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Xu Y, Padley SPG, Devaraj A, Desai SR, Ridge CA. Discrepancy Between Achieved and Vendor-Predicted Ablation Zones in the Lung: Contributing Factors. Cardiovasc Intervent Radiol 2024; 47:613-620. [PMID: 38361010 DOI: 10.1007/s00270-024-03667-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Several factors are known to affect lung ablation zones. Questions remain as to why there are discrepancies between achieved and vendor-predicted ablation zones and what contributing factors can be modified to balance therapeutic effects with avoidance of complications. This retrospective study of lung tumour microwave ablation analyses day 1 post-treatment CT to assess the effects of lesion-specific and operator-dependent factors on ablation zones. METHODS AND MATERIALS Consecutive patients treated at a tertiary centre from 2018 to 2021 were included. All ablations were performed using a single microwave ablation device under lung isolation. The lung tumours were categorised as primary or secondary, and their "resistance" to ablation was graded according to their locations. Intraprocedural pulmonary inflation was assessed as equal to or less than the contralateral non-isolated lung. Ablation energy was categorised as high, medium, or low. Ablation zone dimensions were measured on day 1 CT and compared to vendor reference charts. Ablations with multiple needle positions or indeterminate boundaries were excluded. RESULTS A total of 47 lesions in 31 patients were analysed. Achieved long axes are longer than predicted by 5 mm or 14% (p < 0.01) without overall short axis discrepancy. Secondary tumours (p = 0.020), low-resistance location (p < 0.01), good lung inflation (p < 0.01), low (p = 0.003) and medium (p = 0.038) total energy produce lengthened long axes by 4-6 mm or 10-19%. High total energy results in shorter than predicated short axes by 6 mm or 18% (p = 0.010). CONCLUSION We identified several factors affecting ablation zone dimensions which may have implications for ablation planning and the avoidance of complications.
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Affiliation(s)
- Yiwang Xu
- Department of Radiology, Royal Brompton Hospital, London, UK.
| | - Simon P G Padley
- Department of Radiology, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sujal R Desai
- Department of Radiology, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Carole A Ridge
- Department of Radiology, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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Chang LK, Yang SM, Chung WY, Chen LC, Chang HC, Ho MC, Chang YC, Yu CJ. Cone-beam computed tomography image-guided percutaneous microwave ablation for lung nodules in a hybrid operating room: an initial experience. Eur Radiol 2024; 34:3309-3319. [PMID: 37926741 DOI: 10.1007/s00330-023-10360-5] [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] [Received: 01/03/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES The experience of thermal ablation of lung lesions is limited, especially performing the procedure under localisation by cone-beam CT in the hybrid operation room (HOR). Here, we present the experience of microwave ablation (MWA) of lung nodules in the HOR. METHODS We reviewed patients who underwent image-guide percutaneous MWA for lung nodules in the HOR under general anaesthesia between July 2020 and July 2022. The workflow in the HOR including the pre-procedure preparation, anaesthesia consideration, operation methods, and postoperative care was clearly described. RESULTS Forty lesions in 33 patients who underwent MWA under general anaesthesia (GA) in the HOR were analysed. Twenty-seven patients had a single pulmonary nodule, and the remaining six patients had multiple nodules. The median procedure time was 41.0 min, and the median ablation time per lesion was 6.75 min. The median global operation room time was 115.0 min. The median total dose area product was 14881 μGym2. The median ablation volume was 111.6 cm3. All patients were discharged from the hospital with a median postoperative stay of 1 day. Four patients had pneumothorax, two patients had pleural effusion during the first month of outpatient follow-up, and one patient reported intercostal neuralgia during the 3-month follow-up. CONCLUSIONS Thermal ablation of pulmonary nodules under GA in the HOR can be performed safely and efficiently if we follow the workflow provided. The procedure provides an alternative to managing pulmonary nodules in patients. CLINICAL RELEVANCE STATEMENT Thermal ablation of pulmonary nodules under GA in the HOR can be performed safely and efficiently if the provided workflow is followed. KEY POINTS • We tested the feasibility of microwave ablation of lung lesions performed in a hybrid operating room. • To this end, we provide a description of microwave ablation of the lung under cone-beam CT localisation. • We describe a workflow by which ablation of the pulmonary nodule can be performed safely under general anaesthesia.
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Affiliation(s)
- Ling-Kai Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Shun-Mao Yang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan.
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan.
| | - Wen-Yuan Chung
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan
| | - Lun-Che Chen
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Hao-Chun Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
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Huang H, Chen H, Zheng D, Chen C, Wang Y, Xu L, Wang Y, He X, Yang Y, Li W. Habitat-based radiomics analysis for evaluating immediate response in colorectal cancer lung metastases treated by radiofrequency ablation. Cancer Imaging 2024; 24:44. [PMID: 38532520 DOI: 10.1186/s40644-024-00692-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/20/2024] [Indexed: 03/28/2024] Open
Abstract
PURPOSE To create radiomics signatures based on habitat to assess the instant response in lung metastases of colorectal cancer (CRC) after radiofrequency ablation (RFA). METHODS Between August 2016 and June 2019, we retrospectively included 515 lung metastases in 233 CRC patients who received RFA (412 in the training group and 103 in the test group). Multivariable analysis was performed to identify independent risk factors for developing the clinical model. Tumor and ablation regions of interest (ROI) were split into three spatial habitats through K-means clustering and dilated with 5 mm and 10 mm thicknesses. Radiomics signatures of intratumor, peritumor, and habitat were developed using the features extracted from intraoperative CT data. The performance of these signatures was primarily evaluated using the area under the receiver operating characteristics curve (AUC) via the DeLong test, calibration curves through the Hosmer-Lemeshow test, and decision curve analysis. RESULTS A total of 412 out of 515 metastases (80%) achieved complete response. Four clinical variables (cancer antigen 19-9, simultaneous systemic treatment, site of lung metastases, and electrode type) were utilized to construct the clinical model. The Habitat signature was combined with the Peri-5 signature, which achieved a higher AUC than the Peri-10 signature in the test set (0.825 vs. 0.816). The Habitat+Peri-5 signature notably surpassed the clinical and intratumor radiomics signatures (AUC: 0.870 in the test set; both, p < 0.05), displaying improved calibration and clinical practicality. CONCLUSIONS The habitat-based radiomics signature can offer precise predictions and valuable assistance to physicians in developing personalized treatment strategies.
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Affiliation(s)
- Haozhe Huang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China
| | - Hong Chen
- Department of Medical Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Xuhui District, Shanghai, 200030, China
| | - Dezhong Zheng
- Laboratory for Medical Imaging Informatics, Shanghai Institute of Technical Physics, Chinese Academy of Science, 500 Yutian Road, Hongkou District, Shanghai, 200083, China
- University of Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, 100049, China
| | - Chao Chen
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China
| | - Ying Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China
| | - Lichao Xu
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China
| | - Yaohui Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China
| | - Xinhong He
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China
| | - Yuanyuan Yang
- Laboratory for Medical Imaging Informatics, Shanghai Institute of Technical Physics, Chinese Academy of Science, 500 Yutian Road, Hongkou District, Shanghai, 200083, China.
- University of Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, 100049, China.
| | - Wentao Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China.
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Wang J, Li B, Zhang L, Wang Z, Shen J. Safety and local efficacy of computed tomography-guided microwave ablation for treating early-stage non-small cell lung cancer adjacent to bronchovascular bundles. Eur Radiol 2024; 34:236-246. [PMID: 37505251 DOI: 10.1007/s00330-023-09997-z] [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] [Received: 10/29/2022] [Revised: 05/24/2023] [Accepted: 06/03/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES To retrospectively evaluate the safety and efficacy of computed tomography (CT)-guided percutaneous microwave ablation in treating early-stage non-small cell lung cancer (NSCLC) adjacent to bronchovascular bundles. METHODS Two hundred and thirty-one patients with early-stage NSCLC who underwent CT-guided microwave ablation of the tumor were included for analysis. Among these, 66 lesions were located adjacent to the bronchovascular bundle. Achievement of the specific ablation range (defined as the ablation zone encompassing the tumor and the adjacent vessel) was assessed after ablation. Complications and tumor progression after treatment were examined and compared between the bronchovascular bundle and non-bronchovascular bundle groups. RESULTS A total of 231 patients were included. Overall, 1-, 2-, and 3-year local progression-free survival (LPFS) was 77.4%, 70.5%, and 63.8%, respectively. Bronchovascular bundle proximity, pure-solid tumor, tumor size, and ablation margin < 5 mm were independent risk factors for local progression in multivariate analysis. In the bronchovascular bundle group, the 1-, 2- and 3-year LPFS rates were 63.0%, 50.7%, and 43.4%, respectively; vessel proximity and specific ablation range failure were independent risk factors for local progression. Overall survival in the entire cohort was 93.0% at 1 year, 76.1% at 2 years, and 55.0% at 3 years. The incidence of postoperative complications did not significantly differ between the two groups (p > 0.05). The most common complication was pneumothorax. Severe hemoptysis did not occur. CONCLUSION Tumor location near the bronchovascular bundles was a significant risk factor for local progression after microwave ablation. Achieving a specific ablation range may increase LPFS for these lesions. CLINICAL RELEVANCE STATEMENT Achieving the specific ablation range may improve local efficacy for early-stage non-small cell lung cancer located adjacent to the bronchovascular bundle. KEY POINTS • Local efficacy of percutaneous microwave ablation in treating early-stage non-small cell lung cancer was affected by bronchovascular bundle proximity. • Achieving the specific ablation range may improve local efficacy for lesions located adjacent to the bronchovascular bundle.
