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Mabud TS, Swilling D, Guichet P, Zhu Y, Manduca S, Patel B, Azour L, Taslakian B, Garay SM, Moore W. Pulmonary Cryoablation Outcomes in Octogenarians and Nonagenarians with Primary Lung Cancer. J Vasc Interv Radiol 2023; 34:2006-2011. [PMID: 37527771 DOI: 10.1016/j.jvir.2023.07.022] [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: 02/13/2023] [Revised: 07/11/2023] [Accepted: 07/22/2023] [Indexed: 08/03/2023] Open
Abstract
PURPOSE To characterize the effectiveness, safety, and length of stay (LOS) associated with pulmonary cryoablation for management of primary lung malignancies in patients aged ≥80 years. MATERIALS AND METHODS A retrospective single-center database was compiled of all consecutive patients aged ≥80 years who underwent percutaneous computed tomography-guided cryoablation using modified triple-freeze protocol (1-3 ablation probes) for Stage IA-IIB primary lung malignancies between March 2017 and March 2020 (n = 19; 53% women; mean age, 85 years ± 3.5; range, 80-94 years). Follow-up imaging was assessed for local recurrence. Adverse events and LOS were recorded from chart review. Kaplan-Meier analysis was performed to assess both overall and local recurrence-free survival. RESULTS Mean patient follow-up period was 21.6 months ± 10.8, and mean imaging follow-up period was 19.2 months ± 9.6. Overall survival at 3 years was 94% (95% CI, 81%-100%). Local recurrence-free survival was 100% throughout the imaging follow-up period. Intraprocedural pneumothorax occurred in 37% (7 of 19) of patients; pneumothorax risk was significantly associated with increased tumor distance from pleura (odds ratio, 1.2; P = .018). Sixty-three percent (12 of 19) of patients were discharged on the day of the procedure, with a mean LOS of 7.7 hours ± 1.6, whereas 37% of patients required overnight observation (2 of 19) or admission (5 of 19), with a mean LOS of 48.1 hours ± 19.4. Overall LOS for all patients was 22.6 hours ± 22.9. CONCLUSIONS Percutaneous cryoablation of primary pulmonary malignancies can be performed in select octogenarians and nonagenarians with high 3-year overall and recurrence-free survival. Despite nonnegligible risk of pneumothorax, most patients are discharged on the day of the procedure.
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Affiliation(s)
- Tarub S Mabud
- Department of Radiology, NYU Langone Health, New York, New York; Department of Pulmonary Medicine, NYU Langone Health, New York, New York.
| | - David Swilling
- Department of Radiology, NYU Langone Health, New York, New York
| | - Phillip Guichet
- Department of Radiology, NYU Langone Health, New York, New York
| | - Yuli Zhu
- Department of Radiology, NYU Langone Health, New York, New York
| | - Sophia Manduca
- Department of Radiology, NYU Langone Health, New York, New York
| | - Bhavin Patel
- Department of Radiology, NYU Langone Health, New York, New York
| | - Lea Azour
- Department of Radiology, NYU Langone Health, New York, New York
| | | | - Stuart M Garay
- Department of Pulmonary Medicine, NYU Langone Health, New York, New York
| | - William Moore
- Department of Radiology, NYU Langone Health, New York, New York
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Preaching to the Choir. J Vasc Interv Radiol 2021; 32:1029-1030. [PMID: 33811998 DOI: 10.1016/j.jvir.2021.03.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/20/2021] [Indexed: 11/23/2022] Open
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Li M, Xu X, Qin Y, Zhang P, Shen C, Xia Q, Fan L. Radiofrequency ablation vs. stereotactic body radiotherapy for stage IA non-small cell lung cancer in nonsurgical patients. J Cancer 2021; 12:3057-3066. [PMID: 33854605 PMCID: PMC8040894 DOI: 10.7150/jca.51413] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/27/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Approximately 20% resectable non-small cell lung cancer (NSCLC) patients are treated non-surgically due to various reasons. The aim of the present study was to compare the effectiveness of radiofrequency ablation (RFA) and stereotactic body radiotherapy (SBRT) in patients with stage IA NSCLC who were ineligible for surgery using the surveillance, epidemiology and end-results (SEER) Database. Methods: Using the SEER registry, we identified a total of 6,195 IA NSCLC patients who received SBRT or RFA between 2004 and 2015 because of ineligibility for surgical resection due to various reasons. Complete clinical information was available in all these patients. Overall survival (OS) and cancer-specific survival (CSS) were compared between RFA and SBRT groups by using propensity score matching (PSM), inverse probability of treatment weight (IPTW), and overlap weighting analysis. Additionally, an exploratory analysis was conducted to determine the effectiveness of RFA treatment based on the subsets of clinically relevant patients. Results: Of the 6,195 nonsurgical IA NSCLC patients, 191 patients (3.1%) received RFA and the other 6,004 patients (96.9%) received SBRT. The one-, three- and five-year OS in the unmatched RFA and SBRT groups were 83.3%, 48.5%and 29.1% vs. 83.8%, 48.3% and 27.4%, respectively, there was similar results in the PSM, IPTW, overlap weighing analysis. Nonsurgical IA NSCLC patients receiving RFA seemed to have better five-year survival than those receiving SBRT, though the difference was not statistically significant (OS, HR; 0.986; 95% CI, 0.827-1.175, P=0.8738; CSS, HR; 0.965; 95% CI, 0.765-1.219, P=0.7663). We found that the odds of receiving RFA decreased with larger tumor size (>2, <3 cm, OR; 0.303; 95% CI, 0.191-0.479; >3 cm, OR; 0.153; 95% CI, 0.093-0.251) compared with tumor size <1 cm. In subgroup analysis, patients receiving RFA seemed to have better OS than those receiving SBRT, though the difference was not statistically significant. This specific trend was even more obvious in patients with tumors <1cm in diameter (P=0.1577). Conclusion: In comparison with SBRT, RFA did not seem to adversely affect CSS and OS of IA NSCLC patients who were not suitable for surgical treatment. In addition, RFA seemed to offer better survival to IA NSCLC patients, especially those with tumors <1 cm.
