Stellate ganglion injury after percutaneous radiofrequency ablation of a lung tumor

From diagnosis to therapy in lung cancer: management of CT detected pulmonary nodules, a summary of the 2015 Chinese-German Lung Cancer Expert Panel

The first Chinese-German Lung Cancer Expert Panel was held in November 2015 one day after the 7th Chinese-German Lung Cancer Forum, Shanghai. The intention of the meeting was to discuss strategies for the diagnosis and treatment of lung cancer within the context of lung cancer screening. Improved risk classification criteria and novel imaging approaches for screening populations are highly required as more than half of lung cancer cases are false positive during the initial screening round if the National Lung Screening Trial (NLST) demographic criteria [≥30 pack years (PY) of cigarettes, age ≥55 years] are applied. Moreover, if the NLST criteria are applied to the Chinese population a high number of lung cancer patients are not diagnosed due to non-smoking related risk factors in China. The primary goal in the evaluation of pulmonary nodules (PN) is to determine whether they are malignant or benign. Volumetric based screening concepts such as investigated in the Dutch-Belgian randomized lung cancer screening trial (NELSON) seem to achieve higher specificity. Chest CT is the best imaging technique to identify the origin and location of the nodule since 20% of suspected PN found on chest X-ray turn out to be non-pulmonary lesions. Moreover, novel state-of-the-art CT systems can reduce the radiation dose for lung cancer screening acquisitions down to a level of 0.1 mSv with improved image quality to novel reconstruction techniques and thus reduce concerns related to chest CT as the primary screening technology. The aim of the first part of this manuscript was to summarize the current status of novel diagnostic techniques used for lung cancer screening and minimally invasive treatment techniques for progressive PNs that were discussed during the first Chinese-German Lung Cancer. This part should serve as an educational part for the readership of the techniques that were discussed during the Expert Panel. The second part summarizes the consensus recommendations that were interdisciplinary discussed by the Expert Panel.

Major complications of high-energy microwave ablation for percutaneous CT-guided treatment of lung malignancies: Single-centre experience after 4 years

PURPOSE

To evaluate the rate of major complications related to percutaneous computed tomography (CT)-guided microwave ablation (MWA) of primary and secondary lung malignancies performed at our institution over a 4-year period.

METHODS

From May 2010 to September 2014, 70 MWAs were performed on 51 patients. All major intra- and post-procedural complications (as defined by the classification proposed by the Society of Interventional Radiology) were retrospectively analysed. The results were correlated with a systematic review of the available literature on MWA in the lung.

RESULTS

Major complications were encountered in 14 out of 70 ablations (20%). Twenty-one separate major complications were encountered (some ablations lead to more than one major complication). One death occurred within 30 days of ablation, though the relationship to the procedure remains uncertain. Other major complications included: nine pneumothoraces requiring drain insertion (12.9%), four cases of large effusion requiring drainage (5.7%), two cases of significant pulmonary haemorrhage altering clinical management (2.9%), two infections (2.9%), one case of mechanical failure (1.4%), one chest wall burn (1.4%) and one case of pleural seeding (1.4%). Major complications were much more likely to occur if the nodule was located within 7 mm from the pleura.

CONCLUSION

MWA of pulmonary tumours carries moderate risk; nevertheless, the usually manageable complications should not deter from undertaking a potentially curative therapy for poor surgical candidates.

Major complications after lung microwave ablation: a single-center experience on 204 sessions

BACKGROUND

The purpose of this study is to retrospectively evaluate the incidence of and risk factors for major complications after microwave ablation (MWA) of lung tumors.

METHODS

From January 2011 to May 2013 in 184 consecutive patients (67 women and 117 men; mean age, 61.5 years; range, 19 to 85 years), 204 sessions of MWA were performed on 253 lung tumor lesions. Records were reviewed to evaluate prevalence of major complications and risk factors, which were analyzed using univariate and multivariate analyses.

RESULTS

Major complications developed after 42 sessions (20.6%), including 32 cases (15.7%) of pneumothorax requiring chest tube placement which that were associated with emphysema (p=0.001); 6 cases (2.9%) of pleural effusions requiring chest tube placement, which were associated with a distance of less than 1 cm from chest wall to target tumor (p=0.014); 6 cases (2.9%) of pneumonia which that were associated with target tumor maximal diameter (p=0.040); number of pleural punctures (p=0.001) and ablation time (p=0.006); and 1 case (0.5%) of pulmonary abscess. Two cases (1.0%) of the large pneumothorax occurred at the same time with extensive subcutaneous emphysema, including 1 case (0.5%) caused by bronchopleural fistula. Death related to the procedures occurred after 1 session (0.5%).

CONCLUSIONS

As a relatively practical and safe modality, lung tumor MWA can induce serious complications. Enough attention should be paid to patients with emphysema, subpleural, or large target tumor, but the indications for lung MWA need not be limited as most major complications were easily managed.

Retrospective review of thoracic neural damage during lung ablation - what the interventional radiologist needs to know about neural thoracic anatomy

BACKGROUND AND PURPOSE

Radiofrequency ablation (RFA) is associated with low neural morbidity compared with surgery, which commonly causes debilitating long-term pain. The purpose was to review the thoracic neural anatomy relevant to percutaneous RFA and to retrospectively review symptomatic nerve injury after lung RFA at our institution.

MATERIALS AND METHODS

We retrospectively examined all symptomatic nerve injuries occurring after computed tomography (CT)-guided RFA treatment of lung tumors for 462 patients/509 procedures/708 lesions treated at our large tertiary referral centre during 10 years.

RESULTS

Eight patients experienced neurological complications after heating during the RFA procedure. These complications occurred in the phrenic (n = 1), brachial (n = 3), left recurrent (n = 1), and intercostal nerves (n = 2) and the stellate ganglion (n = 1). Three were grade 2, four grade 3 and one grade 4 injuries (CTCAE v3).

CONCLUSION

Although rare, neurological complications can occur after RFA, and they can occasionally be severe. To prevent these complications, it is important for the interventional radiologist to be aware of the anatomy of nervous structures and to attempt to identify nerves on CT scans during the RFA procedure. Creating a pneumothorax can be useful to avoid nerve damage and related clinical complications.

Radiofrequency ablation of non-resectable lung tumors

BACKGROUND

Radiofrequency thermal ablation (RFA) is a minimally invasive, image guided technique for destroying tumour cells without damage to adjacent healthy tissue. It is used for partial or complete ablation of non resectable lung cancers and cancers of metastases to lung, providing an effective, relatively safe option for patients ineligible for surgery. We describe our experience with it.

METHODS

In 2005 and 2006, we performed radiofrequency ablation of 7 lung lesions in 6 patients. RFA was done percutaneously under image guided CT scan in 5 patients and in one patient during thoracotomy when we found a radically unresectable tumor necessitating debulking. CT lung screening was performed after 6 months and PET/CT was done within 12 months.

RESULTS

In the course of the screening, we diagnosed regression in 2 patients, a stationary state in 2 cases and local tumor progression in 2 patients, using computed tomography within 6 months after RFA. Using PET/CT within 12 months, we diagnosed non-ablation and liver metastases (there were none before) in one of the two patients with a stationary state diagnosed by means of CT before and recurrence of primary tumor in another patient. In one case of diagnosed regression, we diagnosed tumor progression. The patients survived an average of 30 months (range 9 to 60 months).

CONCLUSION

RFA of lung tumors is an easy method with little patient discomfort. It can be performed percutaneously using guided CT under general anaesthesia. RFA of lung tumors possibly alone or in combination with oncology treatment can prolong patient life.