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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: 59] [Impact Index Per Article: 11.8] [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
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Huang BY, Li XM, Song XY, Zhou JJ, Shao Z, Yu ZQ, Lin Y, Guo XY, Liu DJ, Li L. Long-term results of CT-guided percutaneous radiofrequency ablation of inoperable patients with stage Ia non-small cell lung cancer: A retrospective cohort study. Int J Surg 2018; 53:143-150. [DOI: 10.1016/j.ijsu.2018.03.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 03/03/2018] [Accepted: 03/09/2018] [Indexed: 12/29/2022]
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叶 欣, 范 卫, 王 徽, 王 俊, 古 善, 冯 威, 庄 一, 刘 宝, 李 晓, 李 玉, 杨 坡, 杨 霞, 杨 武, 陈 俊, 张 嵘, 林 征, 孟 志, 胡 凯, 柳 晨, 彭 忠, 韩 玥, 靳 勇, 雷 光, 翟 博, 黄 广, 中国抗癌协会肿瘤微创治疗专业委员会肺癌微创治疗分会. [Expert Consensus for Thermal Ablation of Primary and Metastatic Lung Tumors
(2017 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:433-445. [PMID: 28738958 PMCID: PMC5972946 DOI: 10.3779/j.issn.1009-3419.2017.07.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- 欣 叶
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - 卫君 范
- 510060 广州, 中山大学肿瘤医院影像与微创介入中心Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - 徽 王
- 130012 长春, 吉林省肿瘤医院介入治疗中心Interventional Treatment Center, Jilin Provincial Tumor Hospital, Changchun 130012, China
| | - 俊杰 王
- 100191 北京, 北京大学第三医院放射治疗科Department of Radiation Oncology, Peking University 3rd Hospital, Beijing 100191, China
| | - 善智 古
- 410013 长沙, 湖南省肿瘤医院放射介入科Department of Interventional Therapy, Hunan Provincial Tumor Hospital, Changsha 410013, China
| | - 威健 冯
- 100045 北京, 首都医科大学附属复兴医院肿瘤科Department of Oncology, Fuxing Hospital Affiliated to the Capital University of Medical Sciences, Beijing 100045, China
| | - 一平 庄
- 210009 南京, 江苏省肿瘤医院介入科Department of Interventional Therapy, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - 宝东 刘
- 100053 北京, 首都医科大学宣武医院胸外科Department of Thoracic Surgery, Xuanwu Hospital Affiliated to the Capital University of Medical Sciences, Beijing 100053, China
| | - 晓光 李
- 100005 北京, 北京医院肿瘤微创中心Department of Tumor Minimally Invasive Therapy, Beijing Hospital, Beijing 100005, China
| | - 玉亮 李
- 250033 济南, 山东大学第二医院介入治疗中心Interventional Treatment Center, Shandong University Second Hospital, Ji'nan 250033, China
| | - 坡 杨
- 150001 哈尔滨, 哈尔滨医科大学第四人民医院介入放射科Department of Interventional Radiology, The Fourth Hospital of Harbin Medical University, Harbin 150001, China
| | - 霞 杨
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - 武威 杨
- 100071 北京, 解放军307医院肿瘤微创治疗科Department of Tumor Minimally Invasive Therapy, 307 Hospital, Beijing 100071, China
| | - 俊辉 陈
- 510060 广州, 中山大学肿瘤医院影像与微创介入中心Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - 嵘 张
- 518036 深圳, 北京大学深圳医院微创介入科Department of Minimally Invasive Interventional Therapy, Shenzhen Hospital of Beijing University, Shenzhen 518036, China
| | - 征宇 林
- 350005 福州, 福建医科大学附属第一医院介入科Department of Interventional Therapy, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - 志强 孟
- 200032 上海, 复旦大学肿瘤医院微创治疗科Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - 凯文 胡
- 100078 北京, 北京中医药大学东方医院肿瘤科Department of Oncology, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100078, China
| | - 晨 柳
- 100083 北京, 北京肿瘤医院介入治疗科Department of Interventional Therapy, Beijing Cancer Hospital, Beijing 100083, China
| | - 忠民 彭
- 250014 济南, 山东省立医院胸外科Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - 玥 韩
- 100021 北京, 中国医学科学院肿瘤医院介入治疗科Department of Interventional Therapy, Tumor Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
| | - 勇 靳
- 215004 苏州, 苏州大学第二附属医院介入治疗科Department of Interventional Therapy, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - 光焰 雷
- 710061 西安, 陕西省肿瘤医院胸外科Department of Thoracic Surgery, Shanxi Provincial Tumor Hospital, Xi'an 710061, China
| | - 博 翟
- 200127 上海, 上海交通大学仁济医院肿瘤介入治疗科Tumor Interventional Therapy Center, Shanghai Renji Hospital, Shanghai 200127, China
| | - 广慧 黄
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
