière J, Catena V, Gaubert JY, Buy X, de Baere T. Thermo-ablation pulmonaire percutanée. Bull Cancer 2017; 104:417-422. [DOI: 10.1016/j.bulcan.2017.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 03/20/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
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Zheng A, Ye X, Yang X, Huang G, Gai Y. Local Efficacy and Survival after Microwave Ablation of Lung Tumors: A Retrospective Study in 183 Patients. J Vasc Interv Radiol 2016; 27:1806-1814. [PMID: 27789077 DOI: 10.1016/j.jvir.2016.08.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To retrospectively evaluate local efficacy and survival after microwave (MW) ablation of lung tumors and identify predictors of prognosis. MATERIALS AND METHODS Data from 183 consecutive patients (67 women; mean age, 61.5 y ± 13.4) with lung tumors who had undergone 203 lung MW ablation sessions from January 2011 to May 2013 were assessed. The χ2 test, independent-samples t test, Kaplan-Meier analysis, and Cox regression model analysis were used to estimate survival rates and evaluate significance of factors affecting rates of incomplete ablation, local progression, remote progression-free survival (RPFS), and cancer-specific survival (CSS). RESULTS Technical success rate was 100%. Incomplete ablation rate after 183 first MW ablations was 14.2% (26 of 183); maximum diameter of target tumors (P = .00001) was associated with incomplete ablation on univariate analysis. The local progression rate was 19.1% (35 of 183); emphysema (P = .020) and maximum diameter of target tumor (P = .000003) were associated with local progression. Median and 4-year RPFS were 15.0 months (95% confidence interval [CI], 11.1-18.9 mo) and 23.8%, respectively. Tumor stage (P < .01) and incomplete ablation (P = .002) were independent predictors of RPFS. Median and 4-year CSS were 24.9 months (95% CI, 19.9-29.9 mo) and 31.1%, respectively. Median and 4-year overall survival were 23.7 months (95% CI, 20.6-26.8 mo) and 29.6%, respectively. Tumor stage (P < .01) and maximum diameter (P = .009) were independent risk factors for CSS. CONCLUSIONS MW ablation is effective for lung tumors, especially small lesions of early-stage primary lung cancer and solitary lung metastasis.
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Affiliation(s)
- Aimin Zheng
- Departments of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Rd., Jinan 250021, China.
| | - Xin Ye
- Departments of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Rd., Jinan 250021, China
| | - Xia Yang
- Departments of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Rd., Jinan 250021, China
| | - Guanghui Huang
- Departments of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Rd., Jinan 250021, China
| | - Yonghao Gai
- Radiology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Rd., Jinan 250021, China
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Su C, Meyer M, Pirker R, Voigt W, Shi J, Pilz L, Huber RM, Wu Y, Wang J, He Y, Wang X, Zhang J, Zhi X, Shi M, Zhu B, Schoenberg SS, Henzler T, Manegold C, Zhou C, Roessner ED. From diagnosis to therapy in lung cancer: management of CT detected pulmonary nodules, a summary of the 2015 Chinese-German Lung Cancer Expert Panel. Transl Lung Cancer Res 2016; 5:377-88. [PMID: 27652202 DOI: 10.21037/tlcr.2016.07.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The first Chinese-German Lung Cancer Expert Panel was held in November 2015 one day after the 7th Chinese-German Lung Cancer Forum, Shanghai. The intention of the meeting was to discuss strategies for the diagnosis and treatment of lung cancer within the context of lung cancer screening. Improved risk classification criteria and novel imaging approaches for screening populations are highly required as more than half of lung cancer cases are false positive during the initial screening round if the National Lung Screening Trial (NLST) demographic criteria [≥30 pack years (PY) of cigarettes, age ≥55 years] are applied. Moreover, if the NLST criteria are applied to the Chinese population a high number of lung cancer patients are not diagnosed due to non-smoking related risk factors in China. The primary goal in the evaluation of pulmonary nodules (PN) is to determine whether they are malignant or benign. Volumetric based screening concepts such as investigated in the Dutch-Belgian randomized lung cancer screening trial (NELSON) seem to achieve higher specificity. Chest CT is the best imaging technique to identify the origin and location of the nodule since 20% of suspected PN found on chest X-ray turn out to be non-pulmonary lesions. Moreover, novel state-of-the-art CT systems can reduce the radiation dose for lung cancer screening acquisitions down to a level of 0.1 mSv with improved image quality to novel reconstruction techniques and thus reduce concerns related to chest CT as the primary screening technology. The aim of the first part of this manuscript was to summarize the current status of novel diagnostic techniques used for lung cancer screening and minimally invasive treatment techniques for progressive PNs that were discussed during the first Chinese-German Lung Cancer. This part should serve as an educational part for the readership of the techniques that were discussed during the Expert Panel. The second part summarizes the consensus recommendations that were interdisciplinary discussed by the Expert Panel.
