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Leong TL, Steinfort DP. Contemporary Concise Review 2023: Advances in lung cancer and interventional pulmonology. Respirology 2024; 29:665-673. [PMID: 38960450 DOI: 10.1111/resp.14789] [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] [Received: 06/02/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024]
Abstract
Eligibility criteria for lung cancer screening increasingly need to consider family history of lung cancer, as well as age and smoking status. Lung cancer screening will reveal a multitude of incidental findings, of variable clinical significance, and with a need for clear pathways of management. Pulmonary nodule sampling is enhanced by intra-procedural imaging and cutting-edge robotic technology. Systematic thoracic lymph node sampling has implications for treatment efficacy. Bronchoscopic ablative techniques are feasible for peripheral lung cancers. Bronchoscopic sampling continues to have a high yield for lung cancer molecular characterization. Immunotherapy indications have expanded to include early stage and resectable lung cancer.
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Affiliation(s)
- Tracy L Leong
- Department of Respiratory Medicine, Austin Health, Heidelberg, Victoria, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Daniel P Steinfort
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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He JY, Yang L, Wang DD. Efficacy and Safety of thermal ablation for Patients With stage I non-small cell lung cancer. Acad Radiol 2024:S1076-6332(24)00349-0. [PMID: 38942645 DOI: 10.1016/j.acra.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 06/30/2024]
Abstract
RATIONALE AND OBJECTIVES The objective of this study was to measure the safety and efficacy of thermal ablation, including radiofrequency ablation (RFA) and microwave ablation (MWA), for patients with stage I non-small cell lung cancer (NSCLC). MATERIALS AND METHODS The databases PubMed was searched from inception to November 2023 to identify relevant studies. Statistical analyses were performed with R version 3. 6. 3. RESULTS Thirty-three studies involving 1400 patients were finally included. According to our study, the incidence of patients with stage I NSCLC who were older than 60 years old was 98 % (95 % CI [94-100 %]); the lesions were mostly located in RUL (Right Upper Lobe) and LUL (Left Upper Lobe), and the incidence of the two sites was 29 % (95 % CI [23-35 %]) and 27 % (95 % CI [21-33 %]), respectively; the types of lung cancers mainly included adenocarcinoma, squamous carcinoma, and large-cell lung cancer, of which adenocarcinoma accounted for the largest proportion of 63 % (95 % CI [56-70 %]); the causes of death were mainly categorized into cancer-related (57 %, 95 %CI[40-74 %]) and noncancer-related (40 %, 95 %CI [23-58 %]); the common complications in the postoperative period were pneumothorax and pain, with the incidence of 33 % (95 %CI[24-44 %]) and 33 % (95 %CI[19-50 %]), and the rate of the postoperative complications in MWA was slightly higher than those in RFA; the local recurrence rate was 23 % (95 %CI[17-29 %]) and the distant recurrence rate was 18 % (95 %CI[7-32 %]); the pooling result showed the rate of 1-, 2-, 3-, and 5-year survival rate were 96 %, 81 %, 68 %, and 42 %, the Cancer-specific survival (CSS) rates at 1, 2, 3, and 5 years were 98 %, 88 %, 75 %, and 58 %, Disease-free survival (DFS) rates at 1, 2, 3, and 5 years were 87 %, 63 %, 57 %, and 42 %, there were no significant differences existed between the RFA group and MWA group in survival rate, CSS and DFS. CONCLUSION Ablation therapy is safe and effective for stage I NSCLC patient. MWA and RFA have comparable efficacy, safety, and prognosis, which could be recommended for patients with stageⅠNSCLC, especially for patients who cannot tolerate open surgery.
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Affiliation(s)
- Jin-Ying He
- Department of Radiology, Qingdao Municipal Hospital China
| | - Ling Yang
- Department of Interventional Oncology, Qingdao Municipal Hospital China
| | - Dong-Dong Wang
- Department of Interventional Oncology, Qingdao Municipal Hospital China.
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Gu C, Yuan H, Yang C, Xie F, Chen J, Zhu L, Jiang Y, Sun J. Transbronchial cryoablation in peripheral lung parenchyma with a novel thin cryoprobe and initial clinical testing. Thorax 2024; 79:633-643. [PMID: 38242710 PMCID: PMC11187365 DOI: 10.1136/thorax-2023-220227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 12/23/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Transbronchial cryoablation shows potential as a local therapy for inoperable peripheral lung cancer. However, its clinical application for peripheral pulmonary lesions has not been reported yet. METHODS An improved cryoprobe with an 8-mm-long, 1.9-mm-wide cryotip was used. Initially, the safety and effectiveness of this cryoprobe were assessed in an in vivo porcine model. Transbronchial cryoablation with 2 or 3 freeze-thaw cycles (10 min or 15 min in each freezing time) was performed in 18 pigs under CT monitoring. Radiological and pathological examinations were performed to evaluate the extent of cryoablation. Subsequently, nine patients with stage IA peripheral lung cancer or metastases underwent transbronchial cryoablation with this cryoprobe under the guidance of navigation bronchoscopy and cone-beam CT. Technical success, safety and outcomes were assessed. RESULTS 36 cryoablation procedures were performed successfully without any major complications in the porcine model. The extent of cryoablation increased with freezing time and the number of freeze-thaw cycles, which peaked at 24 hours and then gradually decreased. Pathological results showed a change from massive haemorrhage at 24 hours to fibrous hyperplasia with chronic inflammation after 4 weeks. In the clinical trial, 10 cryoablations were performed on 9 tumours with a technical success rate of 100%. One mild treatment-related complication occurred. Of the nine tumours, seven achieved complete ablation, while two exhibited incomplete ablation and subsequent local progression at 6 months. CONCLUSION Our initial experience indicated that transbronchial cryoablation was a safe and feasible procedure for non-surgical peripheral stage IA lung cancer or pulmonary metastases. TRIAL REGISTRATION NUMBER ChiCTR2200061544.
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Affiliation(s)
- Chuanjia Gu
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Haibin Yuan
- Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chi Yang
- Research and Development Department, AccuTarget MediPharma (Shanghai) Co., Ltd, Shanghai, China
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Junxiang Chen
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Lei Zhu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yifeng Jiang
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
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Lau KK, Lau RW, Baranowski R, Krzykowski J, Ng CS. Transbronchial Microwave Ablation of Peripheral Lung Tumors: The NAVABLATE Study. J Bronchology Interv Pulmonol 2024; 31:165-174. [PMID: 37747275 PMCID: PMC10984635 DOI: 10.1097/lbr.0000000000000950] [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] [Received: 02/01/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Image-guided thermal ablation is a minimally invasive local therapy for lung malignancies. NAVABLATE characterized the safety and performance of transbronchial microwave ablation (MWA) in the lung. METHODS The prospective, single-arm, 2-center NAVABLATE study (NCT03569111) evaluated transbronchial MWA in patients with histologically confirmed lung malignancies ≤30 mm in maximum diameter who were not candidates for, or who declined, both surgery and stereotactic body radiation therapy. Ablation of 1 nodule was allowed per subject. The nodule was reached with electromagnetic navigation bronchoscopy. Cone-beam computed tomography was used to verify the ablation catheter position and to evaluate the ablation zone postprocedure. The primary end point was composite adverse events related to the transbronchial MWA device through 1-month follow-up. Secondary end points included technical success (nodule reached and ablated according to the study protocol) and technique efficacy (satisfactory ablation based on 1-month follow-up imaging). RESULTS Thirty subjects (30 nodules; 66.7% primary lung, 33.3% oligometastatic) were enrolled from February 2019 to September 2020. The pre-procedure median nodule size was 12.5 mm (range 5 to 27 mm). Procedure-day technical success was 100% (30/30), with a mean ablative margin of 9.9±2.7 mm. One-month imaging showed 100% (30/30) technique efficacy. The composite adverse event rate related to the transbronchial MWA device through 1-month follow-up was 3.3% (1 subject, mild hemoptysis). No deaths or pneumothoraces occurred. Four subjects (13.3%) experienced grade 3 complications; none had grade 4 or 5. CONCLUSION Transbronchial microwave ablation is an alternative treatment modality for malignant lung nodules ≤30 mm. There were no deaths or pneumothorax. In all, 13.3% of patients developed grade 3 or above complications.
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Affiliation(s)
- Kelvin K.W. Lau
- Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | - Rainbow W.H. Lau
- Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ralitsa Baranowski
- Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | | | - Calvin S.H. Ng
- Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
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Soumagne T, Dutau H, Eapen G, Guibert N, Hergott C, Maldonado F, Saka H, Fortin M. An International Survey of Practices in the Investigation and Endoscopic Treatment of Peripheral Pulmonary Lesions amongst Interventional Bronchoscopists. Respiration 2024; 103:146-154. [PMID: 38402862 DOI: 10.1159/000536271] [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] [Received: 07/02/2023] [Accepted: 12/18/2023] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION The investigation of peripheral pulmonary lesions (PPLs) can be challenging. Several bronchoscopic modalities have been developed to reach and biopsy PPL but the level of adoption of these techniques by interventional pulmonologists (IPs) is unknown. This international survey was conducted to describe current practices in PPL investigation among IP. METHODS This survey was sent to all members of the World Association for Bronchology and Interventional Pulmonology, Canadian Thoracic Society Procedures Assembly, AABIP, and the Groupe d'Endoscopie Thoracique et Interventionnel Francophone. The survey was composed of 48 questions and three clinical cases to establish a portrait of modalities used to investigate and treat PPL by IP around the world. RESULTS Three hundred and twelve IP responded to the survey. Most of them practice in Europe (n = 122), North America (n = 97), and Asia (n = 49). Half of responders perform more than 100 endoscopic procedures for PPL annually. General anesthesia and conscious sedation are used in similar proportions (53% and 47%, respectively). Rapid on site evaluation (ROSE) is used when sampling PPL by 42%. Radial EBUS (69%), fluoroscopy (55%), and electromagnetic navigation (27%) are the most widely used techniques. Most IP combine techniques (89%). Robotic bronchoscopy (15%) and cone-beam CT (8%) are almost exclusively used in the USA where, respectively, 60% and 37% of respondents reported using these modalities. Ten percent of IP currently had access to endoscopic treatment modalities for PPL. However, half of the remaining IP plan to acquire an endoscopic treatment modality in the next 2 years. CONCLUSION Available techniques and practices worldwide vary significantly regarding PPL investigation and treatment.
