1
|
Hung W, Tsai SC, Wu T, Tu H, Lin H, Su C, Wu Y, Lin L, Lin FC. Enhancing precision in lung tumor ablation through innovations in CT-guided technique and angle control. Thorac Cancer 2024; 15:867-877. [PMID: 38419563 PMCID: PMC11016418 DOI: 10.1111/1759-7714.15255] [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: 12/29/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND This retrospective study aimed to evaluate the precision and safety outcomes of image-guided lung percutaneous thermal ablation (LPTA) methods, focusing on radiofrequency ablation (RFA) and microwave ablation (MWA). The study utilized an innovative angle reference guide to facilitate these techniques in the treatment of lung tumors. METHODS This study included individuals undergoing LPTA with the assistance of laser angle guide assembly (LAGA) at our hospital between April 2011 and March 2021. We analyzed patient demographics, tumor characteristics, procedure details, and complications. Logistic regressions were employed to assess risk factors associated with complications. RESULTS A total of 202 patients underwent ablation for 375 lung tumors across 275 sessions involving 495 ablations. Most procedures used RFA, especially in the right upper lobe, and the majority of ablations were performed in the prone position (49.7%). Target lesions were at a median depth of 39.3 mm from the pleura surface, and remarkably, 91.9% required only a single puncture. Complications occurred in 31.0% of ablations, with pneumothorax being the most prevalent (18.3%), followed by pain (12.5%), sweating (6.5%), fever (5.0%), cough (4.8%), hemothorax (1.6%), hemoptysis (1.2%), pleural effusion (2.0%), skin burn (0.6%), and air emboli (0.2%). The median procedure time was 21 min. Notably, smoking/chronic obstructive pulmonary disease emerged as a significant risk factor for complications. CONCLUSION The LAGA-assisted LPTA enhanced safety by improving accuracy and reducing risks. Overall, this investigation contributes to the ongoing efforts to refine and improve the clinical application of these thermal ablation techniques in the treatment of lung tumors.
Collapse
Affiliation(s)
- Wei‐Te Hung
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Stella Chin‐Shaw Tsai
- Superintendent OfficeTaichung MetroHarbor HospitalTaichungTaiwan
- Department of Post‐Baccalaureate Medicine, College of MedicineNational Chung Hsing UniversityTaichungTaiwan
| | - Tzu‐Chin Wu
- Department of Thoracic MedicineChung Shan Medical University HospitalTaichungTaiwan
| | - Hsien‐Tang Tu
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
- Department of Thoracic MedicineChung Shan Medical University HospitalTaichungTaiwan
| | - Huan‐Cheng Lin
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
- Department of Thoracic SurgeryChung Shan Medical University HospitalTaichungTaiwan
| | - Chun‐Lin Su
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Yu‐Chieh Wu
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Li‐Cheng Lin
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Frank Cheau‐Feng Lin
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
- Department of Thoracic SurgeryChung Shan Medical University HospitalTaichungTaiwan
| |
Collapse
|
2
|
Ergun O, Birgi E, Hekimoğlu A, Eraslan Ö, Durmaz HA, Karaçin C, İmamoğlu Gİ, Eren T, Yazılıtaş D, Hekimoğlu B. Percutaneous ablation treatment in metastatic lung tumors: a single-center experience. Acta Radiol 2023; 64:2416-2423. [PMID: 37246396 DOI: 10.1177/02841851231175657] [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: 05/30/2023]
Abstract
BACKGROUND In recent years, many studies have proven that percutaneous thermal ablation is an effective second-line treatment method with low complication rates in early-stage non-small cell lung carcinoma and lung metastases. Radiofrequency ablation and microwave ablation are commonly used for this purpose. PURPOSE To evaluate the factors affecting the success of the percutaneous thermal ablation treatment with technical success, complication rates, and long-term follow-up results in metastatic lung lesions. MATERIAL AND METHODS Computed tomography (CT)-guided percutaneous ablation was performed for 70 metastatic lung lesions in 35 patients (22 men, 13 women; mean age = 61.34 years; age range = 41-75 years). Radiofrequency ablation was performed in 53/70 (75.7%) lesions and microwave ablation in 17/70 (24.3%) lesions. RESULTS The technical success rate was 98.6%. Median overall survival, progression-free survival, and local recurrence-free survival of the patients were 33.9 months (range=25.6-42.1 months), 12 months (range=4.9-19.2 months), and 24.2 months (range=8.2-40.1 months), respectively. One- and two-year overall survival rates were 84% and 74%, respectively. Median progression-free survival times were 20.3 months and 11.4 months, respectively, according to the number of metastatic lung lesions being single and multiple, and the difference was statistically significant (P = 0.046). According to the number of lesions ≤3 and >3, the difference was also found statistically significant (P = 0.024) (14.3 months and 5.7 months, respectively). CONCLUSION In conclusion, CT-guided percutaneous thermal ablation is a safe and effective treatment method in metastatic lung lesions. The number of lesions is the most important factor in predicting treatment success.
Collapse
Affiliation(s)
- Onur Ergun
- Department of Radiology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
| | - Erdem Birgi
- Department of Radiology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Azad Hekimoğlu
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Önder Eraslan
- Department of Radiology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
| | - Hasan Ali Durmaz
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Cengiz Karaçin
- Department of Medical Oncology, Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Gökşen İnanç İmamoğlu
- Department of Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tülay Eren
- Department of Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Doğan Yazılıtaş
- Department of Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Baki Hekimoğlu
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| |
Collapse
|
3
|
Golin M, Izaaryene J, Dassa M, Piana G, Ferre M. An ultra-low-dose protocol for computed tomography-guided lung radiofrequency ablations. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:041510. [PMID: 36575991 DOI: 10.1088/1361-6498/acabd2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
To evaluate the safety and efficacy of ultra-low-dose (ULD) protocol for computed tomography (CT)-guided lung radiofrequency ablation (RFA). Patients who had undergone lung RFA between November 2017 and January 2021 were consecutively and retrospectively included. Thirty patients were treated using a conventional standard protocol (SP), including helical acquisitions with mA automatic adjustment and sequential CT at 80 kVp; and 31, with a ULD protocol defined with helical acquisitions with fixed mA and sequential series at 100 kVp. These parameters were selected from those used for a diagnostic lung low-dose CT scanner. Patient characteristics, dose indicators, technical efficacy (minimal margin [MM], recurrence during follow-up), and complications (pneumothorax, alveolar haemorrhage, and haemoptysis) were recorded. We included 61 patients (median age, 65 [54-73] and 33 women), with no significant differences according to the type of protocol, except for the type of anaesthesia. Even if the number of helical acquisitions did not significantly change, all dose indicators significantly decreased by 1.5-fold-3-fold. The median dose-length-product and effective dose, with their ranges, respectively, were 465 mGy cm (315-554) and 6.5 mSv (4.4-7.8) in the SP group versus 178 mGy cm (154-267) and 2.5 mSv (2.2-3.7) in the ULD group, (p< 001). The ULD group exhibited lower intraoperator variability and better interoperator alignment than those of the SP group. The MM was not significantly different between the two groups (4.6 mm versus 5 mm,p= 16). One local recurrence was observed in each group at 8 months in the SP and at one year in the ULD group (p= 1). The complication rates did not differ significantly. Implementing an ULD protocol during lung RFA may provide similar efficacy, a reduction of dose indicators, and intra- and interoperator variability, without increasing complication rates, compared to those associated with an SP.