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Xiang ZW, Sun L, Li GH, Maharjan R, Huang JH, Li CX. Progress in the treatment of pulmonary metastases after liver transplantation for hepatocellular carcinoma. World J Hepatol 2015; 7:2309-2314. [PMID: 26380655 PMCID: PMC4568491 DOI: 10.4254/wjh.v7.i20.2309] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/19/2015] [Accepted: 09/07/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer in the world, and is the third leading cause of cancer-related death. Liver transplantation (LT) has become a curative treatment for patients with HCC. However, recurrence and metastasis after LT are the main factors reducing long-term survival in patients, and the lung is the most common site of metastasis after LT for HCC, although metastasis to liver, para-aortic lymph nodes and renal periphery are observed. Thus, the treatment of pulmonary metastases after LT for HCC has become a hot research topic, the successful treatment of pulmonary metastases can significantly prolong the survival of LT patients. Although single conventional treatment (chemotherapy, surgery and external beam radiation therapy), immunosuppression, image-guided minimally invasive therapy (radiofrequency ablation, microwave ablation, cryoablation, and brachytherapy) and molecular targeted drugs have had a significant effect, patients do not have durable remission and the long-term survival rate is disappointing. Therefore, improving existing treatments and identifying a more effective combination therapy are important research issues in the prevention and treatment of pulmonary metastases after LT for HCC. The paper reviewed single conventional treatments, new treatments, and combination therapy, to provide a basis for the best treatment of these patients.
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Welch BT, Brinjikji W, Schmit GD, Callstrom MR, Kurup AN, Cloft HJ, Woodrum DA, Nichols FC, Atwell TD. A National Analysis of the Complications, Cost, and Mortality of Percutaneous Lung Ablation. J Vasc Interv Radiol 2015; 26:787-91. [DOI: 10.1016/j.jvir.2015.02.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 02/22/2015] [Accepted: 02/23/2015] [Indexed: 02/07/2023] Open
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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; 6:112-121. [PMID: 26273346 PMCID: PMC4448461 DOI: 10.1111/1759-7714.12152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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.
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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
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Percutaneous cryoablation for inoperable malignant lung tumors: midterm results. Cryobiology 2014; 70:60-5. [PMID: 25541142 DOI: 10.1016/j.cryobiol.2014.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/16/2014] [Accepted: 12/15/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To retrospectively analyze the efficacy and short- to mid-term survival rate of cryoablation for malignant lung tumors. METHODS Percutaneous CT-guided cryoablation for 45 malignant lung tumors in 26 patients during 41 sessions from 2009 to 2013 were performed. Follow up CT-scan were used to determine local tumor progression. Survival rate, local tumor control rate and associated risk factors were analyzed. RESULTS The immediate during and short-term complications with CTCAE grade 2 or upper include pneumothorax (15%), pleural effusion (20%), pulmonary hemorrhage (24%), pneumonitis (15%), hemothorax (15%), hemoptysis (10%), pain (20%), bronchopleural fistula (n=1), and empyema (n=2). Life-threatening bleeding or hemodynamic instability was not observed. There was no procedural-related mortality. Overall survival rate of 1, 2, 3 years are 96%, 88%, 88%. For curative intent, local tumor control (LTC) rate of 1, 2, 3 years are 75%, 72%, 72%. CONCLUSION Cryoablation for malignant lung tumors is effective and feasible in local control of tumor growth, with good short- to mid-term survival rate, as an alternative option for inoperable patients.