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Affiliation(s)
- Ming Li
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Xiao Xu
- Shanghai Clinical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Yingyi Qin
- Department of Health Statistics, Second Military Medical University, Shanghai 200433, China
| | - Peng Zhang
- Department of Cardio-Thoracic Surgery, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Changxing Shen
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Qing Xia
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Lihong Fan
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Shanghai Clinical College, Anhui Medical University, Hefei 230032, Anhui Province, China
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4
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Steinfort DP, Christie M, Antippa P, Rangamuwa K, Padera R, Müller MR, Irving LB, Valipour A. Bronchoscopic Thermal Vapour Ablation for Localized Cancer Lesions of the Lung: A Clinical Feasibility Treat-and-Resect Study. Respiration 2021; 100:432-442. [PMID: 33730740 DOI: 10.1159/000514109] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchoscopic thermal vapour ablation (BTVA) is an established and approved modality for minimally invasive lung volume reduction in severe emphysema. Preclinical data suggest potential for BTVA in minimally invasive ablation of lung cancer lesions. OBJECTIVES The objective of this study is to establish the safety, feasibility, and ablative efficacy of BTVA for minimally invasive ablation of lung cancers. METHODS Single arm treat-and-resect clinical feasibility study of patients with biopsy-confirmed lung cancer. A novel BTVA for lung cancer (BTVA-C) system for minimally invasive treatment of peripheral pulmonary tumours was used to deliver 330 Cal thermal vapour energy via bronchoscopy to target lesion. Patients underwent planned lobectomy to complete oncologic care. Pre-surgical CT chest and post-resection histologic analysis were performed to evaluate ablative efficacy. RESULTS Six patients underwent BTVA-C, and 5 progressed to planned lobectomy. Median procedure duration was 12 min. No major procedure-related complications occurred. All 5 resected lesions were part-solid lung adenocarcinomas with median solid component size 1.32±0.36 cm. Large uniform ablation zones were seen in 4 patients where thermal dose exceeded 3 Cal/mL, with complete/near-complete necrosis of target lesions seen in 2 patients. Tumour positioned within ablation zones demonstrated necrosis in >99% of cross-sectional area examined. CONCLUSION BTVA of lung tumours is feasible and well tolerated, with preliminary evidence suggesting high potential for effective ablation of tumours. Thermal injury is well demarcated, and uniform tissue necrosis is observed within ablation zones receiving sufficient thermal dose per volume of lung. Treatment of smaller volumes and ensuring adequate thermal dose may be important for ablative efficacy.
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Affiliation(s)
- Daniel P Steinfort
- Department Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia, .,Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia,
| | - Michael Christie
- Department of Pathology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Phillip Antippa
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kanishka Rangamuwa
- Department Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Robert Padera
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Rolf Müller
- Department of Thoracic Surgery, North Clinic Vienna, Karl-Landsteiner-Institute of Thoracic Oncology, Sigmund-Freud-University Medical Faculty, Vienna, Austria
| | - Louis B Irving
- Department Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
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Kapetanakis EI, Filippiadis DK, Tomos IP, Karakatsani A, Koumarianou A, Tomos PI. The role of percutaneous interventions in the management of lung cancer patients during the Covid-19 pandemic. J Surg Oncol 2020; 122:989-991. [PMID: 32588444 PMCID: PMC7361764 DOI: 10.1002/jso.26084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/13/2020] [Accepted: 06/13/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Emmanouil I Kapetanakis
- Department of Thoracic Surgery, "Attikon" University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios K Filippiadis
- 2nd Department of Radiology, "Attikon" University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P Tomos
- 2nd Pulmonary Medicine Department, "Attikon" University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - Anna Karakatsani
- 2nd Pulmonary Medicine Department, "Attikon" University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
| | - Anna Koumarianou
- Hematology-Oncology Unit, 4th Department of Internal Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Periklis I Tomos
- Department of Thoracic Surgery, "Attikon" University Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
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Ju X, Zheng L, Niu Y, Guan H, Luo H. Elevated neutrophil to lymphocyte ratio predicts poor prognosis in patients with non-small cell lung cancer after surgery. Asian J Surg 2020; 43:940-941. [PMID: 32522378 DOI: 10.1016/j.asjsur.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Xiaojun Ju
- Department of Human Anatomy, Hunan University of Medicine, Huaihua, China
| | - Ling Zheng
- Department of Surgery, Hunan University of Medicine, Huaihua, China
| | - Youya Niu
- Department of Cell Biology and Genetics, Hunan University of Medicine, Huaihua, China
| | - Haichen Guan
- Department of Imaging Diagnosis, Hunan University of Medicine, Huaihua, China
| | - Hai Luo
- Department of Physiology, Hunan University of Medicine, Huaihua, China.