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Affiliation(s)
- Thibaud Soumagne
- Department of Pulmonology and Thoracic Surgery, Quebec Heart and Lung Institute, Laval University, Quebec, Québec, Canada
- Respiratory Medicine, Intensive Care and Bronchoscopy Department, European Hospital Georges Pompidou, APHP, Paris, France
| | - Hervé Dutau
- Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France
| | - Georgie Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicolas Guibert
- Interventional Pulmonology Unit, Pulmonology Department, Hospital Larrey, Toulouse, France
| | - Christopher Hergott
- Department of Medicine, Division of Respirology University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - Fabien Maldonado
- Interventional Pulmonology, Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hideo Saka
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
- Department of Respiratory Medicine, Matsunami General Hospital, Gifu, Japan
| | - Marc Fortin
- Department of Pulmonology and Thoracic Surgery, Quebec Heart and Lung Institute, Laval University, Quebec, Québec, Canada
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Gesthalter YB, Channick CL. Interventional Pulmonology: Extending the Breadth of Thoracic Care. Annu Rev Med 2024; 75:263-276. [PMID: 37827195 DOI: 10.1146/annurev-med-050922-060929] [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: 10/14/2023]
Abstract
Interventional pulmonary medicine has developed as a subspecialty focused on the management of patients with complex thoracic disease. Leveraging minimally invasive techniques, interventional pulmonologists diagnose and treat pathologies that previously required more invasive options such as surgery. By mitigating procedural risk, interventional pulmonologists have extended the reach of care to a wider pool of vulnerable patients who require therapy. Endoscopic innovations, including endobronchial ultrasound and robotic and electromagnetic bronchoscopy, have enhanced the ability to perform diagnostic procedures on an ambulatory basis. Therapeutic procedures for patients with symptomatic airway disease, pleural disease, and severe emphysema have provided the ability to palliate symptoms. The combination of medical and procedural expertise has made interventional pulmonologists an integral part of comprehensive care teams for patients with oncologic, airway, and pleural needs. This review surveys key areas in which interventional pulmonologists have impacted the care of thoracic disease through bronchoscopic intervention.
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Affiliation(s)
- Yaron B Gesthalter
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA;
| | - Colleen L Channick
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA;
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Mankidy BJ, Mohammad G, Trinh K, Ayyappan AP, Huang Q, Bujarski S, Jafferji MS, Ghanta R, Hanania AN, Lazarus DR. High risk lung nodule: A multidisciplinary approach to diagnosis and management. Respir Med 2023; 214:107277. [PMID: 37187432 DOI: 10.1016/j.rmed.2023.107277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
Pulmonary nodules are often discovered incidentally during CT scans performed for other reasons. While the vast majority of nodules are benign, a small percentage may represent early-stage lung cancer with the potential for curative treatments. With the growing use of CT for both clinical purposes and lung cancer screening, the number of pulmonary nodules detected is expected to increase substantially. Despite well-established guidelines, many nodules do not receive proper evaluation due to a variety of factors, including inadequate coordination of care and financial and social barriers. To address this quality gap, novel approaches such as multidisciplinary nodule clinics and multidisciplinary boards may be necessary. As pulmonary nodules may indicate early-stage lung cancer, it is crucial to adopt a risk-stratified approach to identify potential lung cancers at an early stage, while minimizing the risk of harm and expense associated with over investigation of low-risk nodules. This article, authored by multiple specialists involved in nodule management, delves into the diagnostic approach to lung nodules. It covers the process of determining whether a patient requires tissue sampling or continued surveillance. Additionally, the article provides an in-depth examination of the various biopsy and therapeutic options available for malignant lung nodules. The article also emphasizes the significance of early detection in reducing lung cancer mortality, especially among high-risk populations. Furthermore, it addresses the creation of a comprehensive lung nodule program, which involves smoking cessation, lung cancer screening, and systematic evaluation and follow-up of both incidental and screen-detected nodules.
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Affiliation(s)
- Babith J Mankidy
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1Baylor Plaza, Houston, TX, 77030, USA.
| | - GhasemiRad Mohammad
- Department of Radiology, Division of Vascular and Interventional Radiology, Baylor College of Medicine, USA.
| | - Kelly Trinh
- Texas Tech University Health Sciences Center, School of Medicine, USA.
| | - Anoop P Ayyappan
- Department of Radiology, Division of Thoracic Radiology, Baylor College of Medicine, USA.
| | - Quillan Huang
- Department of Oncology, Baylor College of Medicine, USA.
| | - Steven Bujarski
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1Baylor Plaza, Houston, TX, 77030, USA.
| | | | - Ravi Ghanta
- Department of Cardiothoracic Surgery, Baylor College of Medicine, USA.
| | | | - Donald R Lazarus
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1Baylor Plaza, Houston, TX, 77030, USA.
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Duke JD, Reisenauer J. Robotic bronchoscopy: potential in diagnosing and treating lung cancer. Expert Rev Respir Med 2023; 17:213-221. [PMID: 36939545 DOI: 10.1080/17476348.2023.2192929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Lung cancer remains the deadliest form of cancer in the world. Screening through low-dose CT scans has shown improved detection of pulmonary nodules; however, with the introduction of robotic bronchoscopy, accessing and biopsying peripheral pulmonary nodules from the airway has expanded. Improved diagnostic yield through enhanced navigation has made robotic bronchoscopy an ideal diagnostic technology for many proceduralists. Studies have demonstrated that robotic bronchoscopes can reach further with improved maneuverability into the distal airways compared to conventional bronchoscopes. AREAS COVERED This review paper highlights the literature on the technological advancements associated with robotic bronchoscopy and the future directions the field of interventional pulmonary may utilize this modality for in the treatment of lung cancer. Referenced articles were included at the discretion of the authors after a database search of the particular technology discussed. EXPERT OPINION As the localization of target lesions continues to improve, robotic platforms that provide reach, stability, and accuracy paves the way for future research in endoluminal treatment for lung cancer. Future studies with intratumoral injection of chemotherapy and immunotherapy and ablation modalities are likely to come in the coming years.
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Affiliation(s)
- Jennifer D Duke
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Janani Reisenauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Rochester, MN, USA
- Division of Thoracic Surgery, Mayo Clinic Rochester, Rochester, MN, USA
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Chan JWY, Siu ICH, Chang ATC, Li MSC, Lau RWH, Mok TSK, Ng CSH. Transbronchial Techniques for Lung Cancer Treatment: Where Are We Now? Cancers (Basel) 2023; 15:cancers15041068. [PMID: 36831411 PMCID: PMC9954491 DOI: 10.3390/cancers15041068] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/29/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
The demand for parenchyma-sparing local therapies for lung cancer is rising owing to an increasing incidence of multifocal lung cancers and patients who are unfit for surgery. With the latest evidence of the efficacy of lung cancer screening, more premalignant or early-stage lung cancers are being discovered and the paradigm has shifted from treatment to prevention. Transbronchial therapy is an important armamentarium in the local treatment of lung cancers, with microwave ablation being the most promising based on early to midterm results. Adjuncts to improve transbronchial ablation efficiency and accuracy include mobile C-arm platforms, software to correct for the CT-to-body divergence, metal-containing nanoparticles, and robotic bronchoscopy. Other forms of energy including steam vapor therapy and pulse electric field are under intensive investigation.
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Affiliation(s)
- Joyce W. Y. Chan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ivan C. H. Siu
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Aliss T. C. Chang
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Molly S. C. Li
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Rainbow W. H. Lau
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tony S. K. Mok
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Calvin S. H. Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
- Correspondence:
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Folch E, Guo Y, Senitko M. Therapeutic Bronchoscopy for Lung Nodules: Where Are We Now? Semin Respir Crit Care Med 2022; 43:480-491. [PMID: 36104025 DOI: 10.1055/s-0042-1749368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Lobar resection has been the established standard of care for peripheral early-stage non-small cell lung cancer (NSCLC). Over the last few years, surgical lung sparing approach (sublobar resection [SLR]) has been compared with lobar resection in T1N0 NSCLC. Three nonsurgical options are available in those patients who have a prohibitive surgical risk, and those who refuse surgery: stereotactic body radiotherapy (SBRT), percutaneous ablation, and bronchoscopic ablation. Local ablation involves placement of a probe into a tumor, and subsequent application of either heat or cold energy, pulsing electrical fields, or placement of radioactive source under an image guidance to create a zone of cell death that encompasses the targeted lesion and an ablation margin. Despite being in their infancy, the bronchoscopic ablative techniques are undergoing rapid research, as they extrapolate a significant knowledge-base from the percutaneous techniques that have been in the radiologist's armamentarium since 2000. Here, we discuss selected endoscopic and percutaneous thermal and non-thermal therapies with the focus on their efficacy and safety.