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Affiliation(s)
- Jun Wang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd, Pudong, Shanghai, 200127, China
| | - Bo Li
- Department of Medical Imaging, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd, Pudong, Shanghai, 200127, China
| | - Liang Zhang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd, Pudong, Shanghai, 200127, China
| | - Zhi Wang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd, Pudong, Shanghai, 200127, China
| | - Jialin Shen
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Rd, Pudong, Shanghai, 200127, China.
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Hong HP, Kim HO, Koo DH, Lee YG, Kim MS, Ham SY, Kang DY, Oh TY, Lee H, Jung KU, Kim H. Clinical outcomes and prognostic factors of cone-beam CT-guided radiofrequency ablation for pulmonary metastases in colorectal cancer patients. Asia Pac J Clin Oncol 2023; 19:e215-e222. [PMID: 35822242 DOI: 10.1111/ajco.13832] [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: 06/13/2022] [Revised: 06/13/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022]
Abstract
AIM Radiofrequency ablation (RFA) has been increasingly used for the treatment of pulmonary metastases in various malignancies. METHODS A retrospective analysis was performed to establish the safety and efficacy of cone-beam computed tomography (CBCT)-guided RFA in patients with metastatic colorectal cancer between 2016 and 2019, and the prognostic factors of local tumor control were assessed. RESULTS A total of 31 patients with colorectal cancer underwent 48 sessions of lung RFA. The mean diameter of metastases targeted for RFA was 11 mm (range: 4-32), and the RFA was technically successful in 43 sessions (90%). There were 14 complications (29%), the majority of which required no intervention, with no cases of mortality. The median follow-up duration from RFA in the surviving 29 patients was 18.0 months. Only two patients (6%) died of disease progression, and the 3-year overall survival rate was 91% (95% CI: 83-99). Local tumor progression (LTP) of the RFA site was observed in 27%, and the LTP-free survival rates at 1 and 2 years were 81% (95% CI: 70-82) and 64% (95% CI: 50-77), respectively. Multivariate analysis showed that the progression of extra-RFA sites and the presence of extrapulmonary metastasis were independent prognostic factors significantly associated with LTP at RFA site. CONCLUSION Lung RFA using CBCT guidance is a comparatively safe and effective option for the treatment of lung metastases from colorectal cancer. However, the control of extrapulmonary metastases should be accompanied by combined or sequential systemic treatment and local treatment.
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Affiliation(s)
- Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Ook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Hoe Koo
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yun-Gyoo Lee
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Youn Ham
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Du-Young Kang
- Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Yun Oh
- Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyebin Lee
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hungdai Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Zhou C, Qin Y, Zhao W, Liang Z, Li M, Liu D, Bai L, Chen Y, Chen Y, Cheng Y, Chu T, Chu Q, Deng H, Dong Y, Fang W, Fu X, Gao B, Han Y, He Y, Hong Q, Hu J, Hu Y, Jiang L, Jin Y, Lan F, Li Q, Li S, Li W, Li Y, Liang W, Lin G, Lin X, Liu M, Liu X, Liu X, Liu Z, Lv T, Mu C, Ouyang M, Qin J, Ren S, Shi H, Shi M, Su C, Su J, Sun D, Sun Y, Tang H, Wang H, Wang K, Wang K, Wang M, Wang Q, Wang W, Wang X, Wang Y, Wang Z, Wang Z, Wu L, Wu D, Xie B, Xie M, Xie X, Xie Z, Xu S, Xu X, Yang X, Yin Y, Yu Z, Zhang J, Zhang J, Zhang J, Zhang X, Zhang Y, Zhong D, Zhou Q, Zhou X, Zhou Y, Zhu B, Zhu Z, Zou C, Zhong N, He J, Bai C, Hu C, Li W, Song Y, Zhou J, Han B, Varga J, Barreiro E, Park HY, Petrella F, Saito Y, Goto T, Igai H, Bravaccini S, Zanoni M, Solli P, Watanabe S, Fiorelli A, Nakada T, Ichiki Y, Berardi R, Tsoukalas N, Girard N, Rossi A, Passaro A, Hida T, Li S, Chen L, Chen R. International expert consensus on diagnosis and treatment of lung cancer complicated by chronic obstructive pulmonary disease. Transl Lung Cancer Res 2023; 12:1661-1701. [PMID: 37691866 PMCID: PMC10483081 DOI: 10.21037/tlcr-23-339] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/04/2023] [Indexed: 09/12/2023]
Abstract
Background Lung cancer combined by chronic obstructive pulmonary disease (LC-COPD) is a common comorbidity and their interaction with each other poses significant clinical challenges. However, there is a lack of well-established consensus on the diagnosis and treatment of LC-COPD. Methods A panel of experts, comprising specialists in oncology, respiratory medicine, radiology, interventional medicine, and thoracic surgery, was convened. The panel was presented with a comprehensive review of the current evidence pertaining to LC-COPD. After thorough discussions, the panel reached a consensus on 17 recommendations with over 70% agreement in voting to enhance the management of LC-COPD and optimize the care of these patients. Results The 17 statements focused on pathogenic mechanisms (n=2), general strategies (n=4), and clinical application in COPD (n=2) and lung cancer (n=9) were developed and modified. These statements provide guidance on early screening and treatment selection of LC-COPD, the interplay of lung cancer and COPD on treatment, and considerations during treatment. This consensus also emphasizes patient-centered and personalized treatment in the management of LC-COPD. Conclusions The consensus highlights the need for concurrent treatment for both lung cancer and COPD in LC-COPD patients, while being mindful of the mutual influence of the two conditions on treatment and monitoring for adverse reactions.
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Affiliation(s)
- Chengzhi Zhou
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yinyin Qin
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wei Zhao
- Department of Respiratory and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhenyu Liang
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Min Li
- Department of Respiratory Medicine, Xiangya Cancer Center, Xiangya Hospital, Central South University, Changsha, China
| | - Dan Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Li Bai
- Department of Respiratory Medicine, Xinqiao Hospital Army Medical University, Chongqing, China
| | - Yahong Chen
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Yan Chen
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuan Cheng
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Tianqing Chu
- Department of Respiratory Medicine, Shanghai Chest Hospital, Jiaotong University, Shanghai, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Haiyi Deng
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yuchao Dong
- Department of Pulmonary and Critical Care Medicine, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wenfeng Fang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiuhua Fu
- Division of Respiratory Diseases, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Beili Gao
- Department of Respiratory, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yiping Han
- Department of Respiratory Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yong He
- Department of Pulmonary and Critical Care Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Qunying Hong
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jie Hu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Hu
- Department of Medical Oncology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Liyan Jiang
- Department of Respiratory Medicine, Shanghai Chest Hospital, Jiaotong University, Shanghai, China
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fen Lan
- Department of Respiratory Medicine, The Second Affiliated Hospital of Zhejiang University of Medicine, Hangzhou, China
| | - Qiang Li
- Department of Respiratory Medicine, Shanghai Dongfang Hospital, Shanghai, China
| | - Shuben Li
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Wen Li
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yaqing Li
- Department of Internal Medicine, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China
| | - Wenhua Liang
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Gen Lin
- Department of Thoracic Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Xinqing Lin
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Ming Liu
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xiaofang Liu
- Department of Respiratory and Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiaoju Liu
- Department of Gerontal Respiratory Medicine, The First Hospital of Lanzhou University, Lanzhou, China
| | - Zhefeng Liu
- Department of Oncology, General Hospital of Chinese PLA, Beijing, China
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Chuanyong Mu
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ming Ouyang
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianwen Qin
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Huanzhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Minhua Shi
- Department of Respiratory Medicine, The Second Affiliated Hospital of Suzhou University, Suzhou, China
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jin Su
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dejun Sun
- Department of Respiratory and Critical Care Medicine, Inner Mongolia Autonomous Region People’s Hospital, Hohhot, China
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Huaping Tang
- Department of Respiratory Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Huijuan Wang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Kai Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Zhejiang University of Medicine, Hangzhou, China
| | - Ke Wang
- Department of Respiratory Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Qi Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wei Wang
- Department of Pulmonary and Critical Care Medicine, the First Hospital of China Medical University, Shenyang, China
| | - Xiaoping Wang
- Department of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
| | - Yuehong Wang
- Department of Respiratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhijie Wang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zirui Wang
- Department of Respiratory and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Lin Wu
- Thoracic Medicine Department II, Hunan Cancer Hospital, Changsha, China
| | - Di Wu
- Department of Respiratory Medicine, Shenzhen People’s Hospital, Shenzhen, China
| | - Baosong Xie
- Department of Respiratory Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Min Xie
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaohong Xie