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Cao F, Wan C, Xie L, Qi H, Shen L, Chen S, Song Z, Fan W. Localized RNA interference therapy to eliminate residual lung cancer after incomplete microwave ablation. Thorac Cancer 2019; 10:1369-1377. [PMID: 31017731 PMCID: PMC6558495 DOI: 10.1111/1759-7714.13079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 12/25/2022] Open
Abstract
Background This study evaluated the safety and efficacy of localized injection of polyethylene glycol (PEG)‐hyperbranched polyethyleneimine (PEI)‐EGFR‐small interfering RNA (siRNA) nanocomposites as a treatment for residual lung cancer after incomplete microwave ablation (MWA). Methods Human lung cancer cell lines with high and low EGFR expression were selected for the study. The effects of PEG‐PEI‐EGFR‐siRNA nanocomposite transfection on the proliferation, migration, and apoptosis of lung cancer cells were verified. Sixteen healthy ICR mice were injected into the lung to test the biological safety of the nanocomposites. In addition, 24 subcutaneous xenograft BALB/C nude mice with high EGFR expression were separated into four groups and then treated with an intratumoral injection of PEG‐PEI‐EGFR‐siRNA, PEG‐PEI‐normal control (NC)‐siRNA, PEG‐PEI‐EGFR‐siRNA after MWA, or PEG‐PEI‐NC‐siRNA after MWA. Tumor growth, pathological changes, and EGFR expression in each group were observed. Results PEG‐PEI‐EGFR‐siRNA nanocomposites were transfected to HCC 827 cells showing high EGFR expression and to H23 cells showing low EGFR expression. In HCC827 cells, downregulation of EGFR gene expression reduced cell proliferation, invasion, and migration, whereas cell apoptosis increased. In contrast, in H23 cells, no significant differences in those parameters were detected. No acute toxicity occurred in the ICR mice during the biosafety test. Localized injection of PEG‐PEI‐EGFR‐siRNA nanocomposites significantly inhibited the growth of human lung xenografts in mice and the growth of residual tumors after MWA. Conclusion PEG‐PEI‐EGFR‐siRNA nanocomposites may be a supplemental therapy strategy to treat residual lung cancer after incomplete MWA.
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Affiliation(s)
- Fei Cao
- Department of Minimally Invasive Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chao Wan
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Lin Xie
- Department of Minimally Invasive Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Han Qi
- Department of Minimally Invasive Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lujun Shen
- Department of Minimally Invasive Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shuanggang Chen
- Department of Minimally Invasive Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ze Song
- Department of Oncology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Huang BY, Li XM, Song XY, Zhou JJ, Shao Z, Yu ZQ, Lin Y, Guo XY, Liu DJ, Li L. Long-term results of CT-guided percutaneous radiofrequency ablation of inoperable patients with stage Ia non-small cell lung cancer: A retrospective cohort study. Int J Surg 2018; 53:143-150. [DOI: 10.1016/j.ijsu.2018.03.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 03/03/2018] [Accepted: 03/09/2018] [Indexed: 12/29/2022]
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9
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Hu JM, Sun HT. Serum proton NMR metabolomics analysis of human lung cancer following microwave ablation. Radiat Oncol 2018; 13:40. [PMID: 29530051 PMCID: PMC5848604 DOI: 10.1186/s13014-018-0982-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 02/22/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To find potential serum biomarkers of microwave ablation (MWA) for treatment of human lung cancer by 1H nuclear magnetic resonance (NMR)-based metabolomics analysis. METHODS Serum specimens collected from 43 healthy individuals, 39 patients with advanced non-small cell lung cancer (NSCLC) and 38 NSCLC patients treated with MWA, were subjected to 1H NMR-based metabolomics analysis. Partial least squares discriminant analysis was used to analyze the data. RESULTS Compared with healthy controls, NSCLC patients showed significantly elevated serum levels of lactate, alanine, glutamate, proline, glycoprotein, phenylalanine, tyrosine and tryptophan, and markedly decreased serum levels of glucose, taurine, glutamine, glycine, phosphocreatine and threonine (p < 0.05). MWA treatment reversed the metabolic profiles of NSCLC patients towards the control group. CONCLUSIONS 1H NMR-based metabolomics analysis enhanced the current understanding of the mechanisms involved in NSCLC, and uncovered the therapeutic potential of MWA for treatment of NSCLC. The above disturbed serum metabolites were proposed to be the potential biomarkers that may help to predict NSCLC and to evaluate the efficacy of MWA in the treatment of NSCLC.