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Affiliation(s)
- Erik Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yanglin Guo
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michal Senitko
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, Mississippi.,Division of Cardiothoracic Surgery, University of Mississippi Medical Center, Jackson, Mississippi
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11
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Huseini T, Soder SA, Katz A, Mihalik T, Liberman M, Ferraro P, Lafontaine E, Martin J, Nasir BS. Evaluation of deployment capability of a novel outside-the-scope, detachable catheter system for ablation of lung lesions in ex vivo human lung models. JTCVS Tech 2022; 15:147-154. [PMID: 36276677 PMCID: PMC9579722 DOI: 10.1016/j.xjtc.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/02/2022] [Accepted: 07/10/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives Effective transbronchial ablation of lung nodules requires precise catheter delivery to the target lesion and freedom from the bronchoscope for safety throughout the procedure and to allow for multiple catheter insertions. A fully detachable, outside-the-scope (OTS) probe system was developed that attaches to a flexible bronchoscope. Using this system, the operator can deploy the probe in the target and completely detach it from the scope. Our aim was to demonstrate the endobronchial deployment accuracy and feasibility of an OTS, detachable, simulated ablation catheter driven to peripheral lung targets in ex vivo–ventilated human lung models. Methods A balloon catheter inflated with radiopaque contrast was used as a simulated peripheral target in freshly explanted lungs from lung transplant recipients. A simulated ablation catheter was positioned outside and aligned to the tip of the bronchoscope using the OTS system. Under fluoroscopic guidance, the bronchoscope and the catheter were driven toward the target in mechanically ventilated lungs. Once the catheter tip was confirmed within the target, the OTS system was released and the probe was detached from the scope. The bronchoscope was retracted and fluoroscopy was used to confirm the position of the catheter. Results Twelve peripheral targets were simulated. The ablation catheter was successfully deployed with its tip positioned within 5 mm from the target and confirmed stability during multiple cycles of ventilation. Conclusions A novel, detachable, OTS system can be successfully deployed in peripheral lung targets with potential clinical applications for multiple procedures in advanced bronchoscopy where scope freedom is advantageous.
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Cramer P, Pua BB. The Latest on Lung Ablation. Semin Intervent Radiol 2022; 39:285-291. [PMID: 36062233 PMCID: PMC9433157 DOI: 10.1055/s-0042-1753526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Lung cancer is the second most common cancer in both men and women. Despite smoking cessation efforts and advances in lung cancer detection and treatment, long-term survival remains low. For early-stage primary lung carcinoma, surgical resection offers the best chance of long-term survival; however, only about one-third of patients are surgical candidates. For nonsurgical candidates, minimally invasive percutaneous thermal ablation therapies have become recognized as safe and effective treatment alternatives, including radiofrequency ablation, microwave ablation, and cryoablation. Lung ablation is also an acceptable treatment for limited oligometastatic and oligorecurrent diseases. This article discusses the technologies and techniques available for tumor ablation of thoracic malignancies, as well as new treatments on the horizon.
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Affiliation(s)
- Peyton Cramer
- Division of Interventional Radiology, Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Bradley B. Pua
- Division of Interventional Radiology, Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
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13
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Stone E, Leong TL. Contemporary Concise Review 2021: Pulmonary nodules from detection to intervention. Respirology 2022; 27:776-785. [PMID: 35581532 DOI: 10.1111/resp.14296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 12/11/2022]
Abstract
The US Preventive Task Force (USPSTF) has updated screening criteria by expanding age range and reducing smoking history required for eligibility; the International Lung Screen Trial (ILST) data have shown that PLCOM2012 performs better for eligibility than USPSTF criteria. Screening adherence is low (4%-6% of potential eligible candidates in the United States) and depends upon multiple system and patient/candidate-related factors. Smoking cessation in lung cancer improves survival (past prospective trial data, updated meta-analysis data); smoking cessation is an essential component of lung cancer screening. Circulating biomarkers are emerging to optimize screening and early diagnosis. COVID-19 continues to affect lung cancer treatment and screening through delays and disruptions; specific operational challenges need to be met. Over 70% of suspected malignant lesions develop in the periphery of the lungs. Bronchoscopic navigational techniques have been steadily improving to allow greater accuracy with target lesion approximation and therefore diagnostic yield. Fibre-based imaging techniques provide real-time microscopic tumour visualization, with potential diagnostic benefits. With significant advances in peripheral lung cancer localization, bronchoscopically delivered ablative therapies are an emerging field in limited stage primary and oligometastatic disease. In advanced stage lung cancer, small-volume samples acquired through bronchoscopic techniques yield material of sufficient quantity and quality to support clinically relevant biomarker assessment.
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Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tracy L Leong
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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14
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Goizueta AA, Casal RF. Bronchoscopic Lung Nodule Ablation. CURRENT PULMONOLOGY REPORTS 2022. [DOI: 10.1007/s13665-022-00287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Update on Image-Guided Thermal Lung Ablation: Society Guidelines, Therapeutic Alternatives, and Postablation Imaging Findings. AJR Am J Roentgenol 2022; 219:471-485. [PMID: 35319908 DOI: 10.2214/ajr.21.27099] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Percutaneous image-guided thermal ablation (IGTA) has been endorsed by multiple societies as a safe and effective lung-preserving treatment for primary lung cancer and metastases involving the lung and chest wall. This article reviews the role of IGTA in the care continuum of patients with thoracic neoplasms and discusses strategies to identify the optimal local therapy considering patient and tumor characteristics. The advantages and disadvantages of percutaneous thermal ablation compared to surgical resection and stereotactic body radiotherapy are summarized. Principles of radiofrequency ablation, microwave ablation, and cryoablation, as well as the emerging use of transbronchial thermal ablation, are described. Specific considerations are presented regarding the role of thermal ablation for early-stage non-small cell lung cancer (NSCLC), multifocal primary NSCLC, pulmonary metastases, salvage of recurrent NSCLC after surgery or radiation, and pain palliation for tumors involving the chest wall. Recent changes to professional society guidelines regarding the role of thermal ablation in the lung, including for treatment of oligometastatic disease, are highlighted. Finally, recommendations are provided for imaging follow-up after thermal ablation of lung tumors, accompanied by examples of expected postoperative findings and patterns of disease recurrence.
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16
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Xie F, Chen J, Jiang Y, Sun J, Hogarth DK, Herth FJF. Microwave ablation via a flexible catheter for the treatment of nonsurgical peripheral lung cancer: A pilot study. Thorac Cancer 2022; 13:1014-1020. [PMID: 35166043 PMCID: PMC8977152 DOI: 10.1111/1759-7714.14351] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 12/11/2022] Open
Abstract
Background Endobronchial microwave ablation via flexible catheter offers the potential for local therapy for inoperable peripheral lung cancer. The study aimed to evaluate the feasibility and safety of navigation bronchoscopy‐guided water‐cooled microwave ablation catheter for nonsurgical peripheral lung cancer. Methods This was a prospective single arm pilot study. Patients with early stage or multiple primary peripheral lung cancer who were nonsurgical candidates for surgery were enrolled in the study. Bronchoscopic microwave ablation was performed via a flexible water‐cooled microwave ablation antenna under the guidance of navigation bronchoscopy. Radial probe endobronchial ultrasound combined with fluoroscopy was used to confirm the position. Treatment outcomes were evaluated based on follow‐up chest CT and positron emission tomography scans. Primary endpoints were technical success and safety. Secondary endpoints were complete ablation rate, 2‐year local control rate, and progression‐free survival. Results Thirteen patients were enrolled in the study from April 2018 to July 2019. A total of 19 sessions of microwave ablation were performed on 14 tumors under the guidance of navigation bronchoscopy. The technical success was 100%. Treatment‐related complications occurred in two patients. The complete ablation rate was 78.6% (11/14). The 2‐year local control rate was 71.4%. Median progression‐free survival was 33 months for all patients. Conclusions In this pilot study, bronchoscopic microwave ablation appears to be feasible with acceptable occurrence of complication in the treatment of peripheral lung cancer under the guidance of navigation bronchoscopy.