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Zhanhong Xie
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Shufeng Xu
- Department of Respiratory and Critical Care Medicine, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Xiaoman Xu
- Department of Respiratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xia Yang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yan Yin
- Department of Pulmonary and Critical Care Medicine, the First Hospital of China Medical University, Shenyang, China
| | - Zongyang Yu
- Department of Pulmonary and Critical Care Medicine, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Jian Zhang
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Jianqing Zhang
- Second Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jing Zhang
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingying Zhang
- Department of Medical Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Diansheng Zhong
- Department of Medical Oncology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qing Zhou
- Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiangdong Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yanbin Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo Zhu
- Chongqing Key Laboratory of Immunotherapy, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Chenxi Zou
- Department of Respiratory and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Nanshan Zhong
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chengping Hu
- Department of Pulmonary Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Song
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, China
| | - Jianying Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Baohui Han
- Department of Pulmonology, Shanghai Chest Hospital, Shanghai, China
| | - Janos Varga
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Esther Barreiro
- Pulmonology Department-Lung Cancer and Muscle Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Department of Medicine and Life Sciences (MELIS), Pompeu Fabra University (UPF), CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII) Barcelona, Spain
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Francesco Petrella
- Division of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Yuichi Saito
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Sara Bravaccini
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Michele Zanoni
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy
| | - Piergiorgio Solli
- Department of Cardio-Thoracic Surgery and Hearth & Lung Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Universitàdella Campania Luigi Vanvitelli, Naples, Italy
| | - Takeo Nakada
- Division of Thoracic Surgery, Department of Surgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Yoshinobu Ichiki
- Department of General Thoracic Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy
| | | | - Nicolas Girard
- Institut du Thorax Curie Montsouris, Institut Curie, Paris, France
- Paris Saclay, UVSQ, Versailles, France
| | - Antonio Rossi
- Oncology Center of Excellence, Therapeutic Science & Strategy Unit, IQVIA, Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology IRCCS, Milan, Italy
| | - Toyoaki Hida
- Lung Cancer Center, Central Japan International Medical Center, Minokamo, Japan
| | - Shiyue Li
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Liang’an Chen
- Department of Respiratory and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Rongchang Chen
- Shenzhen Institute of Respiratory Diseases, Shenzhen People’s Hospital, Shenzhen, China
- Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Gangadharan SP, Mathew F. Thermoablative Techniques to Treat Excessive Central Airway Collapse. Thorac Surg Clin 2023; 33:299-308. [PMID: 37414486 DOI: 10.1016/j.thorsurg.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Excessive central airway collapse (ECAC) is a condition characterized by the excessive narrowing of the trachea and mainstem bronchi during expiration, which can be caused by Tracheobronchomalacia (TBM) or Excessive Dynamic Airway Collapse (EDAC). The initial standard of care for central airway collapse is to address any underlying conditions such as asthma, COPD, and gastro-esophageal reflux. In severe cases, when medical treatment fails, a stent-trial is offered to determine if surgical correction is a viable option, and tracheobronchoplasty is suggested as a definitive treatment approach. Thermoablative bronchoscopic treatments, such as Argon plasma coagulation (APC) and laser techniques (potassium-titanyl-phosphate [KTP], holmium and yttrium aluminum pevroskyte [YAP]) are a promising alternative to traditional surgery. However, further research is needed to assess their safety and effectiveness in humans before being widely used.
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Affiliation(s)
- Sidhu P Gangadharan
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, W/DC 201, 185 Pilgrim Road, Boston, MA 02215, USA.
| | - Fleming Mathew
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, W/DC 201, 185 Pilgrim Road, Boston, MA 02215, USA
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Huang H, Zheng D, Chen H, Chen C, Wang Y, Xu L, Wang Y, He X, Yang Y, Li W. A CT-based radiomics approach to predict immediate response of radiofrequency ablation in colorectal cancer lung metastases. Front Oncol 2023; 13:1107026. [PMID: 36798816 PMCID: PMC9927400 DOI: 10.3389/fonc.2023.1107026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/16/2023] [Indexed: 02/01/2023] Open
Abstract
Objectives To objectively and accurately assess the immediate efficacy of radiofrequency ablation (RFA) on colorectal cancer (CRC) lung metastases, the novel multimodal data fusion model based on radiomics features and clinical variables was developed. Methods This case-control single-center retrospective study included 479 lung metastases treated with RFA in 198 CRC patients. Clinical and radiological data before and intraoperative computed tomography (CT) scans were retrieved. The relative radiomics features were extracted from pre- and immediate post-RFA CT scans by maximum relevance and minimum redundancy algorithm (MRMRA). The Gaussian mixture model (GMM) was used to divide the data of the training dataset and testing dataset. In the process of modeling in the training set, radiomics model, clinical model and fusion model were built based on a random forest classifier. Finally, verification was carried out on an independent test dataset. The receiver operating characteristic curves (ROC) were drawn based on the obtained predicted scores, and the corresponding area under ROC curve (AUC), accuracy, sensitivity, and specificity were calculated and compared. Results Among the 479 pulmonary metastases, 379 had complete response (CR) ablation and 100 had incomplete response ablation. Three hundred eighty-six lesions were selected to construct a training dataset and 93 lesions to construct a testing dataset. The multivariate logistic regression analysis revealed cancer antigen 19-9 (CA19-9, p<0.001) and the location of the metastases (p< 0.05) as independent risk factors. Significant correlations were observed between complete ablation and 9 radiomics features. The best prediction performance was achieved with the proposed multimodal data fusion model integrating radiomic features and clinical variables with the highest accuracy (82.6%), AUC value (0.921), sensitivity (80.3%), and specificity (81.4%). Conclusion This novel multimodal data fusion model was demonstrated efficient for immediate efficacy evaluation after RFA for CRC lung metastases, which could benefit necessary complementary treatment.
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Affiliation(s)
- Haozhe Huang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dezhong Zheng
- Laboratory for Medical Imaging Informatics, Shanghai Institute of Technical Physics, Shanghai, China,Department of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China
| | - Hong Chen
- Department of Medical Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Chen
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ying Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lichao Xu
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yaohui Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinhong He
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuanyuan Yang
- Laboratory for Medical Imaging Informatics, Shanghai Institute of Technical Physics, Shanghai, China,Department of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing, China,*Correspondence: Wentao Li, ; Yuanyuan Yang,
| | - Wentao Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Shanghai, China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China,*Correspondence: Wentao Li, ; Yuanyuan Yang,
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9
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Hasegawa T, Takaki H, Kodama H, Matsuo K, Yamanaka T, Nakatsuka A, Takao M, Gobara H, Hayashi S, Inaba Y, Yamakado K. Impact of the Ablative Margin on Local Tumor Progression after Radiofrequency Ablation for Lung Metastases from Colorectal Carcinoma: Supplementary Analysis of a Phase II Trial (MLCSG-0802). J Vasc Interv Radiol 2023; 34:31-37.e1. [PMID: 36209996 DOI: 10.1016/j.jvir.2022.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To explore what extent of ablative margin depicted by computed tomography (CT) immediately after radiofrequency (RF) ablation is required to reduce local tumor progression (LTP) for colorectal cancer (CRC) lung metastases. MATERIALS AND METHODS This retrospective study was undertaken as a supplementary analysis of a previous prospective trial. Seventy patients (49 men and 21 women; mean age ± standard deviation, 64.9 years ± 10.6 years) underwent RF ablation for CRC lung metastases, and 95 tumors that were treated in the trial and followed up with CT at least 12 months after RF ablation were evaluated. The mean tumor size was 1.0 cm ± 0.5 cm. The ablative margin was estimated as the shortest distance between the outer edge of the tumor and the surrounding ground-glass opacity on CT obtained immediately after RF ablation. The impact of the ablative margin on LTP was evaluated using logistic regression analysis. Multivariate logistic regression analysis was also performed to identify the risk factors for LTP. The result was validated with multivariate logistic regression applying a bootstrap method (1,000 times resampling). RESULTS The mean ablative margin was 2.7 mm ± 1.3 (range, 0.4-7.3 mm). LTP developed in 6 tumors (6%, 6/95) 6-19 months after RF ablation. The LTP rate was significantly higher when the margin was less than 2 mm (P = .023). A margin of <2 mm was also found to be a significant factor for LTP (P = .048) on multivariate analysis and validated using the bootstrap method (P = .025). CONCLUSIONS An ablative margin of at least 2 mm is important to reduce LTP after RF ablation for CRC lung metastases.