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Affiliation(s)
- Jian-Ming Hu
- Thoracic surgeons, Jiangxi Provincial People’s Hospital, 152 Patriotic Road, Nanchang City, 333000 People’s Republic of China
| | - Huang-Tao Sun
- Thoracic surgeons, Jiangxi Provincial People’s Hospital, 152 Patriotic Road, Nanchang City, 333000 People’s Republic of China
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Narsule CK, Sridhar P, Nair D, Gupta A, Oommen RG, Ebright MI, Litle VR, Fernando HC. Percutaneous thermal ablation for stage IA non-small cell lung cancer: long-term follow-up. J Thorac Dis 2017; 9:4039-4045. [PMID: 29268414 DOI: 10.21037/jtd.2017.08.142] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Surgical resection is the most effective curative therapy for non-small cell lung cancer (NSCLC). However, many patients are unable to tolerate resection secondary to poor reserve or comorbid disease. Radiofrequency ablation (RFA) and microwave ablation (MWA) are methods of percutaneous thermal ablation that can be used to treat medically inoperable patients with NSCLC. We present long-term outcomes following thermal ablation of stage IA NSCLC from a single center. Methods Patients with stage IA NSCLC and factors precluding resection who underwent RFA or MWA from July 2005 to September 2009 were studied. CT and PET-CT scans were performed at 3 and 6 month intervals, respectively, for first 24 months of follow-up. Factors associated with local progression (LP) and overall survival (OS) were analyzed. Results Twenty-one patients underwent 21 RFA and 4 MWA for a total of 25 ablations. Fifteen patients had T1a and six patients had T1b tumors. Mean follow-up was 42 months, median survival was 39 months, and OS at three years was 52%. There was no significant difference in median survival between T1a nodules and T1b nodules (36 vs. 39 months, P=0.29) or for RFA and MWA (36 vs. 50 months, P=0.80). Ten patients had LP (47.6%), at a median time of 35 months. There was no significant difference in LP between T1a and T1b tumors (22 vs. 35 months, P=0.94) or RFA and MWA (35 vs. 17 months, P=0.18). Median OS with LP was 32 months compared to 39 months without LP (P=0.68). Three patients underwent repeat ablations. Mean time to LP following repeat ablation was 14.75 months. One patient had two repeat ablations and was disease free at 40-month follow-up. Conclusions Thermal ablation effectively treated or controlled stage IA NSCLC in medically inoperable patients. Three-year OS exceeded 50%, and LP did not affect OS. Therefore, thermal ablation is a viable option for medically inoperable patients with early stage NSCLC.
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Affiliation(s)
- Chaitan K Narsule
- Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Praveen Sridhar
- Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Divya Nair
- Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Avneesh Gupta
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Roy G Oommen
- Department of Surgery, Columbia University, NewYork-Presbytarian/Lawrence Hospital Center, Bronxville, NY, USA
| | - Michael I Ebright
- Section of Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Virginia R Litle
- Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Hiran C Fernando
- Division of Thoracic Surgery, Inova Fairfax Medical Center, Inova Schar Cancer Institute, Falls Church, VA, USA
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11
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Feng W, Li J, Han S, Tang J, Yao J, Cui Y, Wang C, Chen Z, Li X, Zhi X. [CT Guided Radiofrequency Ablation Followed Intratumoral Chemotherapy
in the Treatment of Early Stage Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 19:269-78. [PMID: 27215455 PMCID: PMC5973055 DOI: 10.3779/j.issn.1009-3419.2016.05.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
背景与目的 射频消融(radiofrequency ablation, RFA)已经成为无法手术的早期非小细胞肺癌(non-small cell lung cancer, NSCLC)的局部治疗方法之一。本研究观察计算机断层扫描(computed tomography, CT)引导下RFA与瘤内化疗(intratumoral chemotherapy, ITC)(RFA-ITC)的有效性和安全性。 方法 自2005年1月至2015年12月研究组前瞻性入组经病理学证实为早期NSCLC,因心肺功能较差或伴发其他疾病而无法耐受手术或拒绝手术的患者,接受RFA-ITC治疗。RFA采用导向器辅助CT引导穿刺准实时步进法,适形伞状电极、单点或多点消融,完成治疗计划并当CT显示肿瘤周围正常肺组织呈现磨玻璃样后结束消融治疗,经电极针将卡铂200 mg缓慢注射到肿瘤内。随访评估安全性和有效性。 结果 110例患者125次RFA-ITC治疗,技术成功率为100%。中位生存期为48.0个月,总生存率为55.4个月,无进展生存期为55.1个月;1年、2年、3年、5年总生存率分别为100%、90.7%、62.7%、21.9%。消融后有和无磨玻璃样改变的生存期分别是68.3个月、40.1个月,有统计学差异(P=0.001)。肿瘤的大小及有无N1分期的生存率无差异。无围手术期死亡发生,气胸、肺内出血、胸腔积液、发热、术中胸痛、皮下气肿、术中咳嗽等并发症轻微可耐受。 结论 CT引导RFA-ITC治疗不能手术的早期NSCLC,疗效好、并发症少,对患者损伤小,为不能手术治疗的早期NSCLC的治疗提供了一个良好方法。
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Affiliation(s)
- Weijian Feng
- Department of Oncology, Fuxing Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Jin Li
- Department of Oncology, Shijiazhuang Pingan Hospital Affiliated to Hebei Medical University, Shijiazhuang 050011, China
| | - Suhong Han
- Department of Oncology, Beijing Jiangong Hospital, Beijing 100054, China
| | - Jinfeng Tang
- Department of Oncology, Fuxing Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Jie Yao
- Department of Oncology, Fuxing Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Yuqing Cui
- Department of Thoracic Surgery, Beijing Wujing No.2 Hospital, Beijing 100045, China
| | - Chuntang Wang
- Department of Thoracic Surgery, Dezhou Cancer Hospital, Dezhou 253000, China
| | - Zhongcheng Chen
- Department of Oncology, Baicheng City Hospital, Baicheng 137000, China
| | - Xiaoguang Li
- Department of Interventional Radiology, Beijing Union Hospital, Beijing 100005, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Beijing Xuanwu Hospital of Capital Medical University, Beijing 100054, China
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Iyengar P, Lau S, Donington JS, Suh RD. Local Therapy for Limited Metastatic Non-Small Cell Lung Cancer: What Are the Options and Is There a Benefit? Am Soc Clin Oncol Educ Book 2017; 35:e460-7. [PMID: 27249754 DOI: 10.1200/edbk_158734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Distant metastasis is common in non-small cell lung cancer (NSCLC) and typically associated with poor prognosis. Aggressive local therapy including surgery and/or radiation for limited metastatic disease from colorectal cancer and sarcoma is associated with survival benefit and has become part of the standard of care. In this article, we review the literature and ongoing studies concerning surgery, radiation, and radiofrequency ablation for oligometastatic NSCLC.
