PDF herunterladen
Semin intervent Radiol 2013; 30(02): 141-150
DOI: 10.1055/s-0033-1342955
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Lung Cancer Ablation: Technologies and Techniques

Erica S. Alexander
1   Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Damian E. Dupuy
1   Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
28. Mai 2013 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

The incidence of lung cancers in 2012 is estimated to reach 226,160 new cases, with only a third of patients suitable surgical candidates. Tumor ablation has emerged as an important and efficacious treatment option for nonsurgical lung cancer patients. This localized minimally invasive therapy is best suited for small oligonodular lesions or favorably located metastatic tumors. Radiofrequency ablation has been in use for over a decade, and newer modalities including microwave ablation, cryoablation, and irreversible electroporation have emerged as additional treatment options for patients. Ablation therapies can offer patients and clinicians a repeatable and effective therapy for palliation and, in some cases, cure of thoracic malignancies. This article discusses the available technologies and techniques available for tumor ablation of thoracic malignancies including patient selection, basic aspects of procedure technique, imaging follow-up, treatment outcomes, and comparisons between various therapies.

Keywords

lung cancer - thermal ablation - radiofrequency ablation - microwave ablation - cryoablation - interventional radiology
 

  • References

  • 1 American Cancer Society. Cancer facts and figures 2012. Atlanta, GA: American Cancer Society; 2012
    Suche in Google Scholar
  • 2 Rusch VW. Lung metastasis. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, , eds. Clinical Oncology. 4th ed. Philadelphia, PA: Churchill Livingston; 2008: 873-884
    Suche in Google Scholar
  • 3 Robinson LA, Ruckdeschel JC, Wagner Jr H, Stevens CW. 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
    CrossrefPubMedSuche in Google Scholar
  • 4 Ruckdeschel JC, Schwarz AG, Bepler G , et al. Cancer of the lung—NSCLC and SCLC. In: Abeloff MD, Armitage JO, Niederhuber JE, , eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, PA: Elsevier; 2008: 1649-1743
    Suche in Google Scholar
  • 5 Zemlyak A, Moore WH, Bilfinger TV. Comparison of survival after sublobar resections and ablative therapies for stage I non-small cell lung cancer. J Am Coll Surg 2010; 211 (1) 68-72
    CrossrefPubMedSuche in Google Scholar
  • 6 Pennathur A, Abbas G, Gooding WE , et al. Image-guided radiofrequency ablation of lung neoplasm in 100 consecutive patients by a thoracic surgical service. Ann Thorac Surg 2009; 88 (5) 1601-1606 ; discussion 1607–1608
    CrossrefPubMedSuche in Google Scholar
  • 7 Simon CJ, Dupuy DE, DiPetrillo TA , et al. Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients. Radiology 2007; 243 (1) 268-275
    CrossrefPubMedSuche in Google Scholar
  • 8 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
    CrossrefPubMedSuche in Google Scholar
  • 9 Lencioni R, Crocetti L, Cioni R , et al. Response to radiofrequency ablation of pulmonary tumours: a prospective, intention-to-treat, multicentre clinical trial (the RAPTURE study). Lancet Oncol 2008; 9 (7) 621-628
    CrossrefPubMedSuche in Google Scholar
  • 10 Kong FM, Ten Haken RK, Schipper MJ , et al. High-dose radiation improved local tumor control and overall survival in patients with inoperable/unresectable non-small-cell lung cancer: long-term results of a radiation dose escalation study. Int J Radiat Oncol Biol Phys 2005; 63 (2) 324-333
    CrossrefPubMedSuche in Google Scholar
  • 11 Sura S, Yorke E, Jackson A, Rosenzweig KE. High-dose radiotherapy for the treatment of inoperable non-small cell lung cancer. Cancer J 2007; 13 (4) 238-242
    CrossrefPubMedSuche in Google Scholar
  • 12 Bogart JA, Hodgson L, Seagren SL , et al. Phase I study of accelerated conformal radiotherapy for stage I non-small-cell lung cancer in patients with pulmonary dysfunction: CALGB 39904. J Clin Oncol 2010; 28 (2) 202-206
    CrossrefPubMedSuche in Google Scholar
  • 13 Onishi H, Shirato H, Nagata Y , et al. Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol 2007; 2 (7) (Suppl. 03) S94-S100
    CrossrefPubMedSuche in Google Scholar