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Affiliation(s)
- Takaaki Hasegawa
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Aichi, Japan; Department of Radiology, Mie University School of Medicine, Mie, Japan.
| | - Haruyuki Takaki
- Department of Radiology, Mie University School of Medicine, Mie, Japan; Department of Radiology, Hyogo Medical University, Nishinomiya, Japan
| | - Hiroshi Kodama
- Department of Radiology, Mie University School of Medicine, Mie, Japan; Department of Radiology, Hyogo Medical University, Nishinomiya, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Aichi, Japan; Division of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Takashi Yamanaka
- Department of Radiology, Mie University School of Medicine, Mie, Japan
| | | | - Motoshi Takao
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Mie, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Sadao Hayashi
- Department of Radiology, Kagoshima University, Kagoshima, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Koichiro Yamakado
- Department of Radiology, Mie University School of Medicine, Mie, Japan
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Zhang X, Meng L, Xiao Y, Chen Z. Case report: Radiofrequency ablation combined with biopsy for Cushing’s syndrome due to ectopic ACTH lesions in the lung. Front Oncol 2022; 12:1059308. [DOI: 10.3389/fonc.2022.1059308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022] Open
Abstract
Lung carcinoid tumor is one of the major tumors causing ectopic ACTH syndrome, and the most common clinical treatment is surgical resection of the lesion. We herein report a suspected pulmonary carcinoid tumor with difficulty in surgical resection and poor response to drug therapy, which was successfully treated with radiofrequency ablation combined with intraoperative biopsy of the lesion. A 48-year-old female patient, with hypercortisolism (reddening of the face, full moon face, hirsutism, acne, and weight gain) detected three months ago. Small and high-dose dexamethasone suppression tests were not suppressed, Cushing’s syndrome was under consideration. PET-CT examination suggested mild FDG uptake in two nodules in the anterior basal segment of the lower lobe of the right lung, the possibility of ectopic ACTH lesions was considered because of the clinical presentation. Due to difficult surgical approach of the lesion, high risk of surgery and the patient’s anxiety, CT-guided thermal ablation combined with puncture biopsy was considered to treat the lesions. Image-guided thermal ablation can effectively inactivate ectopic ACTH lesions in the lung, rapidly improve the symptoms of high cortisol, and can be combined with biopsy for pathologic diagnosis. Therefore, this technique can be considered for treating pulmonary ACTH lesions that are difficult to resect surgically.
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11
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Shen X, Chen T, Liu N, Yang B, Feng G, Yu P, Zhan C, Yin N, Wang Y, Huang B, Chen S. MRI-guided microwave ablation and albumin-bound paclitaxel for lung tumors: Initial experience. Front Bioeng Biotechnol 2022; 10:1011753. [PMID: 36406211 PMCID: PMC9669312 DOI: 10.3389/fbioe.2022.1011753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Magnetic resonance-guided microwave ablation (MRI-guided MWA) is a new, minimally invasive ablation method for cancer. This study sought to analyze the clinical value of MRI-guided MWA in non-small cell lung cancer (NSCLC). We compared the precision, efficiency, and clinical efficacy of treatment in patients who underwent MRI-guided MWA or computed tomography (CT)-guided microwave ablation (CT-guided MWA). Propensity score matching was used on the prospective cohort (MRI-MWA group, n = 45) and the retrospective observational cohort (CT-MWA group, n = 305). To evaluate the advantages and efficacy of MRI-guided MWA, data including the accuracy of needle placement, scan duration, ablation time, total operation time, length of hospital stay, progression-free survival (PFS), and overall survival (OS) were collected and compared between the two groups. The mean number of machine scans required to adjust the needle position was 7.62 ± 1.69 (range 4–12) for the MRI-MWA group and 9.64 ± 2.14 (range 5–16) for the CT-MWA group (p < 0.001). The mean time for antenna placement was comparable between the MRI and CT groups (54.41 ± 12.32 min and 53.03 ± 11.29 min, p = 0.607). The microwave ablation time of the two groups was significantly different (7.62 ± 2.65 min and 9.41 ± 2.86 min, p = 0.017), while the overall procedure time was comparable (91.28 ± 16.69 min vs. 93.41 ± 16.03 min, p = 0.568). The overall complication rate in the MRI-MWA group was significantly lower than in the CT-MWA group (12% vs. 51%, p = 0.185). The median time to progression was longer in the MRI-MWA group than in the CT-MWA group (11 months [95% CI 10.24–11.75] vs. 9 months [95% CI 8.00–9.99], p = 0.0003; hazard ratio 0.3690 [95% CI 0.2159–0.6306]). OS was comparable in both groups (MRI group 26.0 months [95% CI 25.022–26.978] vs. CT group 23.0 months [95% CI 18.646–27.354], p = 0.18). This study provides hitherto-undocumented evidence of the clinical effects of MRI-guided MWA on patients with NSCLC and determines the relative safety and efficiency of MRI- and CT-guided MWA.
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Affiliation(s)
- Xiaokang Shen
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing, China
- Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - TianMing Chen
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Nianlong Liu
- Department of Medical Imaging, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bo Yang
- Department of Medical Imaging, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - GuoDong Feng
- Department of Interventional Therapy, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Pengcheng Yu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
| | - Chuanfei Zhan
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
| | - Na Yin
- Department of Medical Imaging, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - YuHuang Wang
- Department of Medical Imaging, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bin Huang
- The Comprehensive Cancer Center of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Clinical Cancer Institute of Nanjing University, Nanjing, China
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University and Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing Drum Tower Hospital, Medical School of Southeast University, Nanjing, China
- *Correspondence: Bin Huang, ; Shilin Chen,
| | - Shilin Chen
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing, China
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
- *Correspondence: Bin Huang, ; Shilin Chen,
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Investigation on Imaging Features and Clinical Significance of Cardiac CT in Comprehensive Evaluation of Aortic Valve and Root before Percutaneous Aortic Valve Replacement. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5838670. [PMID: 36177061 PMCID: PMC9514922 DOI: 10.1155/2022/5838670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/04/2022] [Accepted: 08/20/2022] [Indexed: 11/18/2022]
Abstract
Medical imaging feature analysis is the basis of medical image processing and analysis. The solution of this problem not only directly affects the successful application of computer graphics and image technology in medicine but also has important theoretical and practical significance. In this paper, the imaging characteristics and clinical significance are discussed by studying the comprehensive evaluation of aortic valve and root before aortic valve replacement. In recent years, preoperative comprehensive evaluation of the aortic valve and root has been gradually carried out. Compared with traditional methods, minimally invasive surgery brings more accurate diagnosis to patients, quick recovery and discharge after surgery, and less pain. This study retrospectively includes patients with severe aortic stenosis who underwent TAVR with routine computed tomography. Based on CT images, the determination and grouping of bicuspid aortic valve and tricuspid aortic valve were completed. Thirteen cross-sectional levels of the aorta-iliac-femoral vascular access were completed. The results showed that 3 people had stroke (17.6%) and 5 people had myocardial infarction (29.4%) during the follow-up period. Atrial fibrillation occurred in 5 patients (29.4%), permanent pacemaker implantation was performed in 1 patient (5.9%), and acute kidney injury occurred in 7 patients (41.2%). No patient died due to surgery-related causes, and the analysis of imaging features and clinical significance in the preoperative comprehensive evaluation of the aortic valve and root played a crucial role. In the training stage, the principal component analysis method was used to train the shape, and the model of the shape intensity of the aortic valve and the shape change of each principal component was obtained. The most probable aortic valve region in the target image was obtained by matching the similarity of all atlases, and the correct aortic valve segmentation was obtained by using the first level set of shape intensity. The experimental part verified the accuracy of the algorithm.
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Cytoreductive Surgical Treatment of Pleural Mesothelioma in a Porcine Model Using Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) and Radiofrequency Ablation (RFA). Tomography 2022; 8:2232-2242. [PMID: 36136883 PMCID: PMC9498358 DOI: 10.3390/tomography8050187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/25/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
Abstract
A combination of surgery and chemotherapy is the most effective treatment available for Malignant Pleural Mesothelioma (MPM). However, both cause significant collateral damage and cannot eliminate residual microscopic disease. This investigation aimed to compare and determine the feasibility of utilizing Radiofrequency Ablation (RFA) and Magnetic-Resonance-guided Focused Ultrasound Surgery (MRgFUS) as alternative treatments for MPM. A large animal tumor model was developed in 13 Yorkshire female pigs using the MSTO211H cell line. Two pigs were initially used to determine the cyclosporine dose required for immunosuppression and tumor development. Subsequently, 11 other pigs underwent tumor development. Of these 11, 2 died during cell inoculation. Small tumor masses and adhesions were present in the other 9, indicating mesothelioma development. Five pigs then received RFA treatment, and 4 pigs received MRgFUS treatment. Tumor model development and effect of the two treatments were examined using MRI and by necropsy. RFA and MRgFUS both successfully ablated approximately the same sized area in the same treatment time. This study demonstrates that RFA and MRgFUS are feasible for tumor debulking, and while MRgFUS requires more pretreatment planning compared to RFA, MRgFUS is a completely noninvasive procedure.
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14
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Chen J, Yan Y, Lin Q, Chen J, Chen J, Lin Z. The correlation between multimodal radiomics and pathology about thermal ablation lesion of rabbit lung VX2 tumor. Front Oncol 2022; 12:941752. [PMID: 35965559 PMCID: PMC9366720 DOI: 10.3389/fonc.2022.941752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the correlation of CT-MRI pathology with lung tumor ablation lesions by comparing CT, MRI, and pathological performance of rabbit lung VX2 tumor after thermal ablation. Methods Thermal ablation including microwave ablation (MWA) and radiofrequency ablation (RFA) was carried out in 12 experimental rabbits with lung VX2 tumors under CT guidance. CT and MRI performance was observed immediately after ablation, and then the rabbits were killed and pathologically examined. The maximum diameter of tumors on CT before ablation, the central hypointense area on T2-weighted image (T2WI) after ablation, and the central hyperintense area on T1-weighted image (T1WI) after ablation and pathological necrosis were measured. Simultaneously, the maximum diameter of ground-glass opacity (GGO) around the lesion on CT after ablation, the surrounding hyperintense area on T2WI after ablation, the surrounding isointense area on T1WI after ablation, and the pathological ablation area were measured, and then the results were compared and analyzed. Results Ablation zones showed GGO surrounding the original lesion on CT, with a central hypointense and peripheral hyperintense zone on T2WI as well as a central hyperintense and peripheral isointense zone on T1WI. There was statistical significance in the comparison of the maximum diameter of the tumor before ablation with a central hyperintense zone on T1WI after ablation and pathological necrosis. There was also statistical significance in the comparison of the maximum diameter of GGO around the lesion on CT with the surrounding hyperintense zone on T2WI and isointense on T1WI after ablation and pathological ablation zone. There was only one residual tumor abutting the vessel in the RFA group. Conclusions MRI manifestations of thermal ablation of VX2 tumors in rabbit lungs have certain characteristics with a strong pathological association. CT combined with MRI multimodal radiomics is expected to provide an effective new method for clinical evaluation of the immediate efficacy of thermal ablation of lung tumors.