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Ridge CA, Solomon SB, Thornton RH. Thermal ablation of stage I non-small cell lung carcinoma. Semin Intervent Radiol 2014; 31:118-24. [PMID: 25053863 DOI: 10.1055/s-0034-1373786] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ablation options for the treatment of localized non-small cell lung carcinoma (NSCLC) include radiofrequency ablation, microwave ablation, and cryotherapy. Irreversible electroporation is a novel ablation method with the potential of application to lung tumors in risky locations. This review article describes the established and novel ablation techniques used in the treatment of localized NSCLC, including mechanism of action, indications, potential complications, clinical outcomes, postablation surveillance, and use in combination with other therapies.
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Affiliation(s)
- Carol A Ridge
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raymond H Thornton
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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叶 欣, 中国抗癌协会肿瘤微创治疗专业委员会肺癌微创综合治疗分会. [Expert consensus for thermal ablation of primary and metastatic lung tumors]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 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] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 03/24/2014] [Indexed: 02/07/2023]
Affiliation(s)
- 欣 叶
- 510060 广州,中山大学肿瘤防治中心影像介入中心Department of Oncology, Shandong Provincial Hospital Affliated to Shandong University, Ji'nan 250014, China
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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: 1.1] [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.
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Affiliation(s)
- Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Kumamoto, Japan
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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: 1.2] [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.
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Affiliation(s)
- Y Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
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12
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13
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Li W, Huang L, Han Y, Zhou Y, Lu Q, Li X. Bronchopleural fistula after non small cell lung cancer radiofrequency ablation: what it implying to us? Diagn Pathol 2013; 8:202. [PMID: 24326207 PMCID: PMC4077064 DOI: 10.1186/1746-1596-8-202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 11/25/2013] [Indexed: 01/22/2023] Open
Abstract
Abstract Radiofrequency ablation (RFA) is an alternative method to treat the inoperable NSCLC and there were few serious complications after RFA therapy have been reported. Here, we reported a NSCLC patient endured empyema after treatment by RFA for one month. There was a 20 × 25 × 20 mm mass on the right middle lobe by CT scan before RFA and a huge gas cavity with liquid was found in the right chest cavity after RFA treatment for twenty- eight days. A hole in the right middle lobe was found with large amount of pus in the pleural cavity as well as the bronchopleural fistula (BPF) during the operation. Results from the postoperative pathology showed a multiple small foci differentiated adenocarcinoma, partial bronchiolar-alveolar carcinoma, 0.5 cm away around the hole at the same time. It is difficult to diagnose and treat the rare complication of BPF, while, the larger field of ablation might be helpful to postpone the tumor local progression. Therefore, surgery was a good option for BPF especially when an empyema occurred. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/8028049341122276.