Collapse
Affiliation(s)
- Melissa Golin
- Interventional Radiology Department, Institute Paoli Calmettes, Aix Marseille University Institute Paoli Calmettes, 232 boulevard Sainte Marguerite, Marseille, 13009, France
| | - Jean Izaaryene
- Interventional Radiology Department, Institute Paoli Calmettes, Aix Marseille University Institute Paoli Calmettes, 232 boulevard Sainte Marguerite, Marseille, 13009, France
| | - Michael Dassa
- Interventional Radiology Department, Institute Paoli Calmettes, Aix Marseille University Institute Paoli Calmettes, 232 boulevard Sainte Marguerite, Marseille, 13009, France
| | - Gilles Piana
- Interventional Radiology Department, Institute Paoli Calmettes, Aix Marseille University Institute Paoli Calmettes, 232 boulevard Sainte Marguerite, Marseille, 13009, France
| | - Marjorie Ferre
- Interventional Radiology Department, Institute Paoli Calmettes, Aix Marseille University Institute Paoli Calmettes, 232 boulevard Sainte Marguerite, Marseille, 13009, France
| |
Collapse
|
4
|
Zuo T, Lin W, Liu F, Xu J. Artificial pneumothorax improves radiofrequency ablation of pulmonary metastases of hepatocellular carcinoma close to mediastinum. BMC Cancer 2021; 21:505. [PMID: 33957875 PMCID: PMC8101170 DOI: 10.1186/s12885-021-08223-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 04/20/2021] [Indexed: 02/08/2023] Open
Abstract
Background To investigate the feasibility, safety and efficacy of percutaneous radiofrequency ablation (RFA) of pulmonary metastases from hepatocellular carcinoma (HCC) contiguous with the mediastinum using the artificial pneumothorax technique. Method A total of 40 lesions in 32 patients with pulmonary metastases from HCC contiguous with the mediastinum accepted RFA treatment from August 2014 to May 2018 via the artificial pneumothorax technique. After ablation, clinical outcomes were followed up by contrast enhanced CT. Technical success, local tumor progression (LTP), intrapulmonary distant recurrence (IDR), and adverse events were evaluated. Overall survival (OS) and local tumor progression free survival (LTPFS) were recorded for each patient. Results The tumor size was 1.4 ± 0.6 cm in diameter. RFA procedures were all successfully performed without intra-ablative complications. Technical success was noted in 100% of the patients. Five cases of LTP and 8 cases of IDR occurred following the secondary RFA for treatment. Slight pain was reported in all patients. No major complications were observed. The 1, 2, and 3-year LTPFS rates were 90.6, 81.2, and 71.8%, and the 1, 2, and 3-year OS rates were 100, 100 and 87.5%, respectively. Conclusion Artificial pneumothorax adjuvant RFA is a feasible, safe, and efficient method for treatment of pulmonary metastases from HCC contiguous with the mediastinum.
Collapse
Affiliation(s)
- Taiyang Zuo
- Department of Interventional Oncology, Jinan Central Hospital Affiliated to Shandong University, Jinan, 250013, Shandong, China.,Department of Interventional Radiology, Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853, Shandong, China
| | - Wenli Lin
- Department of Interventional Oncology, Jinan Central Hospital Affiliated to Shandong University, Jinan, 250013, Shandong, China
| | - Fengyong Liu
- Department of Interventional Oncology, Jinan Central Hospital Affiliated to Shandong University, Jinan, 250013, Shandong, China.,Department of Interventional Radiology, Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853, Shandong, China
| | - Jinshun Xu
- Department of Interventional Oncology, Jinan Central Hospital Affiliated to Shandong University, Jinan, 250013, Shandong, China. .,Department of Interventional Radiology, Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, 100853, Shandong, China. .,Department of Medical Ultrasound, Laboratory of Ultrasound Imaging Drug, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
5
|
Standardizing percutaneous Microwave Ablation in the treatment of Lung Tumors: a prospective multicenter trial (MALT study). Eur Radiol 2020; 31:2173-2182. [PMID: 32997180 DOI: 10.1007/s00330-020-07299-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/27/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To prospectively assess reproducibility, safety, and efficacy of microwave ablation (MWA) in the treatment of unresectable primary and secondary pulmonary tumors. METHODS Patients with unresectable primary and metastatic lung tumors up to 4 cm were enrolled in a multicenter prospective clinical trial and underwent CT-guided MWA. Treatments were delivered using pre-defined MW power and duration settings, based on target tumor size and histology classifications. Patients were followed for up to 24 months. Treatment safety, efficacy, and reproducibility were assessed. Ablation volumes were measured at CT scan and compared with ablation volumes obtained on ex vivo bovine liver using equal treatment settings. RESULTS From September 2015 to September 2017, 69 MWAs were performed in 54 patients, achieving technical success in all cases and treatment completion without deviations from the standardized protocol in 61 procedures (88.4%). Immediate post-MWA CT scans showed ablation dimensions smaller by about 25% than in the ex vivo model; however, a remarkable volumetric increase (40%) of the treated area was observed at 1 month post-ablation. No treatment-related deaths nor complications were recorded. Treatments of equal power and duration yielded fairly reproducible ablation dimensions at 48-h post-MWA scans. In comparison with the ex vivo liver model, in vivo ablation sizes were systematically smaller, by about 25%. Overall LPR was 24.7%, with an average TLP of 8.1 months. OS rates at 12 and 24 months were 98.0% and 71.3%, respectively. CONCLUSIONS Percutaneous CT-guided MWA is a reproducible, safe, and effective treatment for malignant lung tumors up to 4 cm in size. KEY POINTS • Percutaneous MWA treatment of primary and secondary lung tumors is a repeatable, safe, and effective therapeutic option. • It provides a fairly reproducible performance on both the long and short axis of the ablation zone. • When using pre-defined treatment duration and power settings according to tumor histology and size, LPR does not increase with increasing tumor size (up to 4 cm) for both primary and metastatic tumors.
Collapse
|
6
|
Picchi SG, Lassandro G, Bianco A, Coppola A, Ierardi AM, Rossi UG, Lassandro F. RFA of primary and metastatic lung tumors: long-term results. Med Oncol 2020; 37:35. [PMID: 32219567 DOI: 10.1007/s12032-020-01361-1] [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] [Received: 01/17/2020] [Accepted: 03/10/2020] [Indexed: 12/27/2022]
Abstract
The aim of our study is a retrospective evaluation of effectiveness and safety of Computed Tomography (CT)-guided radiofrequency ablation (RFA) therapy of primary and metastatic lung lesions in patients that cannot be considered surgical candidates. From February 2007 to September 2017, we performed 264 CT-guided ablation sessions on 264 lesions in 174 patients (112 M and 62 F; mean age, 68 years; range 36-83 years) affected by primary and metastatic lung lesions. The 45% of patients was affected by primary lung cancer, with size range lesion of 10-50 mm, and the 55% by metastatic lung lesions with size range of 5-49 mm. All patients had no more than three metastases in the lung and pulmonary relapses were treated up to three times. Overall Survival (OS), Progression-Free Survival (PFS), Local Progression-Free Survival (LPFS) and Cancer-specific survival (CSS) at 1, 3 and 5 years were calculated both in primary lung tumors and in metastatic patients. Immediate and late RFA-related complications were reported. Pulmonary function tests were evaluated after the procedures. The effectiveness of RFA treatment was evaluated by contrast-enhanced CT. In patients affected by primary lung lesions, the OS rates were 66.73% at 1 year, 23.13% at 3 years and 16.19% at 5 years. In patients affected by metastatic lung lesions, the OS rates were 85.11%, 48.86% and 43.33%, respectively, at 1, 3 and 5 years. PFS at 1, 3 and 5 years were 79.8%, 60.42%, 15.4% in primary lung tumors and 78.59%, 51.8% and 6.07% in metastatic patients. LPFS at 1, 3 and 5 years were 79.8%, 64.69%, 18.87% in primary lung tumors and 86.29%, 69.15% and 44.45% in metastatic patients. CSS at 1, 3 and 5 years was 95.56%, 71.84%, 56.72% in primary lung tumors and 94.07%, 71% and 71% in metastatic patients. Immediate RFA-related complications (pneumothorax, pleural effusion and subcutaneous emphysema) were observed, respectively, in 42, 53 and 13 of 264 procedures (15.9%, 20% and 5%). There also occurred one major complication (lung abscess, 0.36%). No significant worsening of pulmonary function was noted. Our retrospective evaluation showed long-term effectiveness, safety and imaging features of CT-guided RFA in patients affected by primary and metastatic lung cancer as an alternative therapy in non-surgical candidates.