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Affiliation(s)
- Chunxia Su
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Mathias Meyer
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Robert Pirker
- Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Wieland Voigt
- Medical Innovation and Management, Steinbeis University Berlin, Germany
| | - Jingyun Shi
- Radiology Department, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Lothar Pilz
- Division of Thoracic Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rudolf M Huber
- Division of Respiratory Medicine and Thoracic Oncology, Ludwig-Maximilians-University of Munich Thoracic Oncology Centre, Munich, Germany
| | - Yilong Wu
- Guangdong General Hospital, Lung Cancer Institute, Guangzhou 510080, China
| | - Jinghong Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yonglan He
- Department of Radiology, Beijing Union Medical College Hospital, Beijing 100730, China
| | - Xuan Wang
- Department of Radiology, Beijing Union Medical College Hospital, Beijing 100730, China
| | - Jian Zhang
- Department of Respiratory, the Fourth Military Medical University Xijing Hospital, Xi'an 710032, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Meiqi Shi
- Department of Oncology, Tumor Hospital of Jiangsu Province, Nanjing 210000, China
| | - Bo Zhu
- Department of Oncology, Xinqiao Hospital of Third Military Medical University, Chongqing 400037, China
| | - Stefan S Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Manegold
- Division of Thoracic Oncology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Caicun Zhou
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Eric Dominic Roessner
- Division of Surgical Oncology and Thoracic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Amabile C, Farina L, Lopresto V, Pinto R, Cassarino S, Tosoratti N, Goldberg SN, Cavagnaro M. Tissue shrinkage in microwave ablation of liver: an ex vivo predictive model. Int J Hyperthermia 2016; 33:101-109. [DOI: 10.1080/02656736.2016.1208292] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
| | - Laura Farina
- Department of Information Engineering, Electronics and Telecommunications, Sapienza University of Rome, Rome
| | - Vanni Lopresto
- Division of Health Protection Technologies, Casaccia Research Centre, Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy
| | - Rosanna Pinto
- Division of Health Protection Technologies, Casaccia Research Centre, Italian National Agency for New Technologies, Energy and Sustainable Economic Development (ENEA), Rome, Italy
| | | | | | - S. Nahum Goldberg
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel, and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Marta Cavagnaro
- Department of Information Engineering, Electronics and Telecommunications, Sapienza University of Rome, Rome
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Hernández JI, Cepeda MFJ, Valdés F, Guerrero GD. Microwave ablation: state-of-the-art review. Onco Targets Ther 2015; 8:1627-32. [PMID: 26185452 PMCID: PMC4500605 DOI: 10.2147/ott.s81734] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This paper reviews state-of-the-art microwave ablation (MWA) of tumors. MWA is a novel method for treating inoperable tumors, ie, tumors that cannot be treated surgically. However, patients generally choose removal of the tumor by conventional techniques. A literature review of MWA for breast, liver, lung, and kidney tumors is reported here, with tabulation of our findings according to the type of technique used, with a detailed description of the time, type of microwave generator used, and number of patients treated with MWA. In some cases, the subjects were not human patients, but pig or bovine liver specimens. MWA is a technique that has proved to be promising and likely to be used increasingly in the ablation of cancerous tumors. However, MWA needs to be used more widely to establish itself as a common tool in the treatment of inoperable tumors.
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Zheng A, Wang X, Yang X, Wang W, Huang G, Gai Y, Ye X. Major Complications After Lung Microwave Ablation: A Single-Center Experience on 204 Sessions. Ann Thorac Surg 2014; 98:243-8. [PMID: 24793688 DOI: 10.1016/j.athoracsur.2014.03.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/19/2014] [Accepted: 03/05/2014] [Indexed: 01/20/2023]
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Abstract
Percutaneous ablation of small non-small cell lung cancer (NSCLC) has been demonstrated to be both feasible and safe in nonsurgical candidates. Radiofrequency ablation (RFA), the most commonly used technique for ablation, has a reported rate of complete ablation of ~90%, with best results obtained in tumors <2 to 3 cm in diameter. The best reported 1-, 3-, and 5-year overall survival rates after RFA of NSCLC are 97.7%, 72.9%, and 55.7%, respectively. It is noteworthy that in most studies, cancer-specific survival is greater than overall survival due to severe comorbidities in patients treated with RFA for NSCLC. Aside from tumor size and tumor stage, these comorbidities are predictive of survival. Other ablation techniques such as microwave and irreversible electroporation may in the future prove to overcome some of the limitations of RFA, namely for large tumors or tumors close to large vessels. Stereotactic body radiation therapy has also been demonstrated to be highly efficacious in treating small lung tumors and will need to be compared with percutaneous ablation. This article reviews the current evidence regarding RFA for lung cancer.
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Affiliation(s)
- Thierry de Baere
- Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, France
| | - Geoffroy Farouil
- Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, France
| | - Frederic Deschamps
- Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, France
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