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Affiliation(s)
- Fangfang Xie
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Junxiang Chen
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Yifeng Jiang
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - D Kyle Hogarth
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
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17
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Development of Radiofrequency Ablation Generator and Balloon-Based Catheter for Microendoluminal Thin-Layer Ablation Therapy Using the Rat Duodenum as a Model of Low-Impedance Tissue. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9986874. [PMID: 34603652 PMCID: PMC8486529 DOI: 10.1155/2021/9986874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 12/03/2022]
Abstract
Radiofrequency ablation (RFA) is a routinely used, safe, and effective method for the tissue destruction. Often, in case of its application in malignant conditions, the extent of tissue destruction is insufficient due to the size of the target lesion, as well as due to the risk of heat-induced damage to the surrounding organs. Nevertheless, there are conditions requiring superficial precise-depth ablation with preservation of deeper layers. These are represented, for example, by mucosal resurfacing in case of Barrett's esophagus or treatment of recurrent mucosal bleeding in case of chronic radiation proctitis. Recently, new indications for intraluminal RFA use emerged, especially in the pancreatobiliary tract. In the case of intraductal use of RFA (e.g., biliary and pancreatic tract), there are currently available rigid and needle tip catheters. An expandable balloon-based RFA catheter suitable for use in such small-diameter tubular organs could be of benefit due to possible increase of contact between the probe and the target tissue; however, to prevent excessive tissue damage, a compatible generator suitable for low-impedance catheter/tissue is essential. This project aimed to develop a radiofrequency ablation generator and bipolar balloon-based catheter optimized for the application in the conditions of low-impedance tissue and (micro)endoluminal environment. Subsequent evaluation of biological effect in vivo was performed using duodenal mucosa in Wistar rat representing conditions of endoluminal radiofrequency ablation of low-impedance tissue. Experiments confirming the safety and feasibility of RFA with our prototype devices were conducted.
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18
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Kramer T, Annema JT. Advanced bronchoscopic techniques for the diagnosis and treatment of peripheral lung cancer. Lung Cancer 2021; 161:152-162. [PMID: 34600406 DOI: 10.1016/j.lungcan.2021.09.015] [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] [Received: 06/24/2021] [Revised: 09/12/2021] [Accepted: 09/18/2021] [Indexed: 12/14/2022]
Abstract
Lung cancer is the leading cause of cancer related deaths worldwide. As a result of the increasing use of chest CT scans and lung cancer screening initiatives, there is a rapidly increasing need for lung lesion analysis and - in case of confirmed cancer - treatment. A desirable future concept is the one-stop outpatient bronchoscopic approach including navigation to the tumor, malignancy confirmation and immediate treatment. Several novel bronchoscopic diagnostic and treatment concepts are currently under evaluation contributing to this concept. As the majority of suspected malignant lung lesions develop in the periphery of the lungs, improved bronchoscopic navigation to the target lesion is of key importance. Fortunately, the field of interventional pulmonology is evolving rapidly and several advanced bronchoscopic navigation techniques are clinically available, allowing an increasingly accurate tissue diagnosis of peripheral lung lesions. Additionally, multiple bronchoscopic treatment modalities are currently under investigation. This review will provide a concise overview of advanced bronchoscopic techniques to diagnose and treat peripheral lung cancer by describing their working mechanisms, strengths and weaknesses, identifying knowledge gaps and indicating future developments. The desired one-step concept of bronchoscopic 'diagnose and treat' peripheral lung cancer is on the horizon.
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Affiliation(s)
- Tess Kramer
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jouke T Annema
- Department of Respiratory Medicine, Amsterdam UMC, Amsterdam, The Netherlands.
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19
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Wang Y, Chen E. Interventional bronchoscopic treatment of lung cancer. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2021. [DOI: 10.1016/j.lers.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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20
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Zheng X, Yuan H, Gu C, Yang C, Xie F, Zhang X, Xu B, Sun J. Transbronchial lung parenchyma cryoablation with a novel flexible cryoprobe in an in vivo porcine model. Diagn Interv Imaging 2021; 103:49-57. [PMID: 34593335 DOI: 10.1016/j.diii.2021.08.005] [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] [Received: 07/28/2021] [Revised: 08/16/2021] [Accepted: 08/31/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the feasibility and safety of transbronchial cryoablation with a novel flexible cryoprobe using nitrogen as the refrigerant in an in vivo porcine model of lung parenchyma. MATERIALS AND METHODS A novel flexible cryoprobe using nitrogen as the refrigerant was used for transbronchial cryoablation of lung parenchyma in six normal female pigs. The cryoprobe was delivered to the distal bronchus in the bilateral porcine lungs via the bronchoscopic working channel under virtual bronchoscopy guidance. The position was confirmed with real-time computed tomography (CT). The whole procedure included two freeze-thaw cycles (15 min and 2 min, respectively). CT images were obtained during cryoablation and at 24 h, one week, two weeks and four weeks after the treatment to assess the effectiveness and safety of the procedure. Ablation zone tissue samples were obtained at 24 h and four weeks after the cryoablation for further histopathological analysis. RESULTS All ablation procedures (12/12; 100%) were performed successfully. No major complications occurred during the procedure or the observation period. The ablation zones were clearly depicted on CT with a maximal ablation zone volume at 24 h (21.88 ± 12.61 [SD] cm3) compared to 3.64 ± 2.06 (SD) cm3 and 10.73 ± 3.84 (SD) cm3 at the end of the 1st and 2nd freeze-thaw cycles, respectively (P < 0.001). Histopathological analysis revealed that a coagulative necrotic zone was formed along the target bronchus, with obvious vascular occlusion and hemorrhage 24 h after treatment. The lesions gradually formed fibrosis after four weeks. CONCLUSION The novel flexible bronchoscopy-guided cryoablation is a feasible, safe and effective modality in an in vivo porcine model of peripheral normal lung parenchyma, suggesting potential capabilities for the treatment of peripheral lung cancer in humans.
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Affiliation(s)
- Xiaoxuan Zheng
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Haibin Yuan
- Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China
| | - Chuanjia Gu
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Chi Yang
- Research and Development Department, AccuTarget MediPharma (Shanghai) Co., Ltd., 201318 Shanghai, China; School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, 200093 Shanghai, China
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Xueyan Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China
| | - Binkai Xu
- Research and Development Department, AccuTarget MediPharma (Shanghai) Co., Ltd., 201318 Shanghai, China; School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, 200093 Shanghai, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China.
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21
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[Expert Consensus on Technical Specifications of Domestic Electromagnetic Navigation Bronchoscopy System in Diagnosis, Localization and Treatment (2021 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:529-537. [PMID: 34412766 PMCID: PMC8387647 DOI: 10.3779/j.issn.1009-3419.2021.101.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Electromagnetic navigation bronchoscopy (ENB) is a novel type of bronchoscopy based on electromagnetic positioning technique combined with virtual bronchoscopy, three-dimensional computed tomography (CT) imaging and respiratory gating technique, which has been widely applied in clinic practice. In recent years, the domestic electromagnetic navigation system has also been developed rapidly, and its effectiveness and safety in the diagnosis, localization, and treatment of peripheral pulmonary lesions have been initially verified. In order to optimize and standardize the technical specifications of domestic ENB and guide its application in clinical practice, the consensus statement has been organized and written in a collaborative effort by the Professional Committee on Respiratory Equipment Technology of Chinese Medical Equipment Association and the Expert Group on Technical of Domestic Electromagnetic Navigation Bronchoscopy.
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22
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Zhong CH, Fan MY, Xu H, Jin RG, Chen Y, Chen XB, Tang CL, Su ZQ, Li SY. Feasibility and Safety of Radiofrequency Ablation Guided by Bronchoscopic Transparenchymal Nodule Access in Canines. Respiration 2021; 100:1097-1104. [PMID: 34412056 DOI: 10.1159/000516506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The treatment of pulmonary malignancies remains a challenge. The efficacy and safety of bronchoscopic radiofrequency ablation (RFA) for the treatment of lung cancer are not well elucidated. OBJECTIVE This study aimed to evaluate the feasibility and safety of RFA guided by bronchoscopic transparenchymal nodule access (BTPNA) in vivo. METHODS In an attempt to determine the parameters of RFA, we first performed RFA in conjunction with automatic saline microperfusion in the lung in vitro with various ablation energy (10, 15, 20, 25, and 30 W) and ablation times (3, 5, 8, and 10 min). The correlation between ablated area and RFA parameter was recorded and analyzed. Further, we conducted a canine study with RFA by BTPNA in vivo, observing the ablation effect and morphological changes in the lung assessed by chest CT and histopathologic examination at various follow-up time points (1 day, n = 3; 30 days, n = 4; 90 days, n = 4). The related complications were also observed and recorded. RESULTS More ablation energy, but not ablation time, induced a greater range of ablation area in the lung. Ablation energy applied with 15 W for 3 min served as the appropriate setting for pulmonary lesions ≤1 cm. RFA guided by BTPNA was performed in 11 canines with 100% success rate. Inflammation, congestion, and coagulation necrosis were observed after ablation, which could be repaired within 7 days; subsequently, granulation and fibrotic scar tissue developed after 30 days. No procedure-related complication occurred during the operation or in the follow-up periods. CONCLUSION The novel RFA system and catheter in conjunction with automatic saline microperfusion present a safe and feasible modality in pulmonary parenchyma. RFA guided by BTPNA appears to be well established with an acceptable tolerance; it might further provide therapeutic benefit in pulmonary malignancies.