Collapse
Affiliation(s)
| | - Giulia Lassandro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Andrea Bianco
- Department of Pulmonology, Luigi Vanvitelli University, Naples, Italy
| | | | - Anna Maria Ierardi
- UOC Radiology Fondazione IRCSS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Umberto G Rossi
- Department of Diagnostic Imaging - Interventional Radiology Unit - EO Galliera Hospital, Genoa, Italy
| | | |
Collapse
|
7
|
Venturini M, Cariati M, Marra P, Masala S, Pereira PL, Carrafiello G. CIRSE Standards of Practice on Thermal Ablation of Primary and Secondary Lung Tumours. Cardiovasc Intervent Radiol 2020; 43:667-683. [PMID: 32095842 DOI: 10.1007/s00270-020-02432-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 02/10/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, Varese, Italy.
| | - Maurizio Cariati
- Department of Diagnostic and Interventional Radiology, ASST Santi Carlo e Paolo Hospital, Milan, Italy
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital Bergamo, Milano-Bicocca University, Milan, Italy
| | - Salvatore Masala
- Department of Radiology, San Giovanni Battista Hospital, Tor Vergata University, Rome, Italy
| | - Philippe L Pereira
- Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK-Kliniken GmbH, Heilbronn, Germany
| | - Gianpaolo Carrafiello
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
8
|
|
9
|
Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol 2018; 29:1483-1501.e2. [DOI: 10.1016/j.jvir.2018.06.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 02/08/2023] Open
|
10
|
Zhao Q, Tian G, Chen F, Zhong L, Jiang T. CT-guided percutaneous laser ablation of metastatic lung cancer: three cases report and literature review. Oncotarget 2018; 8:2187-2196. [PMID: 27974695 PMCID: PMC5356791 DOI: 10.18632/oncotarget.13901] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/22/2016] [Indexed: 01/06/2023] Open
Abstract
Objective To report the efficacy and safety of CT-guided percutaneous laser ablation (PLA) for metastatic lung tumors. Methods Three cases of metastatic lung cancer underwent CT-guided PLA, and we searched for previously published articles on the minimally invasive CT-guided RFA or MWA for lung tumors in recent five years. Results With the guidance of CT, all lesions had good prognosis under laser ablation. Case 1 suffering from severe pulmonary dysfunction and diffuse pulmonary bullae, had small pneumothorax. CT scan obtained four months following the ablation showed two lesions had complete responses and one partial response. Case 2 had successful complete response with absent lung mass, and also had a good postoperative condition without any discomfort in the two-month follow-up. Case 3 showed partial response and improved greatly after five months. 962 cases (mean age of 45.7 years, 62.2% male) of 1297 lung tumors with detailed information were identified from 27 articles. Of these cases, the minority manifested complications such as pneumothorax, hemoptysis, hemothorax, pneumonia, pain and fever. Conclusions Percutaneous CT-guided PLA could be a safe and promising minimally invasive treatment for patients with primary lung cancer or unresectable pulmonary metastases, especially multineedle PLA in large tumors, which still needs more large-scale prospective studies to convince this method in the future.
Collapse
Affiliation(s)
- Qiyu Zhao
- Department of Ultrasonography, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guo Tian
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fen Chen
- Department of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liyun Zhong
- Department of Ultrasonography, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian'an Jiang
- Department of Ultrasonography, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
11
|
Macchi M, Belfiore MP, Floridi C, Serra N, Belfiore G, Carmignani L, Grasso RF, Mazza E, Pusceddu C, Brunese L, Carrafiello G. Radiofrequency versus microwave ablation for treatment of the lung tumours: LUMIRA (lung microwave radiofrequency) randomized trial. Med Oncol 2017; 34:96. [PMID: 28417355 DOI: 10.1007/s12032-017-0946-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/04/2017] [Indexed: 12/24/2022]
Abstract
The LUMIRA trial evaluated the effectiveness of radiofrequency (RFA) and microwave ablation (MWA) in lung tumours ablation and defining more precisely their fields of application. It is a controlled prospective multi-centre random trial with 1:1 randomization. Fifty-two patients in stage IV disease (15 females and 37 males, mean age 69 y.o., range 40-87) were included. We randomized the patients in two different subgroups: MWA group and RFA group. For each group, we evaluated the technical and clinical success, the overall survival and complication rate. Inter-group difference was compared using Chi-square test or Fisher's exact test for categorical variables and one-way ANOVA test for continuous variables. For RFA group, there was a significant reduction in tumour size only between 6 and 12 months (p value = 0.0014). For MWA group, there was a significant reduction in tumour size between 6 and 12 months (p value = 0.0003) and between pre-therapy and 12 months (p value = 0.0215). There were not significant differences between the two groups in terms of survival time (p value = 0.883), while the pain level in MWA group was significantly less than in RFA group (1.79 < 3.25, p value = 0.0043). In conclusion, our trial confirms RFA and MWA are both excellent choices in terms of efficacy and safety in lung tumour treatments. However, when compared to RFA therapy, MWA produced a less intraprocedural pain and a significant reduction in tumour mass.
Collapse
Affiliation(s)
- M Macchi
- Department of Radiology, Circolo e Fondazione Macchi Hospital, Insubria University, Varese, Italy
| | - M P Belfiore
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Floridi
- Radiology Department, Fatebenefratelli Hospital, Milan, Italy.
| | - N Serra
- Department of Radiology and Radiotherapy, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - G Belfiore
- Department of Radiology, Sant'Anna e San Sebastiano Hospital, Caserta, Italy
| | - L Carmignani
- Interventional Radiology Unit, San Jacopo Hospital, Pistoia, Italy
| | - R F Grasso
- Department of Diagnostic and Interventional Radiology, Campus Bio-Medico University, Rome, Italy
| | - E Mazza
- Interventional Radiology Unit, Careggi Hospital, Florence, Italy
| | - C Pusceddu
- Division of Interventional Radiology, Department of Oncological Radiology, Oncological Hospital "A. Businco", Cagliari, Italy
| | - L Brunese
- Department of Radiology, University of Molise, Campobasso, Italy
| | - G Carrafiello
- Department of Radiology, San Paolo Hospital, University of Milan, Milan, Italy
| |
Collapse
|
12
|
Iguchi T, Hiraki T, Gobara H, Fujiwara H, Sakurai J, Matsui Y, Mitsuhashi T, Toyooka S, Kanazawa S. Radiofrequency ablation of pulmonary tumors near the diaphragm. Diagn Interv Imaging 2017; 98:535-541. [PMID: 28236589 DOI: 10.1016/j.diii.2017.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 01/07/2017] [Accepted: 01/11/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE To retrospectively evaluate the feasibility, safety, and efficacy of radiofrequency ablation (RFA) of lung tumors located near the diaphragm. MATERIALS AND METHODS A total of 26 patients (15 men, 11 women; mean age, 61.5 years±13.0 [SD]) with a total of 29 lung tumors near the diaphragm (i.e., distance<10mm) were included. Mean tumor diameter was 11.0mm±5.3 (SD) (range, 2-23mm). Efficacy of RFA, number of adverse events and number of adverse events with a grade≥3, based on the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0, were compared between patients with lung tumors near the diaphragm and a control group of patients with more distally located lung tumors (i.e., distance≥10mm). RESULTS RFA was technically feasible for all tumors near the diaphragm. Four grade 3 adverse events (1 pneumothorax requiring pleurodesis and 3 phrenic nerve injuries) were observed. No grade≥4 adverse events were reported. The median follow-up period for tumors near the diaphragm was 18.3 months. Local progression was observed 3.3 months after RFA in 1 tumor. The technique efficacy rates were 96.2% at 1 year and 96.2% at 2 years and were not different, from those observed in control subjects (186 tumors; P=0.839). Shoulder pain (P<0.001) and grade 1 pleural effusion (P<0.001) were more frequently observed in patients with lung tumor near the diaphragm. The rates of grade≥3 adverse events did not significantly differ between tumors near the diaphragm (4/26 sessions) and the controls (7/133 sessions) (P=0.083). CONCLUSION RFA is a feasible and effective therapeutic option for lung tumors located near the diaphragm. However, it conveys a higher rate of shoulder pain and asymptomatic pleural effusion by comparison with more distant lung tumors.