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Affiliation(s)
- Puneeth Iyengar
- From the Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX; NYU School of Medicine, New York, NY; Department of Radiological Sciences, Thoracic Imaging and Intervention, and Diagnostic Radiology Education, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Steven Lau
- From the Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX; NYU School of Medicine, New York, NY; Department of Radiological Sciences, Thoracic Imaging and Intervention, and Diagnostic Radiology Education, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Jessica S Donington
- From the Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX; NYU School of Medicine, New York, NY; Department of Radiological Sciences, Thoracic Imaging and Intervention, and Diagnostic Radiology Education, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX
| | - Robert D Suh
- From the Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, TX; NYU School of Medicine, New York, NY; Department of Radiological Sciences, Thoracic Imaging and Intervention, and Diagnostic Radiology Education, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Radiation Oncology, Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX
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Thermal Ablation of Colorectal Lung Metastases: Retrospective Comparison Among Laser-Induced Thermotherapy, Radiofrequency Ablation, and Microwave Ablation. AJR Am J Roentgenol 2016; 207:1340-1349. [PMID: 27680945 DOI: 10.2214/ajr.15.14401] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The purpose of this study is to retrospectively evaluate local tumor control, time to tumor progression, and survival rates among patients with lung metastatic colorectal cancer who have undergone ablation therapy performed using laser-induced thermotherapy (LITT), radiofrequency ablation (RFA), or microwave ablation (MWA). MATERIALS AND METHODS Data for this retrospective study were collected from 231 CT-guided ablation sessions performed for 109 patients (71 men and 38 women; mean [± SD] age, 68.6 ± 11.2 years; range, 34-94 years) from May 2000 to May 2014. Twenty-one patients underwent LITT (31 ablations), 41 patients underwent RFA (75 ablations), and 47 patients underwent MWA (125 ablations). CT scans were acquired 24 hours after each therapy session and at follow-up visits occurring at 3, 6, 12, 18, and 24 months after ablation. Survival rates were calculated from the time of the first ablation session, with the use of Kaplan-Meier and log-rank tests. Changes in the volume of the ablated lesions were measured using the Kruskal-Wallis method. RESULTS Local tumor control was achieved in 17 of 25 lesions (68.0%) treated with LITT, 45 of 65 lesions (69.2%) treated with RFA, and 91 of 103 lesions (88.3%) treated with MWA. Statistically significant differences were noted when MWA was compared with LITT at 18 months after ablation (p = 0.01) and when MWA was compared with RFA at 6 months (p = 0.004) and 18 months (p = 0.01) after ablation. The overall median time to local tumor progression was 7.6 months. The median time to local tumor progression was 10.4 months for lesions treated with LITT, 7.2 months for lesions treated with RFA, and 7.5 months for lesions treated with MWA, with no statistically significant difference noted. New pulmonary metastases developed in 47.6% of patients treated with LITT, in 51.2% of patients treated with RFA, and in 53.2% of patients treated with MWA. According to the Kaplan-Meier test, median survival was 22.1 months for patients who underwent LITT, 24.2 months for those receiving RFA, and 32.8 months for those who underwent MWA. The overall survival rate at 1, 2, and 4 years was 95.2%, 47.6%, and 23.8%, respectively, for patients treated with LITT; 76.9%, 50.8%, and 8.0%, respectively, for patients treated with RFA; and 82.7%, 67.5%, and 16.6%, respectively, for patients treated with MWA. The log-rank test revealed no statistically significant difference among LITT, RFA, and MWA. The progression-free survival rate at 1, 2, 3, and 4 years was 96.8%, 52.7%, 24.0%, and 19.1%, respectively, for patients who underwent LITT; 77.3%, 50.2%, 30.8%, and 16.4%, respectively, for patients who underwent RFA; and 54.6%, 29.1%, 10.0%, and 1.0%, respectively, for patients who underwent MWA, with no statistically significant difference noted among the three ablation methods. CONCLUSION LITT, RFA, and MWA can be used as therapeutic options for lung metastases resulting from colorectal cancer. Statistically significant differences in local tumor control revealed a potential advantage in using MWA. No differences in time to tumor progression or survival rates were detected when the three different ablation methods were compared.
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Bhatia S, Pereira K, Mohan P, Narayanan G, Wangpaichitr M, Savaraj N. Radiofrequency ablation in primary non-small cell lung cancer: What a radiologist needs to know. Indian J Radiol Imaging 2016; 26:81-91. [PMID: 27081229 PMCID: PMC4813080 DOI: 10.4103/0971-3026.178347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Lung cancer continues to be one of the leading causes of death worldwide. In advanced cases of lung cancer, a multimodality approach is often applied, however with poor local control rates. In early non-small cell lung cancer (NSCLC), surgery is the standard of care. Only 15-30% of patients are eligible for surgical resection. Improvements in imaging and treatment delivery systems have provided new tools to better target these tumors. Stereotactic body radiation therapy (SBRT) has evolved as the next best option. The role of radiofrequency ablation (RFA) is also growing. Currently, it is a third-line option in stage 1 NSCLC, when SBRT cannot be performed. More recent studies have demonstrated usefulness in recurrent tumors and some authors have also suggested combination of RFA with other modalities in larger tumors. Following the National Lung Screening Trial (NLST), screening by low-dose computed tomography (CT) has demonstrated high rates of early-stage lung cancer detection in high-risk populations. Hence, even considering the current role of RFA as a third-line option, in view of increasing numbers of occurrences detected, the number of potential RFA candidates may see a steep uptrend. In view of all this, it is imperative that interventional radiologists be familiar with the techniques of lung ablation. The aim of this article is to discuss the procedural technique of RFA in the lung and review the current evidence regarding RFA for NSCLC.