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Affiliation(s)
- Jin Chen
- The Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory of Precision Medicine for Cancer, Fuzhou, China
| | - Yuan Yan
- The Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory of Precision Medicine for Cancer, Fuzhou, China
| | - QingFeng Lin
- The Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory of Precision Medicine for Cancer, Fuzhou, China
| | - Jian Chen
- The Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory of Precision Medicine for Cancer, Fuzhou, China
| | - Jie Chen
- The Department of Interventional Radiology, Sanming Second Hospital, Sanming, China
| | - ZhengYu Lin
- The Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fujian Provincial Key Laboratory of Precision Medicine for Cancer, Fuzhou, China
- *Correspondence: ZhengYu Lin,
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15
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Abrishami Kashani M, Campbell-Washburn AE, Murphy MC, Catalano OA, McDermott S, Fintelmann FJ. Magnetic Resonance Imaging for Guidance and Follow-up of Thoracic Needle Biopsies and Thermal Ablations. J Thorac Imaging 2022; 37:201-216. [PMID: 35426857 PMCID: PMC10441002 DOI: 10.1097/rti.0000000000000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Magnetic resonance imaging (MRI) is used for the guidance and follow-up of percutaneous minimally invasive interventions in many body parts. In the thorax, computed tomography (CT) is currently the most used imaging modality for the guidance and follow-up of needle biopsies and thermal ablations. Compared with CT, MRI provides excellent soft tissue contrast, lacks ionizing radiation, and allows functional imaging. The role of MRI is limited in the thorax due to the low hydrogen proton density and many air-tissue interfaces of the lung, as well as respiratory and cardiac motion. Here, we review the current experience of MR-guided thoracic needle biopsies and of MR-guided thermal ablations targeting lesions in the lung, mediastinum, and the chest wall. We provide an overview of MR-compatible biopsy needles and ablation devices. We detail relevant MRI sequences and their relative advantages and disadvantages for procedural guidance, assessment of complications, and long-term follow-up. We compare the advantages and disadvantages of CT and MR for thoracic interventions and identify areas in need of improvement and additional research.
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Affiliation(s)
| | - Adrienne E Campbell-Washburn
- Division of Intramural Research, Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Mark C Murphy
- Division of Thoracic Imaging and Intervention, Department of Radiology
| | - Onofrio A Catalano
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
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Grasso RF, Bernetti C, Pacella G, Altomare C, Castiello G, Andresciani F, Sarli M, Zobel BB, Faiella E. A comparative analysis of thermal ablation techniques in the treatment of primary and secondary lung tumors: a single-center experience. Radiol Med 2022; 127:714-724. [DOI: 10.1007/s11547-022-01508-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 05/23/2022] [Indexed: 11/27/2022]
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17
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Comparison of expected imaging findings following percutaneous microwave and cryoablation of pulmonary tumors: ablation zones and thoracic lymph nodes. Eur Radiol 2022; 32:8171-8181. [PMID: 35704108 DOI: 10.1007/s00330-022-08905-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/04/2022] [Accepted: 05/21/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare temporal changes of ablation zones and lymph nodes following lung microwave ablation (MWA) and cryoablation. METHODS This retrospective cohort study compared lung ablation zones and thoracic lymph nodes following MWA and cryoablation performed 2006-2020. In the ablation zone cohort, ablation zone volumes were measured on serial CT for 12 months. In the lymph node cohort, the sum of bidimensional products of lymph node diameters was measured before (baseline) and up to 6 months following ablation. Cumulative incidence curves estimated the time to 75% ablation zone reduction and linear mixed-effects regression models compared the temporal distribution of ablation zones and lymph node sizes between modalities. RESULTS Ablation zones of 59 tumors treated in 45 sessions (16 MWA, 29 cryoablation) in 36 patients were evaluated. Differences in the time to 75% volume reduction between modalities were not detected. Following MWA, half of the ablation zones required an estimated time of 340 days to achieve a 75% volume reduction compared to 214 days following cryoablation (p = .30). Thoracic lymph node sizes after 33 sessions (13 MWA, 20 cryoablation) differed between modalities (baseline-32 days, p = .01; 32-123 days, p = .001). Following MWA, lymph nodes increased on average by 38 mm2 (95%CI, 5.0-70.7; p = .02) from baseline to 32 days, followed by an estimated decrease of 50 mm2 (32-123 days; p = .001). Following cryoablation, changes in lymph nodes were not detected (baseline-32 days, p = .33). CONCLUSION The rate of ablation zone volume reduction did not differ between MWA and cryoablation. Thoracic lymph nodes enlarged transiently after MWA but not after cryoablation. KEY POINTS • Contrary to current belief, the rate of lung ablation zone volume reduction did not differ between microwave and cryoablation. • Transient enlargement of thoracic lymph nodes after microwave ablation was not associated with regional tumor spread and decreased within six months following ablation. • No significant thoracic lymph node enlargement was observed following cryoablation.
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18
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Early enlarging cavitation after percutaneous radiofrequency ablation of lung tumors: Incidence, risk factors and outcome. Diagn Interv Imaging 2022; 103:464-471. [DOI: 10.1016/j.diii.2022.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023]
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Update on Image-Guided Thermal Lung Ablation: Society Guidelines, Therapeutic Alternatives, and Postablation Imaging Findings. AJR Am J Roentgenol 2022; 219:471-485. [PMID: 35319908 DOI: 10.2214/ajr.21.27099] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Percutaneous image-guided thermal ablation (IGTA) has been endorsed by multiple societies as a safe and effective lung-preserving treatment for primary lung cancer and metastases involving the lung and chest wall. This article reviews the role of IGTA in the care continuum of patients with thoracic neoplasms and discusses strategies to identify the optimal local therapy considering patient and tumor characteristics. The advantages and disadvantages of percutaneous thermal ablation compared to surgical resection and stereotactic body radiotherapy are summarized. Principles of radiofrequency ablation, microwave ablation, and cryoablation, as well as the emerging use of transbronchial thermal ablation, are described. Specific considerations are presented regarding the role of thermal ablation for early-stage non-small cell lung cancer (NSCLC), multifocal primary NSCLC, pulmonary metastases, salvage of recurrent NSCLC after surgery or radiation, and pain palliation for tumors involving the chest wall. Recent changes to professional society guidelines regarding the role of thermal ablation in the lung, including for treatment of oligometastatic disease, are highlighted. Finally, recommendations are provided for imaging follow-up after thermal ablation of lung tumors, accompanied by examples of expected postoperative findings and patterns of disease recurrence.
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20
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CT after Lung Microwave Ablation: Normal Findings and Evolution Patterns of Treated Lesions. Tomography 2022; 8:617-626. [PMID: 35314628 PMCID: PMC8938788 DOI: 10.3390/tomography8020051] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
Imaging-guided percutaneous ablative treatments, such as radiofrequency ablation (RFA), cryoablation and microwave ablation (MWA), have been developed for the treatment of unresectable primary and secondary lung tumors in patients with advanced-stage disease or comorbidities contraindicating surgery. Among these therapies, MWA has recently shown promising results in the treatment of pulmonary neoplasms. The potential advantages of MWA over RFA include faster ablation times, higher intra-tumoral temperatures, larger ablation zones and lower susceptibility to the heat sink effect, resulting in greater efficacy in proximity to vascular structures. Despite encouraging results supporting its efficacy, there is a relative paucity of data in the literature regarding the role of computer tomography (CT) to monitor MWA-treated lesions, and the CT appearance of their morphologic evolution and complications. For both interventional and non-interventional radiologists, it is crucial to be familiar with the CT features of such treated lesions in order to detect incomplete therapy or recurrent disease at early stage, as well as to recognize initial signs of complications. The aim of this pictorial essay is to describe the typical CT features during follow-up of lung lesions treated with percutaneous MWA and how to interpret and differentiate them from other radiological findings, such as recurrence and complications, that are commonly encountered in this setting.