Collapse
Affiliation(s)
- T Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku, Okayama 700-8558, Japan.
| | - T Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku, Okayama 700-8558, Japan.
| | - H Gobara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku, Okayama 700-8558, Japan.
| | - H Fujiwara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku, Okayama 700-8558, Japan.
| | - J Sakurai
- Center for Innovative Clinical Medicine, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku, Okayama 700-8558, Japan.
| | - Y Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku, Okayama 700-8558, Japan.
| | - T Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku, Okayama 700-8558, Japan.
| | - S Toyooka
- Department of General Thoracic Surgery, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku, Okayama 700-8558, Japan; Department of Clinical Genomic Medicine, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku, Okayama 700-8558, Japan.
| | - S Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku, Okayama 700-8558, Japan.
| |
Collapse
|
13
|
Sato T, Iguchi T, Hiraki T, Gobara H, Fujiwara H, Sakurai J, Matsui Y, Mitsuhashi T, Soh J, Toyooka S, Kanazawa S. Radiofrequency ablation of pulmonary metastases from sarcoma: single-center retrospective evaluation of 46 patients. Jpn J Radiol 2016; 35:61-67. [PMID: 27864664 DOI: 10.1007/s11604-016-0601-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/08/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE This retrospective, single-center study evaluated radiofrequency (RF) ablation for pulmonary metastases of sarcoma. MATERIALS AND METHODS Forty-six patients with sarcoma (144 pulmonary metastases) underwent 88 RF ablation sessions. Data regarding local tumor progression, efficacy, procedural adverse events (AEs; National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0), overall survival (OS), and OS-associated prognostic factors were retrospectively evaluated using univariate analyses. RESULTS Local progression occurred in 22 of 144 tumors (15.3%). Primary and secondary efficacy rates were 83.5 and 90.0% at 1 year and 76.3 and 81.4% at 2 years, respectively. Seventy-three grade 1 AEs, 33 grade 2 AEs, and no grade ≥ 3 AEs were observed. Twenty-eight patients (60.9%) remained alive and 18 died, yielding 1-, 2-, and 3-year OS rates of 80.6, 70.1, and 47.1% (median survival time, 31.7 months). Univariate analysis revealed extrapulmonary metastasis (P = 0.005), noncurative RF ablation (P = 0.009), and a post-RF ablation disease-free interval of ≤12 months (P = 0.015) as significant negative prognostic factors. CONCLUSION RF ablation is safe, offers good local control, and may be a viable treatment option for pulmonary metastasis of sarcoma.
Collapse
Affiliation(s)
- Takuya Sato
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroyasu Fujiwara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Jun Sakurai
- Center for Innovative Clinical Medicine, Okayama University Medical School, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Medical School, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Junichi Soh
- General Thoracic Surgery, Okayama University Medical School, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shinichi Toyooka
- General Thoracic Surgery, Okayama University Medical School, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Clinical Genomic Medicine, Okayama University Medical School, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| |
Collapse
|
14
|
23 Lung Metastases Treated by Radiofrequency Ablation Over 10 Years in a Single Patient: Successful Oncological Outcome of a Metastatic Cancer Without Altered Respiratory Function. Cardiovasc Intervent Radiol 2016; 39:1779-1784. [PMID: 27501796 DOI: 10.1007/s00270-016-1445-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/01/2016] [Indexed: 01/23/2023]
Abstract
An 82-year-old man, who was diagnosed in 2002 with an oncocytic (Hürthle cell) thyroid carcinoma, was initially treated by local surgery and was refractory to radioiodine treatment. The patient had successive secondary recurrences from 2006 onwards. Metastases were suspected due to an elevation of thyroglobulin in serum. Hypermetabolic nodules were targeted using FDG PET as well as CT-guided radiofrequency ablations. Thyroglobulin levels decreased following each procedure. 10 years later, tolerance and efficacy are excellent; 23 lung metastases have been treated during 11 sessions without current relapse. Respiratory function and quality of life are not altered. This report illustrates how radiofrequency ablation can be efficiently integrated into the long-term management of poorly aggressive oligometastatic cancer, in combination with other local and/or systemic therapies.
Collapse
|
15
|
Ablation protocols and ancillary procedures in tumor ablation therapy: consensus from Japanese experts. Jpn J Radiol 2016; 34:647-56. [DOI: 10.1007/s11604-016-0569-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/12/2016] [Indexed: 12/27/2022]
|
16
|
Lafuente S, Fuster D, Arguis P, Granados U, Perlaza P, Paredes P, Vollmer I, Sánchez M, Lomeña F. Dual time-point 18 F-FDG PET/CT to assess response to radiofrequency ablation of lung metastases. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2015.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
17
|
Tselikas L, de Baere T, Deschamps F, Hakimé A, Besse B, Teriitehau C, de Montpreville V, Adam J. Diagnostic yield of a biopsy performed immediately after lung radiofrequency ablation. Eur Radiol 2016; 27:1211-1217. [PMID: 27300196 DOI: 10.1007/s00330-016-4447-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 04/24/2016] [Accepted: 05/23/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of lung biopsies performed immediately after radiofrequency ablation (RFA). METHODS Twenty consecutive patients were treated with lung RFA. A biopsy was performed immediately after RFA, through the cannula used to insert the RFA probe to avoid hampering the RFA probe placement. Biopsies were analysed for diagnostic of malignancy and tumour morphological characteristics. Recurrence of RFA and procedure-related complications are reported. RESULTS Mean tumour size was 17.3 mm (±6.2 mm). Ninety per cent (18/20) of biopsies were able to help diagnose malignancy. Cancer subtype and origin were determined in 70 % (14/20) of tumours, including 12 metastases and two primary lung cancers. During a median follow-up of 24 months, one tumour demonstrated local progression (5 %). The overall survival, lung disease-free survival and progression-free survival rates at 12 months were 100 %, 75 % and 65 %, respectively. Adverse events of the procedure including RFA and biopsy were five pneumothoraces requiring chest tube placement (25 %), seven minor pneumothoraces (35 %) and one subsegmental intrapulmonary haemorrhage (5 %) not requiring any treatment. CONCLUSIONS A biopsy performed immediately after lung RFA allowed diagnosis of malignancy in 90 % of cases. This diagnosis is obtained without the need for additional puncture and does not hamper the accuracy of the initial RF probe placement. KEY POINTS • Treatment and biopsy are feasible during the same procedure, avoiding multiple punctures. • The best puncture path can be preserved to treat the lung tumour. • Malignancy can be determined on a post-RFA biopsy in 90 % of cases. • Cancer classification can be assessed in 70 % of cases after lung RFA.
Collapse
Affiliation(s)
- Lambros Tselikas
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, F-94805, Villejuif, France.
| | - Thierry de Baere
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, F-94805, Villejuif, France
| | - Frederic Deschamps
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, F-94805, Villejuif, France
| | - Antoine Hakimé
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, F-94805, Villejuif, France
| | - Benjamin Besse
- Medical Oncology Department, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Christophe Teriitehau
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, F-94805, Villejuif, France
| | - Vincent de Montpreville
- Department of Pathology, Institut d'Oncologie Thoracique, Centre Chirurgical Marie Lannelongue, 92350, Le Plessis Robinson, France
| | - Julien Adam
- Department of Pathology, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| |
Collapse
|
18
|
Bhatia S, Pereira K, Mohan P, Narayanan G, Wangpaichitr M, Savaraj N. Radiofrequency ablation in primary non-small cell lung cancer: What a radiologist needs to know. Indian J Radiol Imaging 2016; 26:81-91. [PMID: 27081229 PMCID: PMC4813080 DOI: 10.4103/0971-3026.178347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Lung cancer continues to be one of the leading causes of death worldwide. In advanced cases of lung cancer, a multimodality approach is often applied, however with poor local control rates. In early non-small cell lung cancer (NSCLC), surgery is the standard of care. Only 15-30% of patients are eligible for surgical resection. Improvements in imaging and treatment delivery systems have provided new tools to better target these tumors. Stereotactic body radiation therapy (SBRT) has evolved as the next best option. The role of radiofrequency ablation (RFA) is also growing. Currently, it is a third-line option in stage 1 NSCLC, when SBRT cannot be performed. More recent studies have demonstrated usefulness in recurrent tumors and some authors have also suggested combination of RFA with other modalities in larger tumors. Following the National Lung Screening Trial (NLST), screening by low-dose computed tomography (CT) has demonstrated high rates of early-stage lung cancer detection in high-risk populations. Hence, even considering the current role of RFA as a third-line option, in view of increasing numbers of occurrences detected, the number of potential RFA candidates may see a steep uptrend. In view of all this, it is imperative that interventional radiologists be familiar with the techniques of lung ablation. The aim of this article is to discuss the procedural technique of RFA in the lung and review the current evidence regarding RFA for NSCLC.