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Affiliation(s)
- Shivank Bhatia
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, Florida, USA
| | - Keith Pereira
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, Florida, USA
| | - Prasoon Mohan
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, Florida, USA
| | - Govindarajan Narayanan
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, Florida, USA
| | - Medhi Wangpaichitr
- Department of Surgery, Jackson Memorial Hospital, University of Miami Hospital, Miami, Florida, USA
| | - Niramol Savaraj
- Department of Hematology and Oncology, Veterans Affairs Medical Center, Miami, Florida, USA
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Ni X, Han JQ, Ye X, Wei ZG. Percutaneous CT-guided microwave ablation as maintenance after first-line treatment for patients with advanced NSCLC. Onco Targets Ther 2015; 8:3227-35. [PMID: 26604789 PMCID: PMC4640441 DOI: 10.2147/ott.s90528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Systemic therapy is recommended for advanced non-small-cell lung cancer (NSCLC). However, conventional first-line treatment has generated a plateau in response rate of 25% to 35%. Few studies have shown patients benefit from microwave ablation (MWA) in combination with radiotherapy and chemotherapy. This study aims to evaluate safety and efficacy of percutaneous computed tomography-guided MWA as maintenance after first-line treatment for patients with advanced NSCLC. METHODS Patients with histologically verified NSCLC stage IIIB or IV between January 2010 and March 2014 were involved. After completion of first-line treatment with partial response or stable disease, 35 patients with 39 tumors underwent 39 MWA procedures. Complications, progression-free survival (PFS), overall survival (OS), and correlated predictors were analyzed. RESULTS During a median follow-up of 17.7 months and 10.8 months after initial MWA, local efficacy was 87.2%, median MWA-related local control time was 10.6 months, and tumor size was the only predictor (P=0.002). Median MWA-related PFS, MWA-related OS, PFS, and OS were 5.4, 10.6, 11.8 and 17.7 months, respectively. Local efficacy was significantly correlated with MWA-related PFS (P=0.003), MWA-related OS (P=0.000), and OS (P=0.001). There were no procedure-specific deaths. Total incidence of major complications was 12.8%, including pneumothorax resolved by closed pleural drainage and pneumonia controlled by antibiotics in a short time. CONCLUSION This study concluded two points, including: 1) patients benefited from MWA as maintenance both in local control and survival; 2) as maintenance MWA was superior to conventional maintenance therapy with improved survival and well-tolerated complications. Therefore, MWA was a safe and effective maintenance after first-line treatment in patients with advanced NSCLC.
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Affiliation(s)
- Xiang Ni
- Department of Oncology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, People’s Republic of China
| | - Jun-Qing Han
- Department of Oncology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, People’s Republic of China
| | - Xin Ye
- Department of Oncology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, People’s Republic of China
| | - Zhi-Gang Wei
- Department of Oncology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, People’s Republic of China
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Treatment of Solitary Painful Osseous Metastases with Radiotherapy, Cryoablation or Combined Therapy: Propensity Matching Analysis in 175 Patients. PLoS One 2015; 10:e0129021. [PMID: 26103516 PMCID: PMC4478013 DOI: 10.1371/journal.pone.0129021] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/03/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE aim of this study was to identify outcomes in pain relief and quality of life in patients with a solitary painful osseous metastasis treated by radiotherapy, cryoablation or the combination using a propensity score matching study design. MATERIALS AND METHODS 175 patients with painful bone metastases were included in the study. Twenty-five of them underwent a radiation course (20 Gy in five daily fractions) 15 days after the cryoablation. These subjects were retrospectively matched by propensity analysis with a group of subjects treated by radiotherapy (125 subjects) and with a group treated byCryoablation (25 subjects). The pain relief in terms of complete response, rate of subjects requiring analgesics after treatments and the changes in self-rated quality of life were measured. Informed consent was obtained from the subject and the study was approved by the local Ethical Committee. RESULTS An higher proportion of subjects treated by cryoablation (32%) or cryoablation followed by RT (72%;) experienced a complete response compared with patients treated by radiotherapy alone (11.2%). After Bonferroni correction strategy, the addition of radiotherapy to cryoablation significantly improved the rate of complete response compared with cryoablation alone (p = 0.011) and this paralleled with an improved self-rated quality of life. Seventeen subjects (13.6%) of patients in the radiotherapy group, 9 (36%) in the cryoablation group, and 19 (76)% in the cryoablation- radiotherapy group did not require narcotic medications. CONCLUSIONS The addition of radiotherapy to cryoablation favorably impacts on perceived pain, with a favorable toxicity profile. However, our data should be interpreted with caution and could serve as a framework around which to design future trials.