  • 14 Timmerman R, Paulus R, Galvin J , et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA 2010; 303 (11) 1070-1076
    CrossrefPubMedSuche in Google Scholar
  • 15 Jain SK, Dupuy DE, Cardarelli GA, Zheng Z, DiPetrillo TA. Percutaneous radiofrequency ablation of pulmonary malignancies: combined treatment with brachytherapy. AJR Am J Roentgenol 2003; 181 (3) 711-715
    CrossrefPubMedSuche in Google Scholar
  • 16 Dupuy DE, Mayo-Smith WW, Abbott GF, DiPetrillo TA. Clinical applications of radio-frequency tumor ablation in the thorax. Radiographics 2002; 22 (Spec No) S259-S269
    CrossrefPubMedSuche in Google Scholar
  • 17 McTaggart RA, Dupuy DE, Dipetrillo T. Image guided ablation in the thorax. In: Geschwind J-FH, Soulen MC, , eds. Interventional Oncology: Principles and Practice. New York, NY: Cambridge University Press; 2008: 440-474
    CrossrefSuche in Google Scholar
  • 18 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. 04) 12-21
    PubMedSuche in Google Scholar
  • 19 Alexander ES, Healey TT, Martin DW, Dupuy DE. Use of endobronchial valves for the treatment of bronchopleural fistulas after thermal ablation of lung neoplasms. J Vasc Interv Radiol 2012; 23 (9) 1236-1240
    CrossrefPubMedSuche in Google Scholar
  • 20 VanSonnenberg E, Shankar S, Morrison PR , 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
    CrossrefPubMedSuche in Google Scholar
  • 21 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
    CrossrefPubMedSuche in Google Scholar
  • 22 Solomon SB, Thornton RH, Dupuy DE, Downey RJ. Protection of the mediastinum and chest wall with an artificial pneumothorax during lung ablations. J Vasc Interv Radiol 2008; 19 (4) 610-615
    CrossrefPubMedSuche in Google Scholar
  • 23 Dupuy DE, Mayo-Smith WW, Abbott GF, DiPetrillo T. Clinical applications of radio-frequency tumor ablation in the thorax. Radiographics 2002; 22 (Spec No) S259-S269
    CrossrefPubMedSuche in Google Scholar
  • 24 Nahum Goldberg S, Dupuy DE. Image-guided radiofrequency tumor ablation: challenges and opportunities—part I. J Vasc Interv Radiol 2001; 12 (9) 1021-1032
    CrossrefPubMedSuche in Google Scholar
  • 25 Beland MD, Dupuy DE. Current and future applications of percutaneous radiofrequency ablation in the treatment of lung neoplasms. Appl Radiol 2006; 35 (12) 21-28
    PubMedSuche in Google Scholar
  • 26 Feng W, Liu W, Li C , et al. Percutaneous microwave coagulation therapy for lung cancer. Zhonghua Zhong Liu Za Zhi 2002; 24 (4) 388-390
    PubMedSuche in Google Scholar
  • 27 Wolf FJ, Grand DJ, Machan JT, Dipetrillo TA, Mayo-Smith WW, Dupuy DE. Microwave ablation of lung malignancies: effectiveness, CT findings, and safety in 50 patients. Radiology 2008; 247 (3) 871-879
    CrossrefPubMedSuche in Google Scholar
  • 28 Lu Q, Cao W, Huang L , et al. CT-guided percutaneous microwave ablation of pulmonary malignancies: results in 69 cases. World J Surg Oncol 2012; 10: 80
    CrossrefPubMedSuche in Google Scholar
  • 29 Belfiore G, Ronza F, Belfiore MP , et al. Patients' survival in lung malignancies treated by microwave ablation: our experience on 56 patients. Eur J Radiol 2013; 82 (1) 177-181
    CrossrefPubMedSuche in Google Scholar
  • 30 Gage AA, Baust JG. Mechanisms of tissue injury in cryosurgery. Cryobiology 1998; 37 (3) 171-186
    CrossrefPubMedSuche in Google Scholar
  • 31 Izumi Y, Oyama T, Ikeda E, Kawamura M, Kobayashi K. The acute effects of transthoracic cryoablation on normal lung evaluated in a porcine model. Ann Thorac Surg 2005; 79 (1) 318-322 ; discussion 322
    CrossrefPubMedSuche in Google Scholar
  • 32 Hinshaw JL, Lee Jr FT, Laeseke PF, Sampson LA, Brace C. Temperature isotherms during pulmonary cryoablation and their correlation with the zone of ablation. J Vasc Interv Radiol 2010; 21 (9) 1424-1428
    CrossrefPubMedSuche in Google Scholar
  • 33 Davalos RV, Mir IL, Rubinsky B. Tissue ablation with irreversible electroporation. Ann Biomed Eng 2005; 33 (2) 223-231
    CrossrefPubMedSuche in Google Scholar
  • 34 Lee EW, Chen C, Prieto VE, Dry SM, Loh CT, Kee ST. Advanced hepatic ablation technique for creating complete cell death: irreversible electroporation. Radiology 2010; 255 (2) 426-433
    CrossrefPubMedSuche in Google Scholar
  • 35 Rubinsky B, Onik G, Mikus P. Irreversible electroporation: a new ablation modality—clinical implications. Technol Cancer Res Treat 2007; 6 (1) 37-48