Collapse
Affiliation(s)
- Shivank Bhatia
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, Florida, USA
| | - Keith Pereira
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, Florida, USA
| | - Prasoon Mohan
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, Florida, USA
| | - Govindarajan Narayanan
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami Hospital, Miami, Florida, USA
| | - Medhi Wangpaichitr
- Department of Surgery, Jackson Memorial Hospital, University of Miami Hospital, Miami, Florida, USA
| | - Niramol Savaraj
- Department of Hematology and Oncology, Veterans Affairs Medical Center, Miami, Florida, USA
| |
Collapse
|
19
|
Lafuente S, Fuster D, Arguis P, Granados U, Perlaza P, Paredes P, Vollmer I, Sánchez M, Lomeña F. Dual time-point (18)F-FDG PET/CT to assess response to radiofrequency ablation of lung metastases. Rev Esp Med Nucl Imagen Mol 2016; 35:226-31. [PMID: 26848142 DOI: 10.1016/j.remn.2015.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 11/16/2022]
Abstract
AIM To establish the usefulness of dual time-point PET/CT imaging in determining the response to radiofrequency ablation (RFA) of solitary lung metastases from gastrointestinal cancer. MATERIALS AND METHODS This prospective study included 18 cases (3 female, 15 male, mean age 71±15 yrs) with solitary lung metastases from malignant digestive tract tumors candidates for RFA. PET/CT images 1h after injection of 4.07MBq/kg of (18)F-FDG (standard images) were performed at baseline, 1 month, and 3 months after RFA. PET/CT images 2h after injection centered in the thorax at 1 month after RFA were also performed (delayed images). A retention index (RI) of dual time-point images was calculated as follows: RI=(SUVmax delayed image-SUVmax standard image/SUVmax standard image)*100. Pathological confirmation of residual tumor by histology of the treated lesion was considered as local recurrence. A negative imaging follow-up was considered as complete response. RESULTS Local recurrence was found in 6/18 lesions, and complete response in the remaining 12. The mean percentage change in SUVmax at 1 month and at 3 months showed a sensitivity and specificity for PET/CT of 50% and 33%, and 67% and 92%, respectively. The RI at 1 month after RFA showed a sensitivity and specificity of 83% and 92%, respectively. CONCLUSIONS Dual time point PET/CT can predict the outcome at one month after RFA in lung metastases from digestive tract cancers. The RI can be used to indicate the need for further procedures to rule out persistent tumor due to incomplete RFA.
Collapse
Affiliation(s)
- S Lafuente
- Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain
| | - D Fuster
- Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain.
| | - P Arguis
- Radiology Department, Hospital Clínic, Barcelona, Spain
| | - U Granados
- Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain
| | - P Perlaza
- Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain
| | - P Paredes
- Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain
| | - I Vollmer
- Radiology Department, Hospital Clínic, Barcelona, Spain
| | - M Sánchez
- Radiology Department, Hospital Clínic, Barcelona, Spain
| | - F Lomeña
- Nuclear Medicine Department, Hospital Clínic, Barcelona, Spain
| |
Collapse
|
20
|
Iguchi T, Hiraki T, Ishii H, Gobara H, Fujiwara H, Matsui Y, Kanazawa S. Transosseous Route for CT Fluoroscopy-Guided Radiofrequency Ablation of Lung Tumors. J Vasc Interv Radiol 2015; 26:1694-8. [PMID: 26432461 DOI: 10.1016/j.jvir.2015.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 07/20/2015] [Accepted: 08/12/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To retrospectively evaluate radiofrequency (RF) ablation of lung tumors performed via the transosseous approach. MATERIALS AND METHODS Twelve lung tumors (mean diameter, 1.0 cm; range, 0.4-1.6 cm) in 12 patients were treated by RF ablation via a transscapular and/or transrib route with the use of a bone biopsy needle under computed tomographic fluoroscopy guidance. Therapeutic outcomes evaluated included feasibility, safety, and local efficacy. Complications were assessed based on the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. RESULTS The transosseous route was successfully employed in all patients, and the electrode was successfully advanced into all tumors with this approach. The mean distance of penetrated bone was 0.57 cm (range, 0.19-1.16 cm). Complications occurred in eight RF ablation sessions, including six grade 1 events (two cases of pneumothorax and one case each of asymptomatic rib fracture 6 mo after treatment, neuralgia, pulmonary hemorrhage, and hemothorax), two grade 2 events (pneumonia and high fever), and one grade 3 event (pneumothorax requiring pleurodesis). No adverse events of grade ≥ 4 occurred. The mean and median tumor follow-up periods were 19.5 and 15.2 mo (range, 3.0-41.5 mo). Local progression occurred in two cases at 3 and 12 mo after treatment and was successfully treated with a second RF ablation procedure. The technique efficacy rates were 91.7% at 6 mo, 81.5% at 1 y, and 81.5% at 2 y. CONCLUSIONS The transosseous approach was feasible in computed tomographic fluoroscopy-guided RF ablation of select lung tumors when no other option was available.
Collapse
Affiliation(s)
- Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan.
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Hiroaki Ishii
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Hiroyasu Fujiwara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| |
Collapse
|
21
|
Plasencia Martínez J. Radiofrecuencia pulmonar (Parte 2): procedimiento y seguimiento. RADIOLOGIA 2015; 57:287-302. [DOI: 10.1016/j.rx.2014.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 12/11/2014] [Accepted: 12/13/2014] [Indexed: 12/11/2022]
|
22
|
Pulmonary radiofrequency ablation (Part 1): Current state. RADIOLOGIA 2015. [DOI: 10.1016/j.rxeng.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
23
|
Plasencia Martínez J. Pulmonary radiofrequency ablation (Part 2): Procedure and follow-up. RADIOLOGIA 2015. [DOI: 10.1016/j.rxeng.2014.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
24
|
Plasencia Martínez JM. Pulmonary radiofrequency ablation (Part 1): current state. RADIOLOGIA 2015; 57:275-86. [PMID: 25766072 DOI: 10.1016/j.rx.2014.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 12/11/2014] [Accepted: 12/13/2014] [Indexed: 02/08/2023]
Abstract
The risks involved in surgical treatment and conventional radiotherapy in patients with early lung cancer or lung metastases often make these treatments difficult to justify. However, on the other hand, it is also unacceptable to allow these lesions to evolve freely because, left untreated, these neoplasms will usually lead to the death of the patient. In recent years, alternative local therapies have been developed, such as pulmonary radiofrequency ablation, which has proven to increase survival with a minimal risk of complications. There are common recommendations for these treatments, and although the specific indications for using one technique or another have yet to be established, there are clearly defined situations that will determine the outcome of the treatment. It is important to know these situations, because appropriate patient selection is essential for therapeutic success. This article aims to describe the characteristics and constraints of pulmonary radiofrequency ablation and to outline its role in thoracic oncology in light of the current evidence.
Collapse
Affiliation(s)
- J M Plasencia Martínez
- Servicio de Radiología. Hospital General Universitario Morales Meseguer, Murcia, España.
| |
Collapse
|
25
|
Iguchi T, Hiraki T, Gobara H, Fujiwara H, Matsui Y, Toyooka S, Nishizaki K, Kanazawa S. Radiofrequency ablation of lung metastases from adenoid cystic carcinoma of the head and neck: retrospective evaluation of nine patients. J Vasc Interv Radiol 2015; 26:703-8. [PMID: 25655029 DOI: 10.1016/j.jvir.2014.11.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/20/2014] [Accepted: 11/29/2014] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To retrospectively evaluate the outcomes of radiofrequency (RF) ablation of lung metastases from head and neck adenoid cystic carcinoma (ACC). MATERIALS AND METHODS Nine patients (two men and seven women; mean age, 61.6 y) with 45 lung metastases (mean diameter, 1.1 cm; range, 0.4-2.7 cm) from head and neck ACC underwent RF ablation in 30 sessions. Primary endpoints were technical success, technique effectiveness, and procedural complications. Secondary endpoints included overall survival (OS). RESULTS RF ablation was technically successful for all 45 metastases. The median tumor follow-up period was 37.1 months (range, 12.9-128.3 mo). Local progression occurred in six tumors, two of which were treated again and subsequently showed complete response. Major complications (pneumothorax requiring chest tube placement) occurred in five sessions (16.7%). The median patient follow-up period was 61.6 months (range, 20.5-134.5 mo). Two patients died of disease progression at 38.9 and 61.6 months after RF ablation, respectively, whereas the other seven remained alive at the end of the study. OS rates from the initial RF ablation were 100% at 3 years and 83.3% at 5 years (mean survival time, 106.4 mo). OS rates from the treatment of the primary site were 100% at 5 years and 62.5% at 10 years (mean survival time, 210.1 mo). CONCLUSIONS Radiofrequency ablation is an acceptable and effective local treatment for lung metastases from head and neck ACC. However, further study is needed to evaluate its effect on patient survival.