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Dupuy DE, Fernando HC, Hillman S, Ng T, Tan AD, Sharma A, Rilling WS, Hong K, Putnam JB. Radiofrequency ablation of stage IA non-small cell lung cancer in medically inoperable patients: Results from the American College of Surgeons Oncology Group Z4033 (Alliance) trial. Cancer 2015; 121:3491-8. [PMID: 26096694 DOI: 10.1002/cncr.29507] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND This study evaluated the 2-year overall survival rate, adverse event rate, local control rate, and impact on pulmonary function tests for medically inoperable patients with stage IA non-small cell lung cancer (NSCLC) undergoing computed tomography (CT)-guided radiofrequency ablation (RFA) in a prospective, multicenter trial. METHODS Fifty-four patients (25 men and 29 women) with a median age of 76 years (range, 60-89 years) were enrolled from 16 US centers; 51 patients were eligible for evaluation (they had biopsy-proven stage IA NSCLC and were deemed medically inoperable by a board-certified thoracic surgeon). Pulmonary function tests were performed within the 60 days before RFA and 3 and 24 months after RFA. Adverse events were recorded and categorized. Patients were followed with CT and fludeoxyglucose positron emission tomography. Local control rate and recurrence patterns were analyzed. RESULTS The overall survival rate was 86.3% at 1 year and 69.8% at 2 years. The local tumor recurrence-free rate was 68.9% at 1 year and 59.8% at 2 years and was worse for tumors > 2 cm. In the 19 patients with local recurrence, 11 were re-treated with RFA, 9 underwent radiation, and 3 underwent chemotherapy. There were 21 grade 3 adverse events, 2 grade 4 adverse events, and 1 grade 5 adverse event in 12 patients within the first 90 days after RFA. None of the grade 4 or 5 adverse events were attributable to RFA. There was no significant change in the forced expiratory volume in the first second of expiration or the diffusing capacity of lung for carbon monoxide after RFA. A tumor size less than 2.0 cm and a performance status of 0 or 1 were associated with statistically significant improved survival of 83% and 78%, respectively, at 2 years. CONCLUSIONS RFA is a single, minimally invasive procedure that is well tolerated in medically inoperable patients, does not adversely affect pulmonary function tests, and provides a 2-year overall survival rate that is comparable to the rate reported after stereotactic body radiotherapy in similar patients.
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Affiliation(s)
- Damian E Dupuy
- Rhode Island Hospital/Alpert Medical School, Brown University, Providence, Rhode Island
| | - Hiran C Fernando
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Shauna Hillman
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Thomas Ng
- Rhode Island Hospital/Alpert Medical School, Brown University, Providence, Rhode Island
| | - Angelina D Tan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | - Amita Sharma
- Radiological Associates, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Kelvin Hong
- Johns Hopkins Medical Center, Johns Hopkins Hospital, Baltimore, Maryland
| | - Joe B Putnam
- Vanderbilt University Medical Center, Vanderbilt Clinic, Nashville, Tennessee
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Ye X, Fan W. [Expert consensus for thermal ablation of primary and metastatic lung tumors]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 17:294-301. [PMID: 24758903 PMCID: PMC6000017 DOI: 10.3779/j.issn.1009-3419.2014.04.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - Weijun Fan
- Imaging Intervention Center, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
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Ye X, Fan W, Chen JH, Feng WJ, Gu SZ, Han Y, Huang GH, Lei GY, Li XG, Li YL, Li ZJ, Lin ZY, Liu BD, Liu Y, Peng ZM, Wang H, Yang WW, Yang X, Zhai B, Zhang J. Chinese expert consensus workshop report: Guidelines for thermal ablation of primary and metastatic lung tumors. Thorac Cancer 2015; 6:112-21. [PMID: 26273346 PMCID: PMC4448461 DOI: 10.1111/1759-7714.12152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/16/2014] [Indexed: 12/31/2022] Open
Abstract
Although surgical resection is the primary means of curing both primary and metastatic lung cancers, about 80% of lung cancers cannot be removed by surgery. As most patients with unresectable lung cancer receive only limited benefits from traditional radiotherapy and chemotherapy, many new local treatment methods have emerged, including local ablation therapy. The Minimally Invasive and Comprehensive Treatment of Lung Cancer Branch, Professional Committee of Minimally Invasive Treatment of Cancer of the Chinese Anti-Cancer Association has organized multidisciplinary experts to develop guidelines for this treatment modality. These guidelines aim at standardizing thermal ablation procedures and criteria for selecting treatment candidates and assessing outcomes; and for preventing and managing post-ablation complications.