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Affiliation(s)
| | | | | | | | - Qiang Lu
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
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Ozawa Y, Hara M, Shibamoto Y, Tamaki T, Nishio M, Omi K. Utility of high-definition FDG-PET image reconstruction for lung cancer staging. Acta Radiol 2013; 54:916-20. [PMID: 23761556 DOI: 10.1177/0284185113488578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High-definition (HD) positron emission tomography (PET) image reconstruction is a new image reconstruction method based on the point spread function system, which improves the spatial resolution of the images. PURPOSE To compare the utility of HD reconstruction of PET images for staging lung cancer with that of conventional 2D ordered subset expectation maximization + Fourier rebinning (2D) reconstruction. MATERIAL AND METHODS Thirty-five lung cancer patients (24 men, 11 women; median age, 66 years) who underwent surgery after 18F-2-deoxy-fluoro-D-glucose (FDG)-PET-CT were studied. Their PET data were reconstructed with 2D and HD PET reconstruction algorithms. Two radiologists individually TNM staged both sets of images. They also evaluated the quality of the images and the diagnostic confidence that the images afforded them using 5-point scales. RESULTS T, N, and M stages were correctly diagnosed on both the 2D and HD reconstructed images in 23 (66%), 25 (71%), and 30 (86%) of 35 cases, respectively. Overall TNM stage was correctly diagnosed on both types of reconstructed images in 23 cases (66%), underestimated in three (9%), and overestimated in nine (26%). No significant difference in T, N, or M stage or overall TNM stage was observed between the two reconstruction methods. However, the HD reconstructed images afforded a significantly higher level of diagnostic confidence during TNM staging than the 2D reconstructed images and were also of higher quality than the 2D reconstructed images. CONCLUSION Although HD reconstruction of FDG-PET images did not improve the diagnostic accuracy of lung cancer staging compared with 2D reconstruction, the quality of the HD reconstructed images and the diagnostic confidence level they afforded the radiologists were higher than those of the conventional 2D reconstructed images.
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Affiliation(s)
- Yoshiyuki Ozawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Masaki Hara
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences
| | - Tsuneo Tamaki
- Department of Radiology, East Nagoya Imaging Diagnosis Center
| | - Masami Nishio
- Department of Radiology, Nagoya PET Imaging Center, Aichi, Japan
| | - Kumiko Omi
- Department of Radiology, East Nagoya Imaging Diagnosis Center
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Roberton BJ, Liu D, Power M, Wan JMC, Stuart S, Klass D, Yee J. Pulmonary ablation: a primer. Can Assoc Radiol J 2013; 65:177-85. [PMID: 23942193 DOI: 10.1016/j.carj.2013.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 01/19/2013] [Accepted: 01/27/2013] [Indexed: 01/20/2023] Open
Abstract
Percutaneous image-guided thermal ablation is safe and efficacious in achieving local control and improving outcome in the treatment of both early stage non-small-cell lung cancer and pulmonary metastatic disease, in which surgical treatment is precluded by comorbidity, poor cardiorespiratory reserve, or unfavorable disease distribution. Radiofrequency ablation is the most established technology, but new thermal ablation technologies such as microwave ablation and cryoablation may offer some advantages. The use of advanced techniques, such as induced pneumothorax and the popsicle stick technique, or combining thermal ablation with radiotherapy, widens the treatment options available to the multidisciplinary team. The intent of this article is to provide the reader with a practical knowledge base of pulmonary ablation by concentrating on indications, techniques, and follow-up.