Collapse
Affiliation(s)
- Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan.
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Hiroyasu Fujiwara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan; Department of Clinical Genomic Medicine, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Kazunori Nishizaki
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, Okayama 700-8558, Japan
| |
Collapse
|
26
|
Ye X, Fan W. [Expert consensus for thermal ablation of primary and metastatic lung tumors]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 17:294-301. [PMID: 24758903 PMCID: PMC6000017 DOI: 10.3779/j.issn.1009-3419.2014.04.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - Weijun Fan
- Imaging Intervention Center, Cancer Center, Sun Yat-sen University, Guangzhou 510060, China
| | | |
Collapse
|
27
|
Ye X, Fan W, Chen JH, Feng WJ, Gu SZ, Han Y, Huang GH, Lei GY, Li XG, Li YL, Li ZJ, Lin ZY, Liu BD, Liu Y, Peng ZM, Wang H, Yang WW, Yang X, Zhai B, Zhang J. Chinese expert consensus workshop report: Guidelines for thermal ablation of primary and metastatic lung tumors. Thorac Cancer 2015; 6:112-21. [PMID: 26273346 PMCID: PMC4448461 DOI: 10.1111/1759-7714.12152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/16/2014] [Indexed: 12/31/2022] Open
Abstract
Although surgical resection is the primary means of curing both primary and metastatic lung cancers, about 80% of lung cancers cannot be removed by surgery. As most patients with unresectable lung cancer receive only limited benefits from traditional radiotherapy and chemotherapy, many new local treatment methods have emerged, including local ablation therapy. The Minimally Invasive and Comprehensive Treatment of Lung Cancer Branch, Professional Committee of Minimally Invasive Treatment of Cancer of the Chinese Anti-Cancer Association has organized multidisciplinary experts to develop guidelines for this treatment modality. These guidelines aim at standardizing thermal ablation procedures and criteria for selecting treatment candidates and assessing outcomes; and for preventing and managing post-ablation complications.
Collapse
Affiliation(s)
- Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Weijun Fan
- Imaging and Interventional Center, Sun Yat-sen University Cancer CenterGuangzhou, China
| | - Jun-hui Chen
- Department of Minimally Invasive Interventional Therapy, Shenzhen Hospital of Beijing UniversityShenzhen, China
| | - Wei-jian Feng
- Department of Oncology, Fuxing Hospital Affiliated to the Capital University of Medical SciencesBeijing, China
| | - Shan-zhi Gu
- Department of Interventional Therapy, Hunan Provincial Tumor HospitalChangsha, China
| | - Yue Han
- Department of Imaging, Tumor Institute and Hospital, Chinese Academy of Medical SciencesBeijing, China
| | - Guang-hui Huang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Guang-yan Lei
- Department of Thoracic Surgery, Shanxi Provincial Tumor HospitalXi'an, China
| | - Xiao-guang Li
- Department of Radiology, Peking Union Medical College HospitalBeijing, China
| | - Yu-liang Li
- Interventional Treatment Center, Shandong University Second HospitalJinan, China
| | - Zhen-jia Li
- Research Office of CT Diagnosis and Treatment, Shandong Provincial Institute of Medical ImagingJinan, China
| | - Zheng-yu Lin
- Department of Interventional Therapy, the First Affiliated Hospital of Fujian Medical UniversityFuzhou, China
| | - Bao-dong Liu
- Department of Thoracic Surgery, Xuanwu Hospital Affiliated to the Capital University of Medical SciencesBeijing, China
| | - Ying Liu
- Department of Oncology, Armed Police Hospital of Guangdong ProvinceGuangzhou, China
| | - Zhong-min Peng
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Hui Wang
- Interventional Treatment Center, Jilin Provincial Tumor HospitalChangchun, China
| | - Wu-wei Yang
- Department of Tumor Minimally Invasive Therapy, 307 HospitalBeijing, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Bo Zhai
- Tumor Interventional Therapy Center, Shanghai Renji HospitalShanghai, China
| | - Jun Zhang
- Center of Lung Cancer, the First Affiliated Hospital of China Medical UniversityShenyang, China
| |
Collapse
|
28
|
Palussiere J, Lagarde P, Aupérin A, Deschamps F, Chomy F, de Baere T. Percutaneous Lung Thermal Ablation of Non-surgical Clinical N0 Non-small Cell Lung Cancer: Results of Eight Years’ Experience in 87 Patients from Two Centers. Cardiovasc Intervent Radiol 2014; 38:160-6. [DOI: 10.1007/s00270-014-0999-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/07/2014] [Indexed: 12/25/2022]
|
29
|
|
30
|
Thermal ablation techniques: a curative treatment of bone metastases in selected patients? Eur Radiol 2014; 24:1971-80. [DOI: 10.1007/s00330-014-3202-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/11/2014] [Accepted: 04/23/2014] [Indexed: 12/11/2022]
|
31
|
Baba Y, Watanabe M, Yoshida N, Kawanaka K, Yamashita Y, Baba H. Radiofrequency ablation for pulmonary metastases from gastrointestinal cancers. Ann Thorac Cardiovasc Surg 2014; 20:99-105. [PMID: 24583709 DOI: 10.5761/atcs.ra.13-00343] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The lung is one of the most common targets of metastases from gastrointestinal (GI) cancers. Surgical treatment (i.e., metastasectomy) is an accepted therapeutic option for pulmonary metastases from GI cancers. However, surgery may be contraindicated in advanced stages of cancer, compromised lung function, and/or comorbidities. This issue has prompted the search for innovative and less invasive ways of treating pulmonary metastases. Image-guided radiofrequency ablation (RFA) has attracted great interest as a minimally invasive approach against intrathoracic malignancies. In this technique, radiofrequency energy is applied via a needle electrode inserted into the target tissue. As the cells are agitated by the applied energy, they release heat, causing denaturation and cell death. Recently, this technique has been used on patients with pulmonary metastatic disease arising from GI cancers such as colorectal cancer, esophageal cancer, and hepatocellular carcinoma, as well as on patients with primary lung cancer. The present review updates the clinical outcomes and advances in RFA therapy of lung metastases from GI cancers.
Collapse
Affiliation(s)
- Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Kumamoto, Japan
| | | | | | | | | | | |
Collapse
|
32
|
Baba Y, Watanabe M, Kawanaka K, Iwagami S, Ishimoto T, Iwatsuki M, Yoshida N, Yamashita Y, Baba H. Radiofrequency ablation for pulmonary metastases from esophageal squamous cell carcinoma. Dis Esophagus 2014; 27:36-41. [PMID: 23384275 DOI: 10.1111/dote.12034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Radiofrequency ablation (RFA) is increasingly being used for the treatment of intrathoracic malignancies. Although RFA has been found to be promising in the treatment of lung metastases from some types of neoplasms, little is known concerning its clinical significance in the treatment of pulmonary metastasis from esophageal squamous cell carcinoma (ESCC). This retrospective study evaluated the feasibility, safety, and effectiveness of computed tomography-guided RFA for pulmonary metastasis from ESCC. A series of 10 ESCC patients with 17 pulmonary tumors were included. Correct placement of the ablation device into the target tumor proved to be feasible in all tumors (100%). The mean visual analog scale score, with values that ranged from 0 (no pain) to 10 (worst pain possible), was 1. This suggested that this procedure was well tolerated. No procedure-related deaths occurred. A pneumothorax needing drainage was a major complication in two patients. Local control of ablated tumor lasting for at least 1 year was achieved in 10 (83%) of 12 assessable tumors. Although locoregional recurrences developed in two tumors, these lesions could be recontrolled by repeat treatment with RFA. Three patients died of recurrent disease. The predicted 1- and 2-year overall survival rates after lung RFA were 77.8% and 62.2%, respectively. Percutaneous computed tomography-guided RFA yielded relatively high levels of local control in patients with pulmonary metastases from ESCC and was associated with an acceptable level of complications. It was concluded that a prospective study will be necessary to evaluate the effectiveness of a combination of systemic therapy and RFA for ESCC lung metastases.