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Affiliation(s)
- Chang-Hao Zhong
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ming-Yue Fan
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hong Xu
- Broncus Municipal High-tech Enterprises Research and Development Center of Minimally Invasive Interventional Diagnostic Devices for Lung Diseases, Hangzhou, China
| | - Rong-Guang Jin
- Broncus Municipal High-tech Enterprises Research and Development Center of Minimally Invasive Interventional Diagnostic Devices for Lung Diseases, Hangzhou, China
| | - Yu Chen
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiao-Bo Chen
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chun-Li Tang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhu-Quan Su
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shi-Yue Li
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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23
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Olive G, Yung R, Marshall H, Fong KM. Alternative methods for local ablation-interventional pulmonology: a narrative review. Transl Lung Cancer Res 2021; 10:3432-3445. [PMID: 34430378 PMCID: PMC8350102 DOI: 10.21037/tlcr-20-1185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/22/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To discuss and summarise the background and recent advances in the approach to bronchoscopic ablative therapies for lung cancer, focusing on focal parenchymal lesions. BACKGROUND This series focusses on the challenges highlighted by increasing recognition of the prognostically more favourable oligometastatic disease rather than the more frequent, but prognostically poor, high tumour burden metastatic disease. While surgery, stereotactic body radiation therapy (SBRT), and trans-thoracic percutaneous ablative techniques such as microwave (MWA) and radiofrequency ablation (RFA) are well recognised options for selected cases of pulmonary oligometastasis, bronchoscopic approaches to pulmonary tumour ablation are becoming realistic alternatives. An underlying tenet driving research and implementation in this domain is that percutaneous ablative techniques are obliged to traverse the pleura leading to a high rate of pneumothorax, and risks also goes up for peri-vascular lesions. Historically low yield bronchoscopic targeting of isolated peripheral tumors have significantly improved by incorporating multi-modality high resolution imaging and processing, including navigation planning and real-time image guidances (ultrasound, electromagnetic navigation, cone-beam CT). Combining advanced image guidance with ablative technology adaptations for bronchoscopic delivery opens up the options for high dose local ablative therapies that may reduce transthoracic complications and provide palliative to curative options for limited stage primary and oligometastatic diseases. METHODS We conduct a narrative review of the literature summarizing the history of bronchoscopic tumor ablation approaches, technical details including biologic rational for their uses, and current evidence for each modality, as well as investigations into future applications. Because of the relative paucity of prospective studies, we have been very inclusive in our inclusion of experiences from the published clinical databases. CONCLUSIONS Whilst surgical resection and SBRT remain the current mainstay of curative therapies for peripheral cancers, in the foreseeable future, developments and further research will see bronchoscopic ablative therapies become viable lung sparing alternatives in those deemed suitable. The future is bright.
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Affiliation(s)
- Gerard Olive
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
- University of Queensland Thoracic Research Centre, Queensland, Australia
| | - Rex Yung
- Chief Medical Officer – IONIQ (ProLung) Inc., Salt Lake City, UT, USA
| | - Henry Marshall
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
- University of Queensland Thoracic Research Centre, Queensland, Australia
| | - Kwun M. Fong
- Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
- University of Queensland Thoracic Research Centre, Queensland, Australia
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Rangamuwa K, Leong T, Weeden C, Asselin-Labat ML, Bozinovski S, Christie M, John T, Antippa P, Irving L, Steinfort D. Thermal ablation in non-small cell lung cancer: a review of treatment modalities and the evidence for combination with immune checkpoint inhibitors. Transl Lung Cancer Res 2021; 10:2842-2857. [PMID: 34295682 PMCID: PMC8264311 DOI: 10.21037/tlcr-20-1075] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022]
Abstract
Lung cancer is the leading cause of cancer death worldwide, with approximately 1.6 million cancer related deaths each year. Prognosis is best in patients with early stage disease, though even then five-year survival is only 55% in some groups. Median survival for advanced non-small cell lung cancer (NSCLC) is 8–12 months with conventional treatment. Immune checkpoint inhibitor (ICI) therapy has revolutionised the treatment of NSCLC with significant long-term improvements in survival demonstrated in some patients with advanced NSCLC. However, only a small proportion of patients respond to ICI, suggesting the need for further techniques to harness the potential of ICI therapy. Thermal ablation utilizes the extremes of temperature to cause tumour destruction. Commonly used modalities are radiofrequency ablation (RFA), cryoablation and microwave ablation (MWA). At present thermal ablation is reserved for curative-intent therapy in patients with localized NSCLC who are unable to undergo surgical resection or stereotactic ablative body radiotherapy (SABR). Limited evidence suggests that thermal ablative modalities can upregulate an anticancer immune response in NSCLC. It is postulated that thermal ablation can increase tumour antigen release, which would initiate and upregulated steps in the cancer immunity cycle required to elicit an anticancer immune response. This article will review the current thermal ablative techniques and their ability to modulate an anti-cancer immune response with a view of using thermal ablation in conjunction with ICI therapy.
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Affiliation(s)
- Kanishka Rangamuwa
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine (RMH), University of Melbourne, Parkville, Australia
| | - Tracy Leong
- Department of Respiratory Medicine, Austin Hospital, Heidelberg, Victoria, Australia
| | - Clare Weeden
- Personalised Oncology Division, Walter Eliza Hall institute, Melbourne, Australia
| | | | - Steven Bozinovski
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Michael Christie
- Department of Pathology, Royal Melbourne Hospital, Melbourne, Australia
| | - Tom John
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Phillip Antippa
- Department of Thoracic Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Daniel Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine (RMH), University of Melbourne, Parkville, Australia
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25
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Chan JWY, Lau RWH, Ngai JCL, Tsoi C, Chu CM, Mok TSK, Ng CSH. Transbronchial microwave ablation of lung nodules with electromagnetic navigation bronchoscopy guidance-a novel technique and initial experience with 30 cases. Transl Lung Cancer Res 2021; 10:1608-1622. [PMID: 34012778 PMCID: PMC8107744 DOI: 10.21037/tlcr-20-1231] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Microwave ablation of lung nodules may provide a faster, larger and more predictable ablation zone than other energy sources, while bronchoscopic transbronchial ablation has theoretical advantage of fewer pleural-based complications than percutaneous approach. Our study aims to determine whether the novel combination of bronchoscopic approach and microwave ablation in management of lung nodules is technically feasible, safe and effective. Methods This is a retrospective analysis of a single center experience in electromagnetic navigation bronchoscopy microwave ablation in hybrid operating room. Patients had high surgical risks while lung nodules were either proven malignant or radiologically suspicious. Primary endpoints include technical feasibility and safety. Results Total of 30 lung nodules from 25 patients were treated. Mean nodule size was 15.1 mm, and bronchus directly leads to the nodules (bronchus sign positive) in only half of them. Technical success rate was 100%, although some nodules required double ablation for adequate coverage. Mean minimal ablation margin was 5.51 mm. The mean actual ablation zone volume was -21.4% compared to predicted, likely due to significant tissue contraction ranging from 0-43%. There was no significant heat sink effect. Mean hospital stay was 1.73 days, and only 1 patient stayed for more than 3 days. Complications included pain (13.3%), pneumothorax requiring drainage (6.67%), post-ablation reaction (6.67%), pleural effusion (3.33%) and hemoptysis (3.33%). After median follow up of 12 months, none of the nodules had evidence of progression. Conclusions Bronchoscopic transbronchial microwave ablation is safe and feasible for treatment of malignant lung nodules. Prospective study on clinical application of this novel technique is warranted.
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Affiliation(s)
- Joyce W Y Chan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Jenny C L Ngai
- Department of Medicine and Therapeutics, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Carita Tsoi
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Cheuk Man Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Tony S K Mok
- State Key Laboratory of Translational Oncology, Department of Clinical Oncology, 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
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26
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Agrawal A. Interventional Pulmonology: Diagnostic and Therapeutic Advances in Bronchoscopy. Am J Ther 2021; 28:e204-e216. [PMID: 33590989 DOI: 10.1097/mjt.0000000000001344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interventional pulmonology is a rapidly evolving subspecialty of pulmonary medicine that offers advanced consultative and procedural services to patients with airway diseases, pleural diseases, as well as in the diagnosis and management of patients with thoracic malignancy. AREAS OF UNCERTAINTY The institution of lung cancer screening modalities as well as the search of additional minimally invasive diagnostic and treatment modalities for lung cancer and other chronic lung diseases has led to an increased focus on the field of interventional pulmonology. Rapid advancements in the field over the last 2 decades has led to development of various new minimally invasive bronchoscopic approaches and techniques for patients with cancer as well as for patients with chronic lung diseases. DATA SOURCES A review of literature was performed using PubMed database to identify all articles published up till October 2020 relevant to the field of interventional pulmonology and bronchoscopy. The reference list of each article was searched to look for additional articles, and all relevant articles were included in the article. THERAPEUTIC ADVANCES Newer technologies are now available such navigation platforms to diagnose and possibly treat peripheral pulmonary nodules, endobronchial ultrasound in diagnosis of mediastinal and hilar adenopathy as well as cryobiopsy in the diagnosis of diffuse lung diseases. In addition, flexible and rigid bronchoscopy continues to provide new and expanding ability to manage patients with benign and malignant central airway obstruction. Interventions are also available for diseases such as asthma, chronic bronchitis, chronic obstructive pulmonary disease, and emphysema that were traditionally treated with medical management alone. CONCLUSIONS With continued high quality research and an increasing body of evidence, interventional bronchoscopy has enormous potential to provide both safe and effective options for patients with a variety of lung diseases.
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Affiliation(s)
- Abhinav Agrawal
- Division of Pulmonary, Critical Care & Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
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Kalsi HS, Thakrar R, Gosling AF, Shaefi S, Navani N. Interventional Pulmonology: A Brave New World. Thorac Surg Clin 2020; 30:321-338. [PMID: 32593365 DOI: 10.1016/j.thorsurg.2020.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Interventional pulmonology is a dynamic and evolving field in respiratory medicine. Advances have improved the ability to diagnose and manage diseases of the airways. A shift toward early detection of malignant disease has generated a focus on innovative diagnostic techniques. With patient populations living longer with malignant and benign diseases, the role for interventional bronchoscopy has grown. In cancer groups, novel immunotherapies have improved the prospects of clinical outcomes and reignited a focus on optimizing patient performance status to enable access to anticancer therapy. This review discusses current and emerging diagnostic modalities and therapeutic approaches available to manage airway diseases.
