Thermal Ablation of Lung Tumors: Focus on Microwave Ablation

Abstract

Background Image-guided thermal ablation can be used for the treatment of medically inoperable primary and metastatic lung cancer. These techniques are based on the heating up or freezing (cryoablation) of a volume of tissue around a percutaneous applicator that induces necrosis of the tumor.

Method The English-language literature concerning thermal ablation of the lung was reviewed. Radiofrequency ablation (RFA) is the most widely performed and investigated of these techniques. Microwave ablation (MWA) represents a relatively new alternative that shares the same indications and is conducted in a very similar fashion as RFA. It has been experimentally and clinically shown that MWA produces larger, more spherical ablation zones over shorter periods of time compared to RFA. Seven different MWA systems are available in Europe and the USA with significant differences in the size and shape of the produced ablation zones.

Results The types of complications caused by MWA and their rates of occurrence are very similar to those caused by RFA. The local progression rates after MWA of lung malignancies vary between 0 % and 34 % and are similar to those in the RFA literature.

Conclusion Despite technical improvements, the current generation of MWA systems has comparable clinical outcomes to those of RFA.

Key Points 

• MWA is a safe technique that should be considered one of the treatment options for medically inoperable lung tumors

• As thermal ablations of lung tumors are becoming more frequent, radiologists should be acquainted with the post-ablation imaging characteristics

• Although MWA has some theoretical advantages over RFA, the clinical outcomes are similar

Citation Format

• Vogl TJ, Nour-Eldin NA, Albrecht MH et al. Thermal Ablation of Lung Tumors: Focus on Microwave Ablation. Fortschr Röntgenstr 2017; 189: 828 – 843

Zusammenfassung

Hintergrund Bild-gesteuerte thermische Ablationen können zur Behandlung von inoperablem primärem und metastatischem Lungenkrebs eingesetzt werden. Diese Techniken basieren auf der Erwärmung oder Abkühlung (Kryotherapie) eines Gewebevolumens um einen perkutanen Applikator, der eine Nekrose des Tumors induziert.

Methode Die englischsprachige Literatur betreffend Thermalablation der Lunge wurde durchgesehen. Die Radiofrequenz-Ablation (RFA) ist das am weitesten verbreitete und erforschte Verfahren dieser Ablationstechniken. Die Mikrowellenablation (MWA) stellt eine relativ neue Alternative dar, die unter gleichen Indikationen und in ähnlicher Weise wie die RFA durchgeführt wird. Es wurde experimentell und klinisch gezeigt, dass mittels MWA größere und sphärischere Ablationszonen über kürzere Zeiträume im Vergleich zu RFA erreicht werden können. In Europa und den USA stehen sieben verschiedene MWA-Systeme zur Verfügung, die signifikante Unterschiede in Größe und Form der erzeugten Ablationszonen aufweisen.

Ergebnisse Die mit der MWA assoziierten Komplikationen, sowie deren Häufigkeiten, sind denen der RFA sehr ähnlich. Die lokalen Progressionsraten nach MWA von Lungentumoren variieren zwischen 0 % und 34 % die mit den Daten der RFA-Literatur vergleichbar sind.

Schlussfolgerung Trotz technischer Verbesserungen hat die aktuelle Generation von MWA-Systemen ähnliche klinische Ergebnisse wie die RFA.

Kernaussagen 

• Bei der MWA handelt es ich um ein sicheres Therapieverfahren welches daher als Behandlungsalternative bei nicht operablen Lungentumoren in Erwägung gezogen werden sollte.

• Da die Thermoablation von Lungentumoren immer mehr Anwendung findet, sollten Radiologen mit dem Erscheinungsbild der Ablation in der Bildgebung vertraut sein.

• Obwohl die MWA theoretische Vorteile gegenüber der RFA hat, ist der Therapieerfolg vergleichbar.

Key words

ablation procedures - lung - metastases - NSCLC

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