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Affiliation(s)
- Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Weijun Fan
- Imaging and Interventional Center, Sun Yat-sen University Cancer CenterGuangzhou, China
| | - Jun-hui Chen
- Department of Minimally Invasive Interventional Therapy, Shenzhen Hospital of Beijing UniversityShenzhen, China
| | - Wei-jian Feng
- Department of Oncology, Fuxing Hospital Affiliated to the Capital University of Medical SciencesBeijing, China
| | - Shan-zhi Gu
- Department of Interventional Therapy, Hunan Provincial Tumor HospitalChangsha, China
| | - Yue Han
- Department of Imaging, Tumor Institute and Hospital, Chinese Academy of Medical SciencesBeijing, China
| | - Guang-hui Huang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Guang-yan Lei
- Department of Thoracic Surgery, Shanxi Provincial Tumor HospitalXi'an, China
| | - Xiao-guang Li
- Department of Radiology, Peking Union Medical College HospitalBeijing, China
| | - Yu-liang Li
- Interventional Treatment Center, Shandong University Second HospitalJinan, China
| | - Zhen-jia Li
- Research Office of CT Diagnosis and Treatment, Shandong Provincial Institute of Medical ImagingJinan, China
| | - Zheng-yu Lin
- Department of Interventional Therapy, the First Affiliated Hospital of Fujian Medical UniversityFuzhou, China
| | - Bao-dong Liu
- Department of Thoracic Surgery, Xuanwu Hospital Affiliated to the Capital University of Medical SciencesBeijing, China
| | - Ying Liu
- Department of Oncology, Armed Police Hospital of Guangdong ProvinceGuangzhou, China
| | - Zhong-min Peng
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Hui Wang
- Interventional Treatment Center, Jilin Provincial Tumor HospitalChangchun, China
| | - Wu-wei Yang
- Department of Tumor Minimally Invasive Therapy, 307 HospitalBeijing, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Bo Zhai
- Tumor Interventional Therapy Center, Shanghai Renji HospitalShanghai, China
| | - Jun Zhang
- Center of Lung Cancer, the First Affiliated Hospital of China Medical UniversityShenyang, China
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To SABR or not to SABR? Indications and contraindications for stereotactic ablative radiotherapy in the treatment of early-stage, oligometastatic, or oligoprogressive non-small cell lung cancer. Semin Radiat Oncol 2014; 25:78-86. [PMID: 25771411 DOI: 10.1016/j.semradonc.2014.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Stereotactic ablative radiotherapy (SABR) is a highly effective treatment for early-stage non-small cell lung cancer. Although direct comparisons from randomized trials are not available, rates of both primary tumor control and distant metastasis are similar between SABR and surgery. Overall survival is lower after SABR compared with surgery, largely reflecting that a primary selection criterion for SABR has been medical inoperability because of decreased cardiopulmonary function and other comorbidities that lead to decreased survival independent of non-small cell lung cancer. Survival outcomes between SABR and surgery are much more similar in propensity-matched cohorts. Newer potential indications for SABR include treatment of operable patients; of oligometastatic lung cancer, in which SABR has emerged as an alternative to metastasectomy; and of oligoprogressive lung cancer, an attractive concept especially as improved personalized systemic therapies emerge, and prospective trials are currently being conducted in these settings. Although toxicity in modern series is low, SABR is clearly capable of producing fatal complications, and understanding the risk factors and approaches for mitigating them has been emerging in recent years. Thus, appropriate patient selection is a vital, evolving, and controversial topic.
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Acksteiner C, Steinke K. Percutaneous microwave ablation for early-stage non-small cell lung cancer (NSCLC) in the elderly: A promising outlook. J Med Imaging Radiat Oncol 2014; 59:82-90. [DOI: 10.1111/1754-9485.12251] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 09/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Karin Steinke
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; University of Queensland School of Medicine; Brisbane Queensland Australia
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22
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Comparison of therapeutic results from radiofrequency ablation and stereotactic body radiotherapy in solitary lung tumors measuring 5 cm or smaller. Int J Clin Oncol 2014; 20:499-507. [DOI: 10.1007/s10147-014-0741-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/04/2014] [Indexed: 12/25/2022]
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23
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Ridge CA, Silk M, Petre EN, Erinjeri JP, Alago W, Downey RJ, Sofocleous CT, Thornton RH, Solomon SB. Radiofrequency Ablation of T1 Lung Carcinoma: Comparison of Outcomes for First Primary, Metachronous, and Synchronous Lung Tumors. J Vasc Interv Radiol 2014; 25:989-96. [DOI: 10.1016/j.jvir.2014.02.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 12/28/2022] Open
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Petre EN, Solomon SB, Sofocleous CT. The role of percutaneous image-guided ablation for lung tumors. Radiol Med 2014; 119:541-8. [DOI: 10.1007/s11547-014-0427-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/11/2014] [Indexed: 12/25/2022]
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25
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Steinke K, Liu H. Minimally invasive techniques for medically inoperable stage I non-small cell lung cancer (NSCLC) - image-guided microwave ablation, a promising therapy option. J Med Imaging Radiat Oncol 2014; 58:79-80. [DOI: 10.1111/1754-9485.12149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Karin Steinke
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Howard Liu
- Radiation Oncology; The Townsville Hospital; Townsville QLD Australia
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Lee KS, Pua BB. Alternative to surgery in early stage NSCLC-interventional radiologic approaches. Transl Lung Cancer Res 2013; 2:340-53. [PMID: 25806253 DOI: 10.3978/j.issn.2218-6751.2013.10.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/24/2013] [Indexed: 12/22/2022]
Abstract
Interventional radiologists have a variety of techniques in their armamentarium to treat pulmonary tumors. While most therapies are targeted to metastasis or palliation, percutaneous thermal ablation represents a potential therapy for not only palliation, but to treat inoperable early stage disease. Although radiofrequency ablation (RFA) is the most studied of these ablative techniques, newer technologies of thermal ablation, such as microwave and cryoablation have emerged as additional options. In this article, we will review the three different thermal ablative modalities, including patient selection, technique, outcomes, complications, and imaging follow-up. A brief discussion of state of the art techniques such as irreversible electroporation (IRE) and catheter directed therapies will also be included.
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Affiliation(s)
- Kyungmouk Steve Lee
- Division of Interventional Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Bradley B Pua
- Division of Interventional Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA
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