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21
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Lu Y, Lu C, Xu D, Huang F, He Z, Lei J, Sun H, Zeng J. Computed Tomography-Guided Percutaneous Radiofrequency Ablation in Older Adults With Early-Stage Peripheral Lung Cancer: A Retrospective Cohort Study. Cancer Control 2022; 29:10732748211070702. [PMID: 35076322 PMCID: PMC8793422 DOI: 10.1177/10732748211070702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives To evaluate the feasibility, safety, and efficacy of computed tomography(CT)-guided percutaneous radiofrequency ablation (RFA) in medically inoperable older adults with clinical stage I non-small cell lung cancer (NSCLC). Patients and Methods We retrospectively reviewed the records of medically inoperable older adults (≥70 years) with clinical stage I NSCLC who underwent percutaneous multi-tined electrode RFA at our institution between January 2014 and December 2018. We analyzed the patients’ characteristics, therapy response, survival, as well as the procedure-related complications. Results Eighteen patients (10 men and 8 women) with a mean age of 75.9 (71−85) years were treated in during the study period. The median tumor size was 25 mm (range, 19−43 mm); 10 and 8 cases involved stage T1 and T2a disease, respectively. The median follow-up duration was 25 (11–45) months. RFA was technically successful for all 18 lesions, with no treatment-related mortality. The disease control rate was 83.3% (15/18 lesions). There were 6 cases of pneumothorax: one symptomatic case requiring thoracic drainage, and five requiring no treatment. Minor complications, including pulmonary infection, chest pain, fever, and cough, were treated within 4 days (range, 1−4 days). The progression-free survival rates were 83.3%, 64.9%, and 51.9% 1, 2, and 3 years, respectively. The corresponding overall survival rates were 92.2%, 81.5%, and 54.3%, respectively. Conclusions CT-guided percutaneous RFA is safe and effective in medically inoperable patients with stage I NSCLC and could be an alternative therapeutic strategy, particularly in older adults with early-stage peripheral lung cancer.
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Affiliation(s)
- Yanda Lu
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Caiwei Lu
- Department of Rehabilitation Medicines, Hainan Medical University, Hainan, China
| | - Danni Xu
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Fen Huang
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Zhihui He
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Junhua Lei
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Huamao Sun
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
| | - Jiangzheng Zeng
- Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Hainan, China
- Jiangzheng Zeng, Department of Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan 571199, China. E-mail:
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22
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Farias LDPGD, Strabelli DG, Teles GBDS. COVID-19 pneumonia and target sign. EINSTEIN-SAO PAULO 2021; 19:eAI6564. [PMID: 34932755 PMCID: PMC8664281 DOI: 10.31744/einstein_journal/2021ai6564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/24/2021] [Indexed: 11/22/2022] Open
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23
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Bao F, Yu F, Wang R, Chen C, Zhang Y, Lin B, Wang Y, Hao X, Gu Z, Fang W. Electromagnetic bronchoscopy guided microwave ablation for early stage lung cancer presenting as ground glass nodule. Transl Lung Cancer Res 2021; 10:3759-3770. [PMID: 34733626 PMCID: PMC8512468 DOI: 10.21037/tlcr-21-474] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022]
Abstract
Background Patients with early-stage lung cancer are sometimes medically inoperable, and for patients with multiple primary lung cancers, surgical resection alone sometimes proves to be impractical. Local treatments like microwave ablation (MWA) are investigational alternatives for these patients. Most reported MWA procedures for lung cancers are performed percutaneously under CT guidance. MWA navigated by electromagnetic bronchoscopy (ENB) has been limitedly studied. In this study, we aimed to evaluate the safety and feasibility of MWA under ENB guidance in patients with inoperable early-stage lung cancers or multiple primary lung cancers which cannot be completely resected. Methods From June 2019 to December 2020, preliminary attempts of ENB-guided MWA were made in five medically inoperable patients with a single early-stage lung cancer and ten patients with multiple primary lung cancers which were difficult to resect at the same time. For patients with concomitant pulmonary nodules which needed surgical resection, thoracoscopic resections were performed following ENB-guided MWA. The safety, feasibility, and technique effectiveness of treatments were evaluated. Results ENB-guided MWA for 15 ground glass nodules (GGNs) in 15 patients was completed in accordance with the planned protocol. Biopsy of 13 GGNs showed malignancy. Five patients received simple ENB-guided MWA without simultaneous surgical resection and ten patients received simultaneous surgical resection for 13 concomitant pulmonary nodules. CT scan by the first postoperative week showed technique effectiveness of ablation for 11 nodules indicated for MWA. Four patients had mild complications after the procedure and recovered shortly after treatment. Conclusions For medically inoperable patients with a single GGN manifesting early-stage lung cancer and patients with multiple primary early-stage lung cancers which cannot be resected at the same time, ENB-guided MWA might be a safe and feasible alternative local treatment, whether combined with surgical resection or not. However, large, prospective, randomized, multicenter studies are needed to confirm its role in the treatment of early-stage lung cancer.
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Affiliation(s)
- Feichao Bao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Fenghao Yu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chunji Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yonghui Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Boyu Lin
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiuxiu Hao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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24
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Zheng X, Yuan H, Gu C, Yang C, Xie F, Zhang X, Xu B, Sun J. Transbronchial lung parenchyma cryoablation with a novel flexible cryoprobe in an in vivo porcine model. Diagn Interv Imaging 2021; 103:49-57. [PMID: 34593335 DOI: 10.1016/j.diii.2021.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/16/2021] [Accepted: 08/31/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the feasibility and safety of transbronchial cryoablation with a novel flexible cryoprobe using nitrogen as the refrigerant in an in vivo porcine model of lung parenchyma. MATERIALS AND METHODS A novel flexible cryoprobe using nitrogen as the refrigerant was used for transbronchial cryoablation of lung parenchyma in six normal female pigs. The cryoprobe was delivered to the distal bronchus in the bilateral porcine lungs via the bronchoscopic working channel under virtual bronchoscopy guidance. The position was confirmed with real-time computed tomography (CT). The whole procedure included two freeze-thaw cycles (15 min and 2 min, respectively). CT images were obtained during cryoablation and at 24 h, one week, two weeks and four weeks after the treatment to assess the effectiveness and safety of the procedure. Ablation zone tissue samples were obtained at 24 h and four weeks after the cryoablation for further histopathological analysis. RESULTS All ablation procedures (12/12; 100%) were performed successfully. No major complications occurred during the procedure or the observation period. The ablation zones were clearly depicted on CT with a maximal ablation zone volume at 24 h (21.88 ± 12.61 [SD] cm3) compared to 3.64 ± 2.06 (SD) cm3 and 10.73 ± 3.84 (SD) cm3 at the end of the 1st and 2nd freeze-thaw cycles, respectively (P < 0.001). Histopathological analysis revealed that a coagulative necrotic zone was formed along the target bronchus, with obvious vascular occlusion and hemorrhage 24 h after treatment. The lesions gradually formed fibrosis after four weeks. CONCLUSION The novel flexible bronchoscopy-guided cryoablation is a feasible, safe and effective modality in an in vivo porcine model of peripheral normal lung parenchyma, suggesting potential capabilities for the treatment of peripheral lung cancer in humans.
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Affiliation(s)
- Xiaoxuan Zheng
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Haibin Yuan
- Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China
| | - Chuanjia Gu
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Chi Yang
- Research and Development Department, AccuTarget MediPharma (Shanghai) Co., Ltd., 201318 Shanghai, China; School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, 200093 Shanghai, China
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Xueyan Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China
| | - Binkai Xu
- Research and Development Department, AccuTarget MediPharma (Shanghai) Co., Ltd., 201318 Shanghai, China; School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, 200093 Shanghai, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030 Shanghai, China; Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China.
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Imaging following thermal ablation of early lung cancers: expected post-treatment findings and tumour recurrence. Clin Radiol 2021; 76:864.e13-864.e23. [PMID: 34420686 DOI: 10.1016/j.crad.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/13/2021] [Indexed: 12/22/2022]
Abstract
Thermal ablation is a minimally invasive technique that is growing in acceptance and popularity in the management of early lung cancers. Although curative resection remains the optimal treatment strategy for stage I pulmonary malignancies, percutaneous ablative treatments may also be considered for selected patients. These techniques can additionally be used in the treatment of oligometastatic disease. Thermal ablation of early lung tumours can be achieved using several different techniques. For example, microwave ablation (MWA) and radiofrequency ablation (RFA) utilise extreme heat, whereas cryoablation uses extremely cold temperatures to cause necrosis and ultimately cell death. Typically, post-ablation imaging studies are performed within the first 1-3 months with subsequent imaging performed at regular intervals to ensure treatment response and to evaluate for signs of recurrent disease. Surveillance imaging is usually undertaken with computed tomography (CT) and integrated positron-emission tomography (PET)/CT. Typical imaging findings are usually seen on CT and PET/CT following thermal ablation of lung tumours, and it is vital that radiologists are familiar with these appearances. In addition, radiologists should be aware of the imaging findings that indicate local recurrence following ablation. The objective of this review is to provide an overview of the expected post-treatment findings on CT and PET/CT following thermal ablation of early primary lung malignancies, as well as describing the imaging appearances of local recurrence.