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Affiliation(s)
- Hardeep S Kalsi
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK
| | - Ricky Thakrar
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK
| | - Andre F Gosling
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA, USA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA, USA
| | - Neal Navani
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK.
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Kniese CM, Musani AI. Bronchoscopic treatment of inoperable nonsmall cell lung cancer. Eur Respir Rev 2020; 29:29/158/200035. [PMID: 33153988 DOI: 10.1183/16000617.0035-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/24/2020] [Indexed: 11/05/2022] Open
Abstract
Patients with unresectable lung cancer range from those with early-stage or pre-invasive disease with comorbidities that preclude surgery to those with advanced stage disease in whom surgery is contraindicated. In such cases, a multidisciplinary approach to treatment is warranted, and may involve medical specialties including medical oncology, radiation oncology and interventional pulmonology. In this article we review bronchoscopic approaches to surgically unresectable lung cancer, including photodynamic therapy, brachytherapy, endoscopic ablation techniques and airway stenting. Current and past literature is reviewed to provide an overview of the topic, including a highlight of potential emerging approaches.
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Affiliation(s)
- Christopher M Kniese
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ali I Musani
- Division of Pulmonary Sciences and Critical Care, University of Colorado School of Medicine, Aurora, CO, USA
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29
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Mohtashami Y, Behdad N, Hagness SC. Ex Vivo Performance of a Flexible Microwave Ablation Antenna. IEEE Trans Biomed Eng 2020; 68:1680-1689. [PMID: 33125323 DOI: 10.1109/tbme.2020.3033986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In this study, we investigate the performance of a flexible microwave ablation antenna for generating localized ablation zones. METHODS We designed a helical dipole antenna to operate at 1.9 GHz in egg white and liver. Semi-rigid prototypes of the antenna were fabricated and used to perform ablation experiments in egg white and perfused liver. Pulsed and continuous-wave power deliveries at different power levels were used. Flexible prototypes of the antenna were fabricated and used to perform ex vivo ablation experiments in perfused liver. RESULTS Pulsing was effective in reducing the shaft heating of semi-rigid cables. The antenna was capable of producing substantial ablation zones in perfused liver. Typical diameters (perpendicular to the antenna axis) of generated ablation zones with semi-rigid antennas in egg white and perfused liver were 30 mm and 20 mm, respectively. The flexible antenna had a good impedance match while bent. Average diameter of generated ablation zones by the flexible antenna with 10-W continuous-wave experiments in perfused liver was 26 mm. No significant difference was observed between the performances of semi-rigid and flexible prototypes. CONCLUSION The flexible helical dipole antenna is capable of maintaining its good impedance match while bent and can generate substantial ablation zones in presence of perfusion. SIGNIFICANCE The proposed flexible antenna is promising for minimally invasive treatment of tumors that are otherwise inaccessible by rigid antennas. One example is lung where a catheter-based deployment of the flexible antenna into the tumor via airways may substantially reduce risks associated with using rigid antennas.
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30
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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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Criner GJ, Eberhardt R, Fernandez-Bussy S, Gompelmann D, Maldonado F, Patel N, Shah PL, Slebos DJ, Valipour A, Wahidi MM, Weir M, Herth FJ. Interventional Bronchoscopy. Am J Respir Crit Care Med 2020; 202:29-50. [PMID: 32023078 DOI: 10.1164/rccm.201907-1292so] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
For over 150 years, bronchoscopy, especially flexible bronchoscopy, has been a mainstay for airway inspection, the diagnosis of airway lesions, therapeutic aspiration of airway secretions, and transbronchial biopsy to diagnose parenchymal lung disorders. Its utility for the diagnosis of peripheral pulmonary nodules and therapeutic treatments besides aspiration of airway secretions, however, has been limited. Challenges to the wider use of flexible bronchoscopy have included difficulty in navigating to the lung periphery, the avoidance of vasculature structures when performing diagnostic biopsies, and the ability to biopsy a lesion under direct visualization. The last 10-15 years have seen major advances in thoracic imaging, navigational platforms to direct the bronchoscopist to lung lesions, and the ability to visualize lesions during biopsy. Moreover, multiple new techniques have either become recently available or are currently being investigated to treat a broad range of airway and lung parenchymal diseases, such as asthma, emphysema, and chronic bronchitis, or to alleviate recurrent exacerbations. New bronchoscopic therapies are also being investigated to not only diagnose, but possibly treat, malignant peripheral lung nodules. As a result, flexible bronchoscopy is now able to provide a new and expanding armamentarium of diagnostic and therapeutic tools to treat patients with a variety of lung diseases. This State-of-the-Art review succinctly reviews these techniques and provides clinicians an organized approach to their role in the diagnosis and treatment of a range of lung diseases.
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Affiliation(s)
- Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Ralf Eberhardt
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | | | - Daniela Gompelmann
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Fabien Maldonado
- Department of Medicine and Department of Thoracic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Neal Patel
- Division of Pulmonary Medicine, Mayo Clinic, Jacksonville, Florida
| | - Pallav L Shah
- Respiratory Medicine at the Royal Brompton Hospital and National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Krankenhaus Nord, Vienna, Austria; and
| | - Momen M Wahidi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Mark Weir
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Felix J Herth
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
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32
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Pritchett MA, Schirmer CC, Laeseke P. Melting the tip of the iceberg: bronchoscopic-guided transbronchial microwave ablation. Transl Lung Cancer Res 2020; 9:960-963. [PMID: 32953475 PMCID: PMC7481599 DOI: 10.21037/tlcr.2020.04.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Michael A Pritchett
- Department of Pulmonary Medicine, FirstHealth of the Carolinas & Pinehurst Medical Clinic, Pinehurst, NC, USA
| | - Charles C Schirmer
- Department of Pathology, FirstHealth of the Carolinas, Pinehurst, NC, USA
| | - Paul Laeseke
- Department of Radiology, University of Wisconsin, Madison, WI, USA
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Steinfort DP, Herth FJF. Bronchoscopic treatments for early-stage peripheral lung cancer: Are we ready for prime time? Respirology 2020; 25:944-952. [PMID: 32643221 DOI: 10.1111/resp.13903] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/29/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
Lung cancer is the leading cause of cancer-related death worldwide and surgical lobectomy remains the preferred therapy for patients with early-stage NSCLC. Medical comorbidities and advanced age preclude resection in many patients and minimally invasive ablative therapies are needed for treatment. Stereotactic ablative radiation is established as an effective modality in this patient group, although may be contraindicated in some patients with prior radiation exposure, comorbidities or centrally positioned tumours. Percutaneous ablative methods are available, although are frequently associated with significant complications. Numerous endoscopic ablative techniques are under evaluation. With a more favourable safety profile and the ability to provide diagnosis and staging information potentially within a single procedure, there is a strong rationale for development of bronchoscopic ablative modalities. In the following article, the authors aim to explore the role bronchoscopic ablation may play in treatment of peripheral lung tumours, and to describe a pathway to establishing these modalities as part of routine care. The current status of several bronchoscopic ablative options is discussed in detail.
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Affiliation(s)
- Daniel P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRCH), German Center for Lung Research, Heidelberg, Germany
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34
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Agrawal A, Hogarth DK, Murgu S. Robotic bronchoscopy for pulmonary lesions: a review of existing technologies and clinical data. J Thorac Dis 2020; 12:3279-3286. [PMID: 32642251 PMCID: PMC7330790 DOI: 10.21037/jtd.2020.03.35] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Bronchoscopic interventions are preferred for sampling suspicious pulmonary lesions as they have lower complications and can achieve diagnosis and staging in one single procedure. Limitations in existing guided bronchoscopy platforms has led to developments in robotic assisted technologies. These devices may allow the bronchoscopist to more precisely maneuver the scope and instruments into the periphery of the lungs under direct visualization while also ensuring stability during sampling of the target lesions. These devices have the potential to improve the diagnostic yield in sampling peripheral lung lesions and may play a role in the treatment of non-operable or oligometastatic peripheral tumors using bronchoscopic ablative therapies. In this article, we review the existing robotic bronchoscopy technologies and summarize the available pre-clinical and clinical data supporting their use.