Collapse
Affiliation(s)
- Y Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Legras A, Mordant P, Cazes A, Riquet M. [Radiofrequency of lung metastases: should initial pneumothorax predict treatment failure?]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:336-339. [PMID: 24051188 DOI: 10.1016/j.pneumo.2013.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/01/2013] [Accepted: 04/09/2013] [Indexed: 06/02/2023]
Abstract
In the management of lung metastases originating from colorectal cancer, RFA is particularly indicated in case of major comorbidities contraindicating thoracic surgery or recurrent disease after previous ipsilateral resection. The most frequent complication of RFA is pneumothorax, requiring chest tube insertion in 5% of cases. Interestingly, this proportion is very close to the rate of local recurrence, suggesting a possible association. We report a case of RFA followed by intractable pneumothorax requiring surgical management, and leading to the diagnosis of residual tumour. This case report illustrates this association and questions its relevance.
Collapse
Affiliation(s)
- A Legras
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - P Mordant
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - A Cazes
- Service d'anatomie pathologique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, université Paris Descartes, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| |
Collapse
|
34
|
Garetto I, Busso M, Sardo D, Filippini C, Solitro F, Grognardi ML, Veltri A. Radiofrequency ablation of thoracic tumours: lessons learned with ablation of 100 lesions. Radiol Med 2013; 119:33-40. [PMID: 24234185 DOI: 10.1007/s11547-013-0308-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/02/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE Our aim was to analyse the results of our first 100 radiofrequency ablation (RFA) procedures, of primary (nonsmall-cell lung cancers, NSCLC) and secondary (MTS) lung cancers to assess what lessons could be learned from our experience. MATERIALS AND METHODS We analysed 100 lesions (mean size 23 mm) in 81 patients (25 NSCLC/56 MTS). On the basis of the clinical-radiological evolution, we analysed complete ablation (CA) versus partial ablation (PA) at the first computed tomography (CT) scan and during the follow-up (mean 23 months), time to progression (TTP) and survival. Possible predictive factors for local effectiveness and survival were sought. RESULTS At the first CT scan CA was obtained in 88 %; the difference between the mean diameter of lesions achieving CA and PA was significant (20 versus 38 mm; p = 0.0001). A threshold of 30 mm (p = 0.0030) and the histological type (NSCLC 75 %/MTS 94 %; p = 0.0305) were also predictive of CA. A total of 18.4 % of the CA recurred (average TTP 19 months). Survival at 1, 2 and 3 years was 84.5, 65.4 and 51.5 %, respectively. The predictors of survival at 3 years were the coexistence of other MTS (p = 0.0422) and a diameter <20 mm (p = 0.0323), but not the local effectiveness of RFA. CONCLUSION RFA for thoracic malignancies is accurate for lesions up to 30 mm, especially if metastatic; survival is more closely related to staging factors than to the local effectiveness of RFA.
Collapse
Affiliation(s)
- Irene Garetto
- Dipartimento di Oncologia, Istituto di Radiologia, Università di Torino, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | | | | | | | | | | | | |
Collapse
|
35
|
Ito N, Pfeffer J, Isfort P, Penzkofer T, Kuhl CK, Mahnken AH, Schmitz-Rode T, Bruners P. Bipolar radiofrequency ablation: development of a new expandable device. Cardiovasc Intervent Radiol 2013; 37:770-6. [PMID: 23892758 DOI: 10.1007/s00270-013-0703-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/19/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE To test the performance of an expandable bipolar probe as a simple technical solution for extending the coagulation volume. METHODS On the basis of a commercially available monopolar radiofrequency (RF) probe (LeVeen), an expandable bipolar RF probe was developed by integrating a second electrode into the probe shaft. The influence of length on the second electrode, and the distance between both electrodes and generator output was investigated by performing ten ablations for each condition on a freshly excised bovine liver. Macroscopically quantified coagulation volumes, lesion shape characteristics, and procedure durations were recorded. Results of the prototype featuring the optimal configuration were compared to the original LeVeen probe and commonly used bipolar RF probe (CelonLabPower). RESULTS Extension of the shaft electrode length, increasing distance between the shaft electrode and the tip electrode, and reduction of generator output resulted in increasing coagulation volumes. The coagulation volumes the prototype generated were significantly smaller and more elliptically shaped than the monopolar probe (9.4 ± 1.5 cm(3) vs. 12.1 ± 1.6 cm(3)), but were larger than the commercially available bipolar RF probe (vs. 7.3 ± 0.5). The procedure duration of the prototype was comparable to the monopolar probe (467 ± 31 s vs. 464 ± 17 s) and shorter than the bipolar probe (vs. 2009 ± 444 s). In comparison to the commercially available bipolar system, the developed prototype exhibited favorable results. CONCLUSION The first benchmark testing of the developed bipolar prototype had promising results. However, further optimization of the applicator design and ablation protocol is needed to enlarge the achievable coagulation volume.
Collapse
Affiliation(s)
- Nobutake Ito
- Department for Diagnostic Radiology, RWTH Aachen University, Aachen, Germany,
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Palussière J, Canella M, Cornelis F, Catena V, Descat E, Brouste V, Montaudon M. Retrospective review of thoracic neural damage during lung ablation - what the interventional radiologist needs to know about neural thoracic anatomy. Cardiovasc Intervent Radiol 2013; 36:1602-1613. [PMID: 23576208 DOI: 10.1007/s00270-013-0597-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 02/08/2013] [Indexed: 11/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- Jean Palussière
- Department of Interventional Radiology, Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux cedex, France.
| | - Mathieu Canella
- Department of Radiology, Centre Hospitalier Pau, 4 boulevard Hauterive, 64046, Pau Cedex, France
| | - François Cornelis
- Department of Interventional Radiology, Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux cedex, France
| | - Vittorio Catena
- Department of Interventional Radiology, Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux cedex, France
| | - Edouard Descat
- Department of Interventional Radiology, Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux cedex, France
| | - Véronique Brouste
- Clinical and Epidemiological Research Unit, Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux Cedex, France
| | - Michel Montaudon
- Department of Radiology, CHU Haut Lévêque, Avenue de Magellan, 33604, Pessac, France
| |
Collapse
|
37
|
Factors influencing local tumor control in patients with neoplastic pulmonary nodules treated with microwave ablation: a risk-factor analysis. AJR Am J Roentgenol 2013; 200:665-72. [PMID: 23436860 DOI: 10.2214/ajr.12.8721] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study was performed to evaluate risk factors predictive of local tumor control after microwave ablation of primary and secondary lung malignancies up to 3 cm in maximal diameter. MATERIALS AND METHODS The single-antenna microwave ablation treatment of 91 index tumors in 57 patients was studied retrospectively. Time to local tumor progression was monitored on CT scans over the follow-up period. Estimation of overall time to local tumor progression was performed with the Cox regression model. Factors hypothesized to correlate with ablation response included tumor diameter, tumor shape (round or oval versus irregular), clear versus ill-defined tumor margin, adjacency to the pleura, adjacency to bronchi, presence of vessels at least 3 mm in diameter a maximum of 5 mm from the index tumor, energy applied to the index tumor, and the occurrence of cavernous formations after ablation. A logistic regression model was used to correlate the data. RESULTS Thirty of 91 (33.0%) index tumors, found in 21 of 57 (36.8%) patients, underwent local progression. The mean time to local tumor progression was 8.3 ± 5.5 months (range 2.1-25.2 months), and the estimated median time to local tumor progression was 22.6 ± 12.4 months. The risk factors that correlated significantly with local tumor progression were a maximal diameter greater than 15.5 mm (p < 0.01), irregular shape of the index tumor (p < 0.01), pleural contact (p = 0.02), and less than 26.7 J/mm(3) applied to the index tumor (p < 0.001). After regression analysis, shape of the index tumor (p = 0.03) and energy deployed per unit volume of the index tumor (p = 0.001) were found to be independent risk factors. Conversely, tumor margin definition (p = 0.06) and proximity of cavernous formations (p = 0.19), juxtatumoral vessels (p = 0.08), and bronchi (p = 0.89) did not affect tumor progression after ablation. CONCLUSION The independent predictive factors for local tumor progression in primary and secondary lung neoplasms up to 3 cm in diameter observed in this study were irregular shape of the index tumor and energy application of less than 26.7 J/mm(3) to the index tumor.