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26
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Ahrar K, Tam AL, Kuban JD, Wu CC. Imaging of the thorax after percutaneous thermal ablation of lung malignancies. Clin Radiol 2021; 77:31-43. [PMID: 34384562 DOI: 10.1016/j.crad.2021.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/22/2021] [Indexed: 01/25/2023]
Abstract
Image-guided thermal ablation is a minimally invasive treatment option for patients with early stage non-small cell lung cancer or metastatic disease to the lungs. Percutaneous ablation treats malignant tumours in situ, which precludes histopathological evaluation of the ablated tumours. Imaging studies are used as surrogates to assess technical and clinical success. Although it is not universally accepted, a common protocol for surveillance imaging includes contrast-enhanced computed tomography (CT) at 1, 3, 6, 9, 12, 18, 24 months, and yearly thereafter. Integrated 2-[18F]-fluoro-2-deoxy-d-glucose positron-emission tomography (PET)/CT imaging is recommended at 3 and 12 months and when recurrent disease is suspected. There is a complex evolution of the ablation zone on CT and PET imaging studies. The zone of ablation, initially larger than the ablated tumour, undergoes gradual involution. In the process, it may cavitate and resemble a lung abscess. Different contrast-enhancement and radionuclide uptake patterns in and around the ablation zone may indicate a wide range of diagnostic possibilities from a normal physiological response to local progression. Ultimately, the zone of ablation may be replaced by a variety of findings including linear bands of density, pleural thickening, or residual necrotic tumour. Diagnostic and interventional radiologists interpreting post-ablation imaging studies must have a clear understanding of the ablation process and imaging findings on surveillance studies. Accurate and timely recognition of complications and/or local recurrence is necessary to guide further therapy. The purpose of this article is to review imaging protocols and salient imaging findings after thermal ablation of lung malignancies.
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Affiliation(s)
- K Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA.
| | - A L Tam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - J D Kuban
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - C C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA
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27
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Grasso RF, Andresciani F, Altomare C, Pacella G, Castiello G, Carassiti M, Quattrocchi CC, Faiella E, Beomonte Zobel B. Lung Thermal Ablation: Comparison between an Augmented Reality Computed Tomography (CT) 3D Navigation System (SIRIO) and Standard CT-Guided Technique. BIOLOGY 2021; 10:biology10070646. [PMID: 34356501 PMCID: PMC8301158 DOI: 10.3390/biology10070646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/25/2021] [Accepted: 07/08/2021] [Indexed: 12/25/2022]
Abstract
Simple Summary Lung cancer is the leading cause of cancer mortality worldwide. In recent years, numerous technologies have been used to perform image-guided percutaneous thermal ablation, mainly including radiofrequency ablation, microwave ablation, and cryoablation. These image-guided ablation techniques have emerged as a safe, cost-effective, minimally invasive treatment alternative for patients who do not require surgery. Procedural planning, monitoring, and lesion targeting are generally performed with the help of computed tomography; navigation systems are emerging as valid tool to reduce procedural time and radiation dose administration. In the present paper, we investigate the efficacy of an optical-based navigation system (SIRIO) to perform lung thermal ablation. SIRIO proved to be a reliable and effective tool when performing CT-guided LTA, displaying a significant decrease in the number of required CT scans, procedure time, and radiation doses administered to patients. Abstract (1) Background: The aim of this retrospective study is to assess safety and efficacy of lung radiofrequency (RFA) and microwave ablation (MWA) using an augmented reality computed tomography (CT) navigation system (SIRIO) and to compare it with the standard CT-guided technique. (2) Methods: Lung RFA and MWA were performed with an augmented reality CT 3D navigation system (SIRIO) in 52 patients. A comparison was then performed with a group of 49 patients undergoing the standard CT-guided technique. All the procedures were divided into four groups based on the lesion diameter (>2 cm or ≤2 cm), and procedural time, the number of CT scans, radiation dose administered, and complications rate were evaluated. Technical success was defined as the presence of a “ground glass” area completely covering the target lesion at the immediate post-procedural CT. (3) Results: Full technical success was achieved in all treated malignant lesions for all the considered groups. SIRIO-guided lung thermo-ablations (LTA) displayed a significant decrease in the number of CT scans, procedure time, and patients’ radiation exposure (p < 0.001). This also resulted in a dosage reduction in hypnotics and opioids administrated for sedation during LTA. No significant differences were observed between the SIRIO and non-SIRIO group in terms of complications incidence. (4) Conclusions: SIRIO is an efficient tool to perform CT-guided LTA, displaying a significant reduction (p < 0.001) in the number of required CT scans, procedure time, and patients’ radiation exposure.
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Affiliation(s)
- Rosario Francesco Grasso
- Department of Diagnostic and Interventional Radiology, University Hospital Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.A.); (C.A.); (G.P.); (G.C.); (C.C.Q.); (E.F.); (B.B.Z.)
- Correspondence:
| | - Flavio Andresciani
- Department of Diagnostic and Interventional Radiology, University Hospital Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.A.); (C.A.); (G.P.); (G.C.); (C.C.Q.); (E.F.); (B.B.Z.)
| | - Carlo Altomare
- Department of Diagnostic and Interventional Radiology, University Hospital Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.A.); (C.A.); (G.P.); (G.C.); (C.C.Q.); (E.F.); (B.B.Z.)
| | - Giuseppina Pacella
- Department of Diagnostic and Interventional Radiology, University Hospital Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.A.); (C.A.); (G.P.); (G.C.); (C.C.Q.); (E.F.); (B.B.Z.)
| | - Gennaro Castiello
- Department of Diagnostic and Interventional Radiology, University Hospital Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.A.); (C.A.); (G.P.); (G.C.); (C.C.Q.); (E.F.); (B.B.Z.)
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, University Hospital Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128 Rome, Italy;
| | - Carlo Cosimo Quattrocchi
- Department of Diagnostic and Interventional Radiology, University Hospital Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.A.); (C.A.); (G.P.); (G.C.); (C.C.Q.); (E.F.); (B.B.Z.)
| | - Eliodoro Faiella
- Department of Diagnostic and Interventional Radiology, University Hospital Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.A.); (C.A.); (G.P.); (G.C.); (C.C.Q.); (E.F.); (B.B.Z.)
| | - Bruno Beomonte Zobel
- Department of Diagnostic and Interventional Radiology, University Hospital Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.A.); (C.A.); (G.P.); (G.C.); (C.C.Q.); (E.F.); (B.B.Z.)
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Habert P, Di Bisceglie M, Bartoli A, Jacquier A, Brige P, Vidal V, Hak JF, Tradi F, Gaubert JY. Description of morphological evolution of lung tumors treated by percutaneous radiofrequency ablation: long term follow-up of 100 lesions with chest CT. Int J Hyperthermia 2021; 38:786-794. [PMID: 34032532 DOI: 10.1080/02656736.2021.1928773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Radiofrequency ablation (RFA) is a safe and effective minimally invasive treatment for pulmonary tumors. Patterns on chest computed tomography (CT) after RFA are classified into five types; however, the follow-up has not been fully described. The objectives of this study were to describe (1) the CT pattern 3 years after RFA and (2) its evolution over 7 years. MATERIALS AND METHODS Lesions treated with RFA between 2009 and 2017 and with ≥3 years of follow-up CT data were included. Lesions with local recurrences were excluded from the study. The morphology of the ablation zone was classified as nodular, fibrotic, atelectatic, cavitary, and disappeared. Other initial anatomical parameters were recorded. Kruskal-Wallis or Chi-square tests were used to compare the groups. RESULTS One hundred lung RFA scars were included, and a retrospective longitudinal study was performed. Three years after RFA, nodular, fibrotic, atelectatic, and cavitary scars, and disappearance were observed in 49%, 36%, 5%, 3%, and 6% of the scars, respectively. Evolution over 7 years showed that the fibrosis, atelectasis, and disappearance remained stable over time, whereas 28% of nodular scars evolved into fibrotic scars. Additionally, 45% of cavitary scars evolved into nodular scars. Pleural contact was associated with disappearance, and the use of a 20-mm needle was associated with atelectasis. CONCLUSION Follow-up after RFA showed that fibrosis, disappearance, and atelectasis remained stable over time. Nodular scars could evolve into fibrotic scars, and cavitary scars could evolve into nodular scars.
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Affiliation(s)
- Paul Habert
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
| | - Mathieu Di Bisceglie
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
| | - Axel Bartoli
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,Centre d'exploration métabolique par résonnance magnétique CEMEREM, Aix-Marseille Université, Marseille, France
| | - Alexis Jacquier
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,Centre d'exploration métabolique par résonnance magnétique CEMEREM, Aix-Marseille Université, Marseille, France
| | - Pauline Brige
- LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
| | - Vincent Vidal
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
| | - Jean-François Hak
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
| | - Farouk Tradi
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
| | - Jean-Yves Gaubert
- Department of Medical Imaging, La Timone Hôpital, Marseille, France.,LIIE, Aix Marseille University, Marseille, France.,CERIMED, Aix Marseille University, Marseille, France
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29
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Genshaft SJ, Suh RD, Abtin F, Baerlocher MO, Dariushnia SR, Devane AM, Himes E, Lisberg A, Padia S, Patel S, Yanagawa J. Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation of Non-Small Cell Lung Cancer and Metastatic Disease to the Lungs. J Vasc Interv Radiol 2021; 32:1242.e1-1242.e10. [PMID: 34000388 DOI: 10.1016/j.jvir.2021.04.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To provide guidance on quality improvement thresholds for outcomes and complications of image-guided thermal ablation for the treatment of early stage non-small cell lung cancer, recurrent lung cancer, and metastatic disease. MATERIALS AND METHODS A multidisciplinary writing group conducted a comprehensive literature search to identify studies on the topic of interest. Data were extracted from relevant studies and thresholds were derived from a calculation of 2 standard deviations from the weighted mean of each outcome. A modified Delphi technique was used to achieve consensus agreement on the thresholds. RESULTS Data from 29 studies, including systematic reviews and meta-analyses, retrospective cohort studies, and single-arm trials were extracted for calculation of the thresholds. The expert writing group agreed on thresholds for local control, overall survival and adverse events associated with image-guided thermal ablation. CONCLUSION SIR recommends utilizing the indicator thresholds to review and assess the efficacy of ongoing quality improvement programs. When performance falls above or below specific thresholds, consideration of a review of policies and procedures to assess for potential causes, and to implement changes in practices, may be warranted.