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Affiliation(s)
- Abhinav Agrawal
- Interventional Pulmonology, Section of Pulmonary & Critical Care Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - D Kyle Hogarth
- Interventional Pulmonology, Section of Pulmonary & Critical Care Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Septimiu Murgu
- Interventional Pulmonology, Section of Pulmonary & Critical Care Medicine, University of Chicago Medicine, Chicago, IL, USA
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35
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Usuda J, Inoue T, Tsuchida T, Ohtani K, Maehara S, Ikeda N, Ohsaki Y, Sasaki T, Oka K. Clinical trial of photodynamic therapy for peripheral-type lung cancers using a new laser device in a pilot study. Photodiagnosis Photodyn Ther 2020; 30:101698. [PMID: 32198020 DOI: 10.1016/j.pdpdt.2020.101698] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/11/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION/AIM Photodynamic therapy (PDT) involves the use of a tumor-specific photosensitizer and laser irradiation, and is one of the treatment options recommended for early centrally located lung cancers, but not yet for peripheral-type lung cancers. We developed a new laser probe, the composite-type optical fiberscope (COF), which allows accurate laser irradiation of a cancer lesion with simultaneous visualization of the lesion. In this study, we attempted a new endobronchial PDT technique using the new laser probe, and evaluated the effectiveness and feasibility of this novel PDT technique for peripheral lung cancers. METHODS This phase I study was conducted in 7 patients with peripheral lung cancers (primary tumor ≤20 mm in diameter). We performed endobronchial PDT for these patients using the new laser probe and talaporfin sodium as the photosensitizer. RESULTS We performed PDT for 3 patients with peripheral lung cancer using a laser dose of 50 J/cm2 at 120 mW, and confirmed the feasibility of using this dose. Then, we escalated the laser dose to 100 J/cm2 in 4 additional patients. A total of 7 patients met our inclusion criteria. Evaluation at 2 weeks and 3 months after the PDT revealed no complication such as pneumonia or pneumothorax. At the evaluation conducted 6 months later, we found CR in 3 cases and SD in the remaining 4 cases. CONCLUSION PDT was found to be a feasible and non-invasive treatment modality for early peripheral-type lung cancer. In the future, PDT could become a standard treatment option for peripheral-type lung cancer.
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Affiliation(s)
- Jitsuo Usuda
- Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan.
| | - Tatsuya Inoue
- Department of Thoracic Surgery, Nippon Medical School, Tokyo, Japan
| | - Takaaki Tsuchida
- Department of Respiratory Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | - Keishi Ohtani
- Department of Thoracic Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Sachio Maehara
- Department of Thoracic Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Thoracic Surgery, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yoshinobu Ohsaki
- Respiratory Center, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Takaaki Sasaki
- Respiratory Center, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Kiyoshi Oka
- Kansai Photon Science Institute, National Institutes for Quantum and Radiological Science and Technology, Kyoto, Japan
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Seder CW. Commentary: Has the Time Finally Arrived for Radiofrequency Ablation to Enter the Game? Semin Thorac Cardiovasc Surg 2020; 32:580-581. [PMID: 32114109 DOI: 10.1053/j.semtcvs.2020.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/21/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Illinois.
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Motooka Y, Fujino K, Gregor A, Bernards N, Chan H, Inage T, Ujiie H, Kato T, Kinoshita T, Ishiwata T, Suzuki M, Yasufuku K. Endobronchial Ultrasound-Guided Radiofrequency Ablation of Lung Tumors and Mediastinal Lymph Nodes: A Preclinical Study in Animal Lung Tumor and Mediastinal Adenopathy Models. Semin Thorac Cardiovasc Surg 2020; 32:570-578. [PMID: 32057971 DOI: 10.1053/j.semtcvs.2020.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/04/2020] [Indexed: 12/19/2022]
Abstract
Radiofrequency ablation (RFA) can be a therapeutic option in medically inoperable lung cancer patients. In this study, we evaluated a prototype bipolar RFA device applicator that can be deployed from a standard endobronchial ultrasound (EBUS) bronchoscope to determine feasibility and histopathological analysis in animal models. Rabbit lung cancers were created by transbronchial injection of VX2 rabbit cancer cells. Once the tumors were developed, they were ablated transpleurally, under EBUS guidance using the prototype RFA device. The animals were then sacrificed for specimen resection. Pig inflammatory lung pseudo-tumors and lymphadenopathy were created by transbronchial injection of a talc paste and ablated transbronchially under EBUS guidance. Pigs were evaluated at 5 days, 2 weeks, and 4 weeks following ablation by bronchoscopy and cone beam computed tomography before necropsy. Nicotinamide adenine dinucleotide hydrogen diaphorase staining was employed to measure the ablation area. Twenty-four VX2 rabbit tumors were ablated. The total ablated area ranged from 0.6 to 3.0 cm2 (mean: 1.8 cm2), corresponding to a total energy range of 1 to 6 kJ. Six pig lung pseudo-tumors and 5 mediastinal lymph nodes were ablated. Adjacent airway ulceration was observed in 3 ablations of lymph nodes. These airway complications resolved within 4 weeks of RFA without any treatment. There was no hemoptysis, air embolism, respiratory distress, or other serious complication noted. In these 2 animal models, we provide evidence that EBUS-guided bipolar RFA is feasible and histopathology shows that can ablate lung tumors and mediastinal lymph nodes under real-time ultrasound guidance.
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Affiliation(s)
- Yamato Motooka
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Kosuke Fujino
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Alexander Gregor
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Nicholas Bernards
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Harley Chan
- TECHNA Institute for the Advancement of Technology for Health, University Health Network, Toronto, Ontario, Canada
| | - Terunaga Inage
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tatsuya Kato
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tomonari Kinoshita
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tsukasa Ishiwata
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Makoto Suzuki
- Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; TECHNA Institute for the Advancement of Technology for Health, University Health Network, Toronto, Ontario, Canada
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Aboudara M, Rickman O, Maldonado F. Therapeutic Bronchoscopic Techniques Available to the Pulmonologist: Emerging Therapies in the Treatment of Peripheral Lung Lesions and Endobronchial Tumors. Clin Chest Med 2020; 41:145-160. [PMID: 32008626 DOI: 10.1016/j.ccm.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Therapeutic bronchoscopy for both endobronchial tumors and peripheral lung cancer is rapidly evolving. The expected increase in early stage lung cancer detection and significant improvement in near real-time imaging for diagnostic bronchoscopy has led to the development of bronchoscopy-delivered ablative technologies. Therapies targeting obstructing central airway tumors for palliation and as a method of local disease control, patient selection and patient-centered outcomes have been areas of ongoing research. This review focuses on patient selection when considering therapeutic bronchoscopy and new and developing technologies for endobronchial tumors and reviews the status of bronchoscopy-delivered ablative tools for peripheral lung cancers.
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Affiliation(s)
- Matt Aboudara
- Division of Pulmonary and Critical Care, St. Luke's Health System, 4321 Washington Street, Suite 6000, Kansas City, MO 64111, USA
| | - Otis Rickman
- Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, 1161 21st Avenue South, T-1218 Medical Center North, Nashville, TN 37232, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, 1161 21st Avenue South, T-1218 Medical Center North, Nashville, TN 37232, USA.
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39
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Yuan HB, Wang XY, Sun JY, Xie FF, Zheng XX, Tao GY, Pan L, Hogarth DK. Flexible bronchoscopy-guided microwave ablation in peripheral porcine lung: a new minimally-invasive ablation. Transl Lung Cancer Res 2019; 8:787-796. [PMID: 32010557 DOI: 10.21037/tlcr.2019.10.12] [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: 01/18/2023]
Abstract
Background Transbronchial lung biopsy is an important approach to diagnose peripheral lung cancer, but bronchoscopy based treatment options are limited and poorly studied. A flexible bronchoscopy-guided water-cooled microwave ablation (MWA) catheter was developed to evaluate the feasibility and safety both in ex vivo and in vivo porcine models. Methods Using direct penetration of the catheter through the surface of ex vivo porcine lung, ablations (n=9) were performed at 70, 80, 90 W for 10 minutes. Temperatures of the catheter and 10, 15, 20 mm away from the tip were measured. Under bronchoscopy conditions in porcine lung, ablations (n=18, 6 in ex vivo and 12 in vivo) were performed at 80 W for 5 minutes. Computed tomography (CT) was acquired perioperative, 24 hours, 2 weeks, and 4 weeks post ablation. Ablation zones were excised at 24 hours and 4 weeks respectively. Long-axis diameter (Dl) and short-axis diameter (Ds) were measured and tissues were sectioned for pathological examination. Results In-ex vivo lung, the temperature at 20 mm removed was over 60 °C at 80 W for 288±26 seconds. The ablations under bronchoscopic conditions were successful in-ex vivo and in vivo lung. No complications occurred during the procedures. Coagulation necrosis was visible at 24 hours, and repaired fibrous tissue was seen at 4 weeks. Conclusions The flexible bronchoscopy-guided water-cooled MWA is feasible and safe. This early animal data holds promise of MWA becoming a potential therapeutic tool for Peripheral Lung Cancers.
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Affiliation(s)
- Hai-Bin Yuan
- Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xiang-Yu Wang
- Department of Respiration, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 451200, China
| | - Jia-Yuan Sun
- Department of Respiratory Endoscopy and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Fang-Fang Xie
- Department of Respiratory Endoscopy and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Xiao-Xuan Zheng
- Department of Respiratory Endoscopy and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Guang-Yu Tao
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Lei Pan
- Department of Respiration, Shanghai Public Health Clinic Center, Fudan University, Shanghai 201058, China
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Wahidi MM, Herth FJF, Chen A, Cheng G, Yarmus L. State of the Art: Interventional Pulmonology. Chest 2019; 157:724-736. [PMID: 31678309 DOI: 10.1016/j.chest.2019.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/13/2019] [Accepted: 10/09/2019] [Indexed: 12/17/2022] Open
Abstract
Interventional pulmonology (IP) has evolved over the past decade from an obscure subspecialty in pulmonary medicine to a recognized discipline offering advanced consultative and procedural services to patients with thoracic malignancy, anatomic airway disease, and pleural disease. Innovative interventions are now also available for diseases not traditionally treated procedurally, such as asthma and emphysema. The IP field has established certification examinations and training standards for IP training programs in an effort to enhance training quality and ensure competency. Validating new technology and proving its cost-effectiveness and effect on patient outcomes present the biggest challenge to IP as the health-care environment marches toward value-based health care. High-quality research is now thriving in IP and promises to elevate its practice into patient-centric evidence-based care.
