Current Status of Thermal Ablation Treatments for Lung Malignancies

ABSTRACT

About 75% of lung cancer patients are not surgical candidates, either due to advanced disease or medical comorbidities. Furthermore, conventional treatments that can be offered to these patients are beneficial only to a small percentage of them. Thermal ablation is a minimally invasive treatment that is commonly used in this group of patients, and which has shown promising results. Currently, the most widely used ablation techniques in the treatment of lung malignancies are radiofrequency ablation (RFA), microwave ablation, and cryoablation. Although the most studied technique is RFA, recent studies with microwave ablation and cryoablation have shown some advantages over RFA. This article reviews the application of thermal ablation in the thorax, including patient selection, basic aspects of procedure technique, imaging follow-up, treatment outcomes, and comparison of ablation techniques.

KEYWORDS

Lung cancer - thermal ablation - radiofrequency ablation - cryoablation - microwave ablation

REFERENCES

• 1 American Cancer Society .Cancer Facts and Figures 2008. Atlanta, GA; American Cancer Society 2008
• 2 Robinson L A, Ruckdeschel J C, Wagner Jr H, Stevens C W. American College of Chest Physicians . Treatment of non-small cell lung cancer-stage IIIA: ACCP evidence-based clinical practice guidelines (2nd edition).  Chest. 2007;  132(3, Suppl) 243S-265S
• 3 Gandhi N S, Dupuy D E. Image-guided radiofrequency ablation as a new treatment option for patients with lung cancer.  Semin Roentgenol. 2005;  40(2) 171-181
• 4 McTaggart R A, Dupuy D E, Dipetrillo T. Image guided ablation in the thorax. In: Geschwind J-F H, Soulen MC Interventional Oncology: Principles and Practice. New York; Cambridge University Press 2008: 440-474
• 5 Jain S K, Dupuy D E, Cardarelli G A, Zheng Z, DiPetrillo T A. Percutaneous radiofrequency ablation of pulmonary malignancies: combined treatment with brachytherapy.  AJR Am J Roentgenol. 2003;  181(3) 711-715
• 6 Grieco C A, Simon C J, Mayo-Smith W W, DiPetrillo T A, Ready N E, Dupuy D E. Percutaneous image-guided thermal ablation and radiation therapy: outcomes of combined treatment for 41 patients with inoperable stage I/II non-small-cell lung cancer.  J Vasc Interv Radiol. 2006;  17(7) 1117-1124
• 7 Hines-Peralta A, Goldberg S N. Image guided interventions: fundamentals of radiofrequency tumor ablation. In: Geschwind J-F H, Soulen MC Interventional Oncology: Principles and Practice. New York; Cambridge University Press 2008: 55-63
• 8 Suh R, Reckamp K, Zeidler M, Cameron R. Radiofrequency ablation in lung cancer: promising results in safety and efficacy.  Oncology (Williston Park). 2005;  19(11, Suppl 4) 12-21
• 9 VanSonnenberg E, Shankar S, Morrison P R et al.. Radiofrequency ablation of thoracic lesions: part 2, initial clinical experience—technical and multidisciplinary considerations in 30 patients.  AJR Am J Roentgenol. 2005;  184(2) 381-390
• 10 Kawamura M, Izumi Y, Tsukada N et al.. Percutaneous cryoablation of small pulmonary malignant tumors under computed tomographic guidance with local anesthesia for nonsurgical candidates.  J Thorac Cardiovasc Surg. 2006;  131(5) 1007-1013
• 11 Dupuy D E, Mayo-Smith W W, Abbott G F, DiPetrillo T. Clinical applications of radio-frequency tumor ablation in the thorax.  Radiographics. 2002;  22 S259-S269
• 12 Nahum Goldberg S, Dupuy D E. Image-guided radiofrequency tumor ablation: challenges and opportunities—part I.  J Vasc Interv Radiol. 2001;  12(9) 1021-1032
• 13 Beland M D, Dupuy D E. Current and future applications of percutaneous radiofrequency ablation in the treatment of lung neoplasms.  Appl Radiol. 2006;  35(12) 21-26
• 14 Simon C J, Dupuy D E, Mayo-Smith W W. Microwave ablation: principles and applications.  Radiographics. 2005;  25(Suppl 1) S69-S83
• 15 Shibata T, Iimuro Y, Yamamoto Y et al.. Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy.  Radiology. 2002;  223(2) 331-337
• 16 Seki T, Tamai T, Nakagawa T et al.. Combination therapy with transcatheter arterial chemoembolization and percutaneous microwave coagulation therapy for hepatocellular carcinoma.  Cancer. 2000;  89(6) 1245-1251
• 17 Lu M D, Chen J W, Xie X Y et al.. Hepatocellular carcinoma: US-guided percutaneous microwave coagulation therapy.  Radiology. 2001;  221(1) 167-172
• 18 Gadaleta C, Catino A, Ranieri G et al.. Radiofrequency thermal ablation of 69 lung neoplasms.  J Chemother. 2004;  16(Suppl 5) 86-89
• 19 Akeboshi M, Yamakado K, Nakatsuka A et al.. Percutaneous radiofrequency ablation of lung neoplasms: initial therapeutic response.  J Vasc Interv Radiol. 2004;  15(5) 463-470
• 20 Wolf F J, Grand D J, Machan J T, Dipetrillo T A, Mayo-Smith W W, Dupuy D E. Microwave ablation of lung malignancies: effectiveness, CT findings, and safety in 50 patients.  Radiology. 2008;  247(3) 871-879
• 21 Kvale P A, Simoff M, Prakash U B. American College of Chest Physicians. Lung cancer. Palliative care.  Chest. 2003;  123(1, Suppl) 284S-311S
• 22 Munden R F, Swisher S S, Stevens C W, Stewart D J. Imaging of the patient with non-small cell lung cancer.  Radiology. 2005;  237(3) 803-818
• 23 Simon C J, Dupuy D E, DiPetrillo T A et al.. Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients.  Radiology. 2007;  243(1) 268-275
• 24 de Baère T, Palussière J, Aupérin A et al.. Midterm local efficacy and survival after radiofrequency ablation of lung tumors with minimum follow-up of 1 year: prospective evaluation.  Radiology. 2006;  240(2) 587-596
• 25 Kawamura M, Izumi Y, Tsukada N et al.. Percutaneous cryoablation of small pulmonary malignant tumors under computed tomographic guidance with local anesthesia for nonsurgical candidates.  J Thorac Cardiovasc Surg. 2006;  131(5) 1007-1013
• 26 Wang H, Littrup P J, Duan Y, Zhang Y, Feng H, Nie Z. Thoracic masses treated with percutaneous cryotherapy: initial experience with more than 200 procedures.  Radiology. 2005;  235(1) 289-298
• 27 Jin G Y, Lee J M, Lee Y C, Han Y M, Lim Y S. Primary and secondary lung malignancies treated with percutaneous radiofrequency ablation: evaluation with follow-up helical CT.  AJR Am J Roentgenol. 2004;  183(4) 1013-1020
• 28 Vaughn C, Mychaskiw II G, Sewell P. Massive hemorrhage during radiofrequency ablation of a pulmonary neoplasm.  Anesth Analg. 2002;  94(5) 1149-1151
• 29 Dupuy D E. Microwave ablation compared with radiofrequency ablation in lung tissue-is microwave not just for popcorn anymore?.  Radiology. 2009;  251(3) 617-618