    CrossrefPubMedSuche in Google Scholar
  • 36 Rempp H, Boss A, Helmberger T, Pereira P. The current role of minimally invasive therapies in the management of liver tumors. Abdom Imaging 2011; 36 (6) 635-647
    CrossrefPubMedSuche in Google Scholar
  • 37 McTaggart RA, Dupuy DE. Thermal ablation of lung tumors. Tech Vasc Interv Radiol 2007; 10 (2) 102-113
    CrossrefPubMedSuche in Google Scholar
  • 38 Dupuy DE, Aswad B, Ng T. Irreversible electroporation in a swine lung model. Cardiovasc Intervent Radiol 2011; 34 (2) 391-395
    CrossrefPubMedSuche in Google Scholar
  • 39 Mali B, Jarm T, Corovic S , et al. The effect of electroporation pulses on functioning of the heart. Med Biol Eng Comput 2008; 46 (8) 745-757
    CrossrefPubMedSuche in Google Scholar
  • 40 Grieco CA, Simon CJ, Mayo-Smith WW, Dipetrillo TA, Ready NE, Dupuy DE. Image-guided percutaneous thermal ablation for the palliative treatment of chest wall masses. Am J Clin Oncol 2007; 30 (4) 361-367
    CrossrefPubMedSuche in Google Scholar
  • 41 Suh RD, Wallace AB, Sheehan RE, Heinze SB, Goldin JG. Unresectable pulmonary malignancies: CT-guided percutaneous radiofrequency ablation—preliminary results. Radiology 2003; 229 (3) 821-829
    CrossrefPubMedSuche in Google Scholar
  • 42 Gadaleta C, Mattioli V, Colucci G , et al. Radiofrequency ablation of 40 lung neoplasms: preliminary results. AJR Am J Roentgenol 2004; 183 (2) 361-368
    CrossrefPubMedSuche in Google Scholar
  • 43 Steinke K, King J, Glenn D, Morris DL. Radiologic appearance and complications of percutaneous computed tomography-guided radiofrequency-ablated pulmonary metastases from colorectal carcinoma. J Comput Assist Tomogr 2003; 27 (5) 750-757
    CrossrefPubMedSuche in Google Scholar
  • 44 Jin GY, Lee JM, Lee YC, Han YM, Lim YS. 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
    CrossrefPubMedSuche in Google Scholar
  • 45 Swensen SJ, Viggiano RW, Midthun DE , et al. Lung nodule enhancement at CT: multicenter study. Radiology 2000; 214 (1) 73-80
    CrossrefPubMedSuche in Google Scholar
  • 46 Yoo DC, Dupuy DE, Hillman SL , et al. Radiofrequency ablation of medically inoperable stage IA non-small cell lung cancer: are early posttreatment PET findings predictive of treatment outcome?. AJR Am J Roentgenol 2011; 197 (2) 334-340
    CrossrefPubMedSuche in Google Scholar
  • 47 Brace CL, Hinshaw JL, Laeseke PF, Sampson LA, Lee Jr FT. Pulmonary thermal ablation: comparison of radiofrequency and microwave devices by using gross pathologic and CT findings in a swine model. Radiology 2009; 251 (3) 705-711
    CrossrefPubMedSuche in Google Scholar
  • 48 Dupuy DE. Microwave ablation compared with radiofrequency ablation in lung tissue—is microwave not just for popcorn anymore?. Radiology 2009; 251 (3) 617-618
    CrossrefPubMedSuche in Google Scholar
  • 49 Goldberg SN, Gazelle GS, Solbiati L, Rittman WJ, Mueller PR. Radiofrequency tissue ablation: increased lesion diameter with a perfusion electrode. Acad Radiol 1996; 3 (8) 636-644
    CrossrefPubMedSuche in Google Scholar
  • 50 Simon CJ, Dupuy DE, Mayo-Smith WW. Microwave ablation: principles and applications. Radiographics 2005; 25 (Suppl. 01) S69-S83
    CrossrefPubMedSuche in Google Scholar
  • 51 Yu NC, Lu DS, Raman SS , et al. Hepatocellular carcinoma: microwave ablation with multiple straight and loop antenna clusters—pilot comparison with pathologic findings. Radiology 2006; 239 (1) 269-275
    CrossrefPubMedSuche in Google Scholar
  • 52 Maiwand MO. The role of cryosurgery in palliation of tracheo-bronchial carcinoma. Eur J Cardiothorac Surg 1999; 15 (6) 764-768
    CrossrefPubMedSuche in Google Scholar
  • 53 Maiwand MO, Homasson JP. Cryotherapy for tracheobronchial disorders. Clin Chest Med 1995; 16 (3) 427-443
    PubMedSuche in Google Scholar
  • 54 Sanderson DR, Neel III HB, Fontana RS. Bronchoscopic cryotherapy. Ann Otol Rhinol Laryngol 1981; 90 (4 Pt 1) 354-358
    PubMedSuche in Google Scholar
  • 55 Wang H, Littrup PJ, 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
    CrossrefPubMedSuche in Google Scholar
  • 56 Thomson KR, Cheung W, Ellis SJ , et al. Investigation of the safety of irreversible electroporation in humans. J Vasc Interv Radiol 2011; 22 (5) 611-621
    CrossrefPubMedSuche in Google Scholar