Collapse
|
38
|
Baisi A, Raveglia F, De Simone M, Cioffi U. Recurrence after radiofrequency ablation for stage I non-small cell lung cancer. Ann Thorac Surg 2012; 94:1788-9; author reply 1788. [PMID: 23098979 DOI: 10.1016/j.athoracsur.2012.04.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 03/06/2012] [Accepted: 04/16/2012] [Indexed: 11/26/2022]
|
39
|
Baisi A, De Simone M, Raveglia F, Cioffi U. Thermal ablation in the treatment of lung cancer: present and future. Eur J Cardiothorac Surg 2012; 43:683-6. [PMID: 23096460 DOI: 10.1093/ejcts/ezs558] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alessandro Baisi
- Thoracic Surgery Unit, Azienda Ospedaliera San Paolo, University of Milan, Milan, Italy
| | | | | | | |
Collapse
|
40
|
Wiggermann P, Puls R, Vasilj A, Sieroń D, Schreyer AG, Jung EM, Wawrzynek W, Stroszczynski C. Thermal ablation of unresectable liver tumors: factors associated with partial ablation and the impact on long-term survival. Med Sci Monit 2012; 18:CR88-92. [PMID: 22293882 PMCID: PMC3560593 DOI: 10.12659/msm.882463] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Thermal ablation procedures, including radiofrequency ablation (RFA) or laser-induced interstitial thermotherapy (LITT), are now well established in the treatment of malignant unresectable hepatic tumors. But the impact of partial ablation (PA) on long-term survival following computed tomography (CT)-guided radiofrequency ablation and laser- induced interstitial thermotherapy of unresectable malignant liver lesions and the associated risk factors of PA remain partially unknown. Material/Methods This study included 254 liver tumors in 91 consecutive patients (66 men and 25 women; age 60.9±10.4 years; mean tumor size 25±14 mm [range 5–70 mm]) who underwent thermal ablation (RFA or LITT) between January 2000 and December 2007. Mean follow-up period was 21.1 month (range 1–69 months). Survival rate and local progression-free survival (PFS) were calculated for patients with complete ablation (CA) vs. patients with partial ablation (PA) to assess the impact on long-term survival. Results Median survival after CA was 47 months compared to 25 months after PA (P=0.04). The corresponding 5-year survival rates were 44% vs. 20%. Median PFS for CA was 11 months compared to 7 months for PA (P=0.118). The sole statistically significant risk factor for PA was tumor size (>30 mm; P=0.0003). Sustained complete ablation was achieved in 71% of lesions ≤30 mm vs. 47% of lesions >30 mm. Conclusions We conclude that achievement of complete ablation is a highly important predictor of long-term survival and that tumor size is by far the most important predictor of the likelihood of achieving complete ablation.
Collapse
Affiliation(s)
- Philipp Wiggermann
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Standards of practice: guidelines for thermal ablation of primary and secondary lung tumors. Cardiovasc Intervent Radiol 2012; 35:247-54. [PMID: 22271076 DOI: 10.1007/s00270-012-0340-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 01/03/2012] [Indexed: 12/26/2022]
|
42
|
Wolf FJ, Aswad B, Ng T, Dupuy DE. Intraoperative microwave ablation of pulmonary malignancies with tumor permittivity feedback control: ablation and resection study in 10 consecutive patients. Radiology 2011; 262:353-60. [PMID: 22106348 DOI: 10.1148/radiol.11110015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine histologic changes induced by microwave ablation (MWA) in patients with pulmonary malignancy by using an ablation system with tumor permittivity feedback control, enabling real-time modulation of energy power and frequency. MATERIALS AND METHODS Institutional review board approval and patient informed consent were obtained for this prospective HIPAA-complaint ablation and resection study. Between March 2009 and January 2010, 10 patients (four women, six men; mean age, 71 years; age range, 52-82 years) underwent intraoperative MWA of pulmonary malignancies. Power (10-32 W) and frequency (908-928 MHz) were continuously adjusted by the generator to maintain a temperature of 110°-120°C at the 14-gauge antenna tip for one 10-minute application. After testing for an air leak, tumors were resected surgically. Gross inspection, slicing, and hematoxylin-eosin (10 specimens) and nicotinamide adenine dinucleotide (six specimens) staining were performed. RESULTS Tumors included adenocarcinomas (n = 5), squamous cell carcinomas (n = 3), and metastases from endometrial (n = 1) and colorectal (n = 1) primary carcinomas. Mean maximum tumor diameter was 2.4 cm (range, 0.9-5.0 cm), and mean maximum volume was 8.6 cm(3) (range, 0.5-52.7 cm(3)). One air leak was detected. Five of 10 specimens were grossly measurable, revealing a mean maximum ablation zone diameter of 4.8 cm (range, 3.0-6.5 cm) and a mean maximum ablation zone volume of 15.1 cm(3) (range, 7.3-25.1 cm(3)). At hematoxylin-eosin staining, coagulation necrosis was observed in all ablation zones, extended into the normal lung in nine of 10 specimens, and up to blood vessel walls without evidence of vessel (>4 mm) thrombosis. Nicotinamide adenine dinucleotide staining enabled confirmation of no viability within ablation zones extending into normal lung in five of six specimens. CONCLUSION MWA with tumor permittivity feedback control results in cytotoxic intratumoral temperatures and extension of ablation zones into aerated peritumoral pulmonary parenchyma, possibly forming the equivalent of an oncologic resection margin.
Collapse
Affiliation(s)
- Farrah J Wolf
- Department of Diagnostic Imaging, Office of Research Administration, Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, USA
| | | | | | | |
Collapse
|
43
|
Radiofrequency ablation of lung tumours. Insights Imaging 2011; 2:567-576. [PMID: 22347976 PMCID: PMC3259330 DOI: 10.1007/s13244-011-0110-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 03/17/2011] [Accepted: 06/08/2011] [Indexed: 12/17/2022] Open
Abstract
Pulmonary radiofrequency ablation (RFA) has become an increasingly adopted treatment option for primary and metastatic lung tumours. It is mainly performed in patients with unresectable or medically inoperable lung neoplasms. The immediate technical success rate is over 95%, with a low periprocedural mortality rate and 8–12% major complication rate. Pneumothorax represents the most frequent complication, but requires a chest tube drain in less than 10% of cases. Sustained complete tumour response has been reported in 85–90% of target lesions. Lesion size represents the most important risk factor for local recurrence. Survival data are still scarce, but initial results are very promising. In patients with stage I non-small-cell lung cancer, 1- and 2-year survival rates are within the ranges of 78–95% and 57–84%, respectively, with corresponding cancer-specific survival rates of 92% and 73%. In selected cases, the combination of RFA and radiotherapy could improve these results. In patients with colorectal lung metastasis, initial studies have reported survival data that compare favourably with the results of metastasectomy, with up to a 45% 5-year survival rate. Further studies are needed to understand the potential role of RFA as a palliative treatment in more advanced disease and the possible combination of RFA with other treatment options.
Collapse
|
44
|
Single-Session Radiofrequency Ablation of Bilateral Lung Metastases. Cardiovasc Intervent Radiol 2011; 35:852-9. [DOI: 10.1007/s00270-011-0191-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 05/10/2011] [Indexed: 01/28/2023]
|
45
|
Palussière J, Italiano A, Descat E, Ferron S, Cornélis F, Avril A, Brouste V, Bui BN. Sarcoma Lung Metastases Treated with Percutaneous Radiofrequency Ablation: Results from 29 Patients. Ann Surg Oncol 2011; 18:3771-7. [DOI: 10.1245/s10434-011-1806-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Indexed: 11/18/2022]
|
46
|
Stellate ganglion injury after percutaneous radiofrequency ablation of a lung tumor. Cardiovasc Intervent Radiol 2010; 34:873-6. [PMID: 21153414 DOI: 10.1007/s00270-010-0054-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 11/09/2010] [Indexed: 10/18/2022]
Abstract
The purpose of this case report is to describe the potential damage to the stellate ganglion during percutaneous lung radiofrequency ablation, to analyze the consequences of these complications, and to review the location of the stellate ganglion, which is usually not visible on imaging.
Collapse
|