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Affiliation(s)
- Benjamin J Roberton
- Radiology Department, Chelsea and Westminster Hospital, London, United Kingdom
| | - David Liu
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Mark Power
- Radiology Department, St Georges Hospital, Sydney, Australia
| | | | - Sam Stuart
- Department of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Darren Klass
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Yee
- Department of Cardiothoracic Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
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Sofocleous CT, Garg SK, Cohen P, Petre EN, Gonen M, Erinjeri JP, Downey RJ, Travis WD, Solomon SB. Ki 67 is an independent predictive biomarker of cancer specific and local recurrence-free survival after lung tumor ablation. Ann Surg Oncol 2013; 20 Suppl 3:S676-83. [PMID: 23897007 DOI: 10.1245/s10434-013-3140-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Indexed: 12/28/2022]
Abstract
BACKGROUND The objective of this work was to evaluate the feasibility of histopathological analysis of tissue extracted on multitined electrodes and assess whether tissue characteristics can be used as biomarkers of oncologic outcomes after lung tumor radiofrequency (RF) ablation. METHODS Treatment-related data regarding RF ablation of lung malignancies at our institution was collected using a Health Insurance Portability and Accountability Act-compliant ablation database. Institutional review board waiver was obtained for this study. Immunohistochemical analysis of tissue extracted from the electrodes after lung tumor RF ablation was performed for proliferation (Ki-67) and apoptosis (caspase-3). Patient, tumor demographics, and ablation parameters were recorded. Local tumor progression-free survival (LPFS), disease-specific survival (DSS), and overall survival (OS) were assessed using Kaplan-Meier methodology. Multivariate analysis determined factors affecting these oncological outcomes. RESULTS A total of 47 lung tumors in 42 patients were ablated; 30 specimens were classified as coagulation necrosis (CN) and 17 as Ki-67-positive (+) tumor cells (viable). Tumor sizes were similar in the CN and Ki-67+ groups (P = 0.32). Median LPFS was 10 versus 16 months for Ki-67+ and CN groups, and 1-year LPFS was 34 and 75 %, respectively (P = 0.003). Median OS was 20 and 46 months (P = 0.12), and median DSS was 20 and 68 months (P = 0.01) for the Ki-67 + and CN groups, respectively. Identification of Ki-67+ tumor cells more than tripled the risk of death from cancer [hazard ratio (HR) = 3.65; 95 % confidence interval (95 % CI), 1.34-9.95; P = 0.01] and tripled the risk of local tumor progression (LTP) (HR = 3.01; 95 % CI, 1.39-6.49; P = 0.005). CONCLUSIONS Ki-67+ tumor cells on the electrode after pulmonary tumor RF ablation is an independent predictor of LTP, shorter LPFS, and DSS.
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Schneider T, Heussel CP, Herth FJF, Dienemann H. Thermal ablation of malignant lung tumors. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:394-400. [PMID: 23826028 DOI: 10.3238/arztebl.2013.0394] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 02/18/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND About 50 000 new cases of non-small-cell carcinoma of the lung are diagnosed in Germany each year. More than 20% of the affected patients cannot be offered radical resection because of comorbidity alone. The lung is also the second most common site of distant metastases of extrathoracic tumors; it is the only site of such metastases in 20% of cases. In recent years, image-guided thermoablation has been used with increasing frequency in patients who are unable to undergo surgery for medical reasons. METHODS The PubMed database was selectively searched for publications on the indications, complications, and results of the thermoablative techniques currently in clinical use, with special attention to radiofrequency ablation (RFA). RESULTS There is only a small evidence base to date concerning the treatment of malignant lung tumors with thermoablation. Retrospective and prospective case series have been published, but no randomized controlled trials have yet been conducted. RFA, the most common technique, involves the image-guided percutaneous placement of one or more probes in the tumor, to which thermal energy is then applied. For peripherally located tumors that measure less than 3 cm in diameter, local control of tumor growth can be achieved in about 90% of cases. The long-term results that are now available from smaller series provisionally indicate 5-year survival rates of 20% to 61%. The most common complication is pneumothorax requiring drainage, which occurs in about 10% of cases. In the intermediate term, thermoablation does not cause any clinically relevant loss of pulmonary function. CONCLUSION Image-guided thermoablation cannot now be considered an alternative to surgery for the treatment of malignant lung tumors with curative intent. It does, however, widen the spectrum of therapeutic options for patients who are medically unable to undergo a surgical procedure.
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Affiliation(s)
- Thomas Schneider
- Department of Thoracic Surgery, St. Vincentius-Kliniken Karlsruhe.