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Affiliation(s)
- Momen M Wahidi
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, Durham, NC.
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center, University of Heidelberg, Heidelberg, Germany
| | - Alexander Chen
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
| | - George Cheng
- Division of Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine, Durham, NC
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
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Bronchoscopic Ablative Therapies for Malignant Central Airway Obstruction and Peripheral Lung Tumors. Ann Am Thorac Soc 2019; 16:1220-1229. [DOI: 10.1513/annalsats.201812-892cme] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Palussière J, Catena V, Lagarde P, Cousin S, Cabart M, Buy X, Chomy F. Primary tumors of the lung: should we consider thermal ablation as a valid therapeutic option? Int J Hyperthermia 2019; 36:46-52. [DOI: 10.1080/02656736.2019.1647351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
| | | | | | - Sophie Cousin
- Oncology Department, Institut Bergonié, Bordeaux, France
| | | | - Xavier Buy
- Imaging Department, Institut Bergonié, Bordeaux, France
| | - François Chomy
- Oncology Department, Institut Bergonié, Bordeaux, France
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Abstract
Lung cancer is the leading cause of cancer-related death worldwide and lobectomy remains the standard of care for patients with early-stage non-small cell lung cancer (NSCLC). The combination of an aging population and the implementation of low-dose CT for lung cancer screening is leading to an increase in diagnosis of early stage NSCLC in medically "inoperable" patients. The recommended treatment for this latter group of patients is stereotactic body radiation therapy (SBRT). However, many patients cannot undergo SBRT because they have received prior radiation or because the tumor is located next to vital structures. Percutaneous ablative therapies have become an alternative to SBRT but, unfortunately, they all violate the pleura and are associated with high rate of pneumothorax. With a more favorable safety profile and the ability to provide also diagnosis and nodal staging, bronchoscopic ablation is hence emerging as a potential future therapeutic alternative for these patients. Herein we review the current state of the art including animal and human data that exists thus far. We also discuss technical and research challenges as well as future directions that this exciting new technology may take.
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Affiliation(s)
- Bruce F Sabath
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Zhao ZR, Lau RWH, Ng CSH. Electromagnetic Navigation Bronchoscopy in Hybrid Theater. Front Surg 2019; 6:10. [PMID: 30941352 PMCID: PMC6433845 DOI: 10.3389/fsurg.2019.00010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/18/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ze-Rui Zhao
- State Key Laboratory of Oncology in Southern China, Department of Thoracic Surgery and Collaborative Innovation Centre for Cancer Medicine, Sun Yat-Sen University Cancer Centre, Guangzhou, China
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, China
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Abstract
Much has changed since the last review of interventional pulmonology (IP) published in this Clinics series. The rate of development of new techniques and their complexities require IP physicians to be constantly maintaining and updating their skill set. International agreed training pathways help ensure that the interventionalists of the present and future have the required knowledge of anatomy, manual dexterity, and clinical judgment to keep up with the continuing advances that are constantly expanding IP's diagnostic and therapeutic boundaries. IP remains one of the most desirable subspecialities in pulmonology, and the technologic advances make the future an exciting one.
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Affiliation(s)
- Alastair J Moore
- Oxford Interventional Pulmonology, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, OX3 7LE, UK
| | - Rachel M Mercer
- Oxford Interventional Pulmonology, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, OX3 7LE, UK; Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, OX3 7LE, UK
| | - Ali I Musani
- Interventional Pulmonology, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, University of Colorado School of Medicine, Denver, Academic Office 1, 12631 East 17th Avenue, M/S C323, Office # 8102, Aurora, CO 80045, USA.
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Abstract
Current advances in guided bronchoscopy methods permit minimally invasive access to essentially any area of the lungs. This provides a potential means to treat patients with localized lung malignancies who might not otherwise tolerate conventional treatment, which commonly relies on surgical resection. Ablation methods have long been used for bronchoscopic treatment of central airway malignancies and percutaneous treatment of peripheral lung cancer. This article reviews ablation technologies being adapted for use with guided bronchoscopy and the current state of investigation for the treatment of peripheral lung malignancies.
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Affiliation(s)
- David W Hsia
- Division of Respiratory and Critical Care Physiology and Medicine, Harbor-UCLA Medical Center, 1000 West Carson Street, Box #402, Torrance, CA 90502, USA.
| | - Ali I Musani
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine and University Hospital, 12631 East 17th Avenue, M/S C323, Office #8102, Aurora, CO 80045, USA
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Yuan Z, Wang Y, Zhang J, Zheng J, Li W. A Meta-Analysis of Clinical Outcomes After Radiofrequency Ablation and Microwave Ablation for Lung Cancer and Pulmonary Metastases. J Am Coll Radiol 2019; 16:302-314. [DOI: 10.1016/j.jacr.2018.10.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/12/2018] [Accepted: 10/14/2018] [Indexed: 12/12/2022]
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Maxwell AWP, Park WKC, Baird GL, Martin DW, Lombardo KA, Dupuy DE. Effects of a Thermal Accelerant Gel on Microwave Ablation Zone Volumes in Lung: A Porcine Study. Radiology 2019; 291:504-510. [PMID: 30747590 DOI: 10.1148/radiol.2019181652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Thermal ablation of cancers may be associated with high rates of local tumor progression. A thermal accelerant gel has been developed to improve the transmission of microwave energy in biologic tissues with the aim of enlarging the thermal ablation zone. Purpose To determine the effects of a thermal accelerant gel on microwave ablation zone volumes in porcine lung and to compare percutaneous and endobronchial delivery methods. Materials and Methods Thirty-two consecutive microwave lung ablations were performed in nine 12-week-old domestic male swine under general anesthesia by using fluoroscopic guidance between September 2017 and April 2018. Experimental ablations were performed following percutaneous injection of thermal accelerant into the lung (n = 16) or after endobronchial injection by using a flexible bronchoscope (n = 8). Control ablations were performed without accelerant gel (n = 8). Lung tissue was explanted after the animals were killed, and ablation zone volumes were calculated as the primary outcome measure by using triphenyltetrazolium chloride vital staining. Differences in treatment volumes were analyzed by generalized mixed modeling. Results Thermal accelerant ablation zone volumes were larger than control ablations (accelerant vs control ablation, 4.3 cm3 [95% confidence interval: 3.4, 5.5] vs 2.1 cm3 [95% confidence interval: 1.4, 2.9], respectively; P < .001). Among ablations with the thermal accelerant, those performed following percutaneous injection had a larger average ablation zone volume than those performed following endobronchial injection (percutaneous vs endobronchial, 4.8 cm3 [95% confidence interval: 3.6, 6.4] vs 3.3 cm3 [95% confidence interval: 2.9, 3.8], respectively; P = .03). Ablation zones created after endobronchial gel injection were more uniform in size distribution (standard error, percutaneous vs endobronchial: 0.13 vs 0.07, respectively; P = .03). Conclusion Use of thermal accelerant results in larger microwave ablation zone volumes in normal porcine lung tissue. Percutaneous thermal accelerant injection leads to a larger ablation zone volume compared with endobronchial injection, whereas a more homogeneous and precise ablation zone size is observed by using the endobronchial approach. © RSNA, 2019 See also the editorial by Goldberg in this issue.
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Affiliation(s)
- Aaron W P Maxwell
- From the Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903
| | - William K C Park
- From the Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903
| | - Grayson L Baird
- From the Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903
| | - Douglas W Martin
- From the Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903
| | - Kara A Lombardo
- From the Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903
| | - Damian E Dupuy
- From the Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903
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A new bronchoscopic catheter for the transbronchial ablation of pulmonary nodules. Lung Cancer 2018; 124:125-129. [PMID: 30268450 DOI: 10.1016/j.lungcan.2018.07.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/22/2018] [Accepted: 07/24/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES With the objective of simultaneous bronchoscopic biopsy and ablation of malignant solitary pulmonary nodules, we have developed a flexible monopolar radiofrequency (RF) catheter that can be deployed through the working channel of most bronchoscopes. MATERIALS AND METHODS Fresh tumor specimens were heated in a water bath to 37 °C, and the RF catheter was inserted into the tumors within the specimen. Temperature sensors were positioned 3 mm, 5 mm and 7 mm from the electrode to measure the temperature of the surrounding tissue every 1 s. The ablation was conducted by applying RF energy for 8 min. The ablated specimens were evaluated by cutting the tissue samples along the top of the device and measuring the ablation zones. RESULTS Five ablations were performed in 3 specimens. All of the ablation zones had a major axis length (along the electrode axis) between 18.9 mm and 22.8 mm and a minor axis length (perpendicular to the major axis) between 13.3 mm and 18.0 mm. The temperature data showed that all of the temperature sensors detected 60 °C or higher. These results demonstrate that the RF catheter was capable of generating ablation zones that were locally contained in ex vivo human cancerous lung specimens and that incorporated the tumor tissues. CONCLUSION We present the results of a benchtop study demonstrating the local control of ablation achieved using the RF device. This study suggests that the ex vivo ablation of lung malignancy with a new bronchoscopic RF catheter is feasible and that in vivo tumor ablation with this method in humans merits further study.
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