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18
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Radiofrequency Ablation Does Not Induce the Significant Increase of CD4+CD25+Foxp3+ Regulatory T Cells Compared with Surgical Resection in Hepal-6 Tumor Model. Arch Immunol Ther Exp (Warsz) 2013; 61:333-40. [DOI: 10.1007/s00005-013-0226-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 03/25/2013] [Indexed: 01/19/2023]
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Radiothérapie stéréotaxique et radiofréquence dans le traitement du cancer bronchopulmonaire. Bull Cancer 2012; 99:1077-81. [DOI: 10.1684/bdc.2012.1661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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: 0.5] [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.
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Affiliation(s)
- Philipp Wiggermann
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany.
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Pan CC, Wu PH, Yu JR, Li W, Huang ZL, Wang JP, Zhao M. Comparative survival analysis in patients with pulmonary metastases from nasopharyngeal carcinoma treated with radiofrequency ablation. Eur J Radiol 2012; 81:e473-7. [DOI: 10.1016/j.ejrad.2011.05.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 05/26/2011] [Accepted: 05/27/2011] [Indexed: 01/25/2023]
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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: 52] [Impact Index Per Article: 4.0] [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]
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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: 1.6] [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.
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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
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Abstract
Neuroendocrine neoplasms arise in almost every organ of the body and are variably defined according to the site of origin. This Review focuses on neuroendocrine neoplasms of the digestive tract and pancreas. The 2010 WHO classification of tumors of the digestive system introduces grading and staging tools for neuroendocrine neoplasms. A carcinoid is now defined as a grade 1 or 2 neuroendocrine tumor and grade 3, small-cell or large-cell carcinomas are defined as neuroendocrine carcinoma. Epidemiological data show a worldwide increase in the prevalence and incidence of gastroentero-pancreatic neuroendocrine tumors in the past few decades, which is probably due to improved methods of detection of these tumors. The current diagnostic procedures and treatment options for neuroendocrine neoplasms are defined and summarized in the Review, although evidence-based data are lacking. Surgery remains the treatment mainstay and somatostatin analogues the basis for both diagnosis and therapy as the only 'theranostic' tool. Emerging compounds including chemotherapeutic agents, small molecules and biological therapies may provide new hope for patients.
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Affiliation(s)
- Guido Rindi
- Institute of Pathology, Università Cattolica del Sacro Cuore-Policlinico A. Gemelli, Largo A. Gemelli 8, I-00168 Rome, Italy.
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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: 1.1] [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.
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Filosso PL, Sandri A, Oliaro A, Filippi AR, Cassinis MC, Ricardi U, Lausi PO, Asioli S, Ruffini E. Emerging treatment options in the management of non-small cell lung cancer. LUNG CANCER-TARGETS AND THERAPY 2011; 2:11-28. [PMID: 28210115 DOI: 10.2147/lctt.s8618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Lung cancer (LC) has become the leading cancer-related cause of death in the US and in developed European countries in the last decade. Its incidence is still growing in females and in smokers. Surgery remains the treatment of choice whenever feasible, but unfortunately, many patients have an advanced LC at presentation and one-third of potentially operable patients do not receive a tumor resection because of their low compliance for intervention due to their compromised cardiopulmonary functions and other comorbidities. For these patients the alternative therapeutic options are stereotactic radiotherapy or percutaneous radiofrequency. When surgery is planned, an anatomical resection (segmentectomy, lobectomy, bilobectomy, pneumonectomy, sleeve lobectomy) is usually performed; wedge resection (considered as a nonanatomical one) is generally the accepted option for unfit patients. The recent increase in discovering small and peripheral LCs and/or ground-glass opacities with screening programs has dramatically increased surgeons' interest in limited resections. The role of these resections is discussed. Also, recent improvements in molecular biology techniques have increased the chemotherapic options for neoadjuvant LC treatment. The role and the importance of targeted chemotherapy is also discussed.
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Affiliation(s)
| | | | | | | | | | - Umberto Ricardi
- Department of Medical and Surgical Disciplines, Radiation Therapy Division
| | | | - Sofia Asioli
- Department of Oncology and Biomedical Sciences, University of Torino, Torino, Italy
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