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Affiliation(s)
- Scott J Genshaft
- Department of Radiologic Sciences, David Geffen School of Medicine at University of California, Los Angeles, California.
| | - Robert D Suh
- Department of Radiology, David Geffen School of Medicine at University of California, Los Angeles, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Fereidoun Abtin
- Department of Radiology, Thoracic and Interventional Section, David Geffen School of Medicine at University of California, Los Angeles
| | | | - Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - A Michael Devane
- Department of Radiology, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, South Carolina
| | | | - Aaron Lisberg
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Siddharth Padia
- Department of Radiology, Section of Interventional Radiology, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Sheena Patel
- Society of Interventional Radiology, Fairfax, Virginia
| | - Jane Yanagawa
- Division of Thoracic Surgery, David Geffen School of Medicine at University of California, Los Angeles, California
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30
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Tetta C, Carpenzano M, Algargoush ATJ, Algargoosh M, Londero F, Maessen JG, Gelsomino S. Non-surgical Treatments for Lung Metastases in Patients with Soft Tissue Sarcoma: Stereotactic Body Radiation Therapy (SBRT) and Radiofrequency Ablation (RFA). Curr Med Imaging 2021; 17:261-275. [PMID: 32819261 DOI: 10.2174/1573405616999200819165709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radio-frequency ablation (RFA) and Stereotactic Body Radiation Therapy (SBRT) are two emerging therapies for lung metastases. INTRODUCTION Aliterature review was performed to evaluate the outcomes and complications of these procedures in patients with lung metastases from soft tissue sarcoma (STS). METHODS After selection, seven studies were included for each treatment encompassing a total of 424 patients: 218 in the SBRT group and 206 in the RFA group. RESULTS The mean age ranged from 47.9 to 64 years in the SBRT group and from 48 to 62.7 years in the RFA group. The most common histologic subtype was, in both groups, leiomyosarcoma. In the SBRT group, median overall survival ranged from 25.2 to 69 months and median disease- free interval was from 8.4 to 45 months. Two out of seven studies reported G3 and one G3 toxicity, respectively. In RFA patients, overall survival ranged from 15 to 50 months. The most frequent complication was pneumothorax. Local control showed a high percentage for both procedures. CONCLUSION SBRT is recommended in patients unsuitable to surgery, in synchronous bilateral pulmonary metastases, in case of deep lesions and patients receiving high-risk systemic therapies. RFA is indicated in case of a long disease-free interval, in oligometastatic disease, when only the lung is involved, in small size lesions far from large vessels. Further large randomized studies are necessary to establish whether these treatments may also represent a reliable alternative to surgery.
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Affiliation(s)
- Cecilia Tetta
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Carpenzano
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Areej T J Algargoush
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Marwah Algargoosh
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Francesco Londero
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jos G Maessen
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sandro Gelsomino
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
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31
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Araujo-Filho JDAB, Menezes RSAA, Horvat N, Panizza PSB, Bernardes JPG, Damasceno RS, Oliveira BC, Menezes MR. Lung radiofrequency ablation: post-procedure imaging patterns and late follow-up. Eur J Radiol Open 2020; 7:100276. [PMID: 33225024 PMCID: PMC7666375 DOI: 10.1016/j.ejro.2020.100276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/30/2022] Open
Abstract
RFA is an effective minimally invasive treatment for selected patients with primary and secondary lung tumors. We described the expected imaging features after RFA of lung tumors, and their frequency over time after the procedure. Radiologists should be familiar with these features in order to avoid misinterpretation and inadequate treatments. These normal post-procedure imaging features must be considered in future post-ablation follow-up protocols.
Purpose To describe expected imaging features on chest computed tomography (CT) after percutaneous radiofrequency ablation (RFA) of lung tumors, and their frequency over time after the procedure. Methods In this double-center retrospective study, we reviewed CT scans from patients who underwent RFA for primary or secondary lung tumors. Patients with partial ablation or tumor recurrence during the imaging follow-up were not included. The imaging features were assessed in pre-defined time points: immediate post-procedure, ≤4 weeks, 5−24 weeks, 25−52 weeks and ≥52 weeks. Late follow-up (3 and 5 years after procedure) was assessed clinically in 48 patients. Results The study population consisted of 69 patients and 144 pulmonary tumors. Six out of 69 (9%) patients had primary lung nodules (stage I) and 63/69 (91 %) had metastatic pulmonary nodules. In a patient-level analysis, immediately after lung RFA, the most common CT features were ground glass opacities (66/69, 96 %), consolidation (56/69, 81 %), and hyperdensity within the nodule (47/69, 68 %). Less than 4 weeks, ground glass opacities (including reversed halo sign) was demonstrated in 20/22 (91 %) patients, while consolidation and pleural thickening were detected in 17/22 patients (77 %). Cavitation, pneumatocele, pneumothorax and pleural effusions were less common features. From 5 weeks onwards, the most common imaging features were parenchymal bands. Conclusions Our study demonstrated the expected CT features after lung RFA, a safe and effective minimally invasive treatment for selected patients with primary and secondary lung tumors. Diagnostic and interventional radiologists should be familiar with the expected imaging features immediately after RFA and their change over time in order to avoid misinterpretation and inadequate treatments.
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Affiliation(s)
| | | | - Natally Horvat
- Radiology Department, Hospital Sírio-Libanês, Adma Jafet 91, São Paulo, SP, 01308-050, Brazil.,Radiology Department, Universidade de São Paulo, Travessa da Rua Dr. Ovídio Pires de Campos 75, São Paulo, SP, 05403-900, Brazil
| | | | - João Paulo Giacomini Bernardes
- Radiology Department, Hospital Sírio-Libanês Brasília - Centro De Oncologia Asa Sul, SGAS 613/614 Conjunto E Lote 95 - Asa Sul, Brasília, DF, 70200-730, Brazil
| | | | - Brunna Clemente Oliveira
- Radiology Department, Hospital Sírio-Libanês, Adma Jafet 91, São Paulo, SP, 01308-050, Brazil.,Radiology Department, Universidade de São Paulo, Travessa da Rua Dr. Ovídio Pires de Campos 75, São Paulo, SP, 05403-900, Brazil
| | - Marcos Roberto Menezes
- Radiology Department, Hospital Sírio-Libanês, Adma Jafet 91, São Paulo, SP, 01308-050, Brazil.,Radiology Department, Universidade de São Paulo, Travessa da Rua Dr. Ovídio Pires de Campos 75, São Paulo, SP, 05403-900, Brazil
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32
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Quirk MT, Lee S, Murali N, Genshaft S, Abtin F, Suh R. Alternatives to Surgery for Early-Stage Non-Small Cell Lung Cancer: Thermal Ablation. Clin Chest Med 2020; 41:197-210. [PMID: 32402356 DOI: 10.1016/j.ccm.2020.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Thermal ablation involves the application of heat or cold energy to the lung under image guidance to eradicate tumors. It is indicated for treatment of early-stage non-small cell lung cancer in nonsurgical patients. Ablation technologies have advanced, such that nearly all small tumors can now be treated safely and effectively. Ablation does not cause a lasting decline in pulmonary function tests and may therefore be used to treat multiple synchronous and metachronous lung tumors, a chief advantage over other treatments. Large series with intermediate- and long-term data have been reported showing favorable overall survival, similar to radiation therapy.
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Affiliation(s)
- Matthew T Quirk
- Department of Radiology, UCLA Health, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095, USA.
| | - Shimwoo Lee
- Department of Radiology, UCLA Health, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095, USA
| | - Nikitha Murali
- Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Scott Genshaft
- Department of Radiology, UCLA Health, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095, USA
| | - Fereidoun Abtin
- Department of Radiology, UCLA Health, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095, USA
| | - Robert Suh
- Department of Radiology, UCLA Health, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095, USA
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33
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Canan A, Batra K, Saboo SS, Landay M, Kandathil A. Radiological approach to cavitary lung lesions. Postgrad Med J 2020; 97:521-531. [PMID: 32934178 DOI: 10.1136/postgradmedj-2020-138694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 11/03/2022]
Abstract
Cavitary lesions in the lung are not an uncommon imaging encounter and carry a broad differential diagnosis that includes a wide range of pathological conditions from cancers, infections/inflammatory processes to traumatic and congenital lung abnormalities. In this review article, we describe a comprehensive approach for evaluation of cavitary lung lesions and discuss the differential diagnosis in the light of radiological findings.
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Affiliation(s)
| | - Kiran Batra
- Department of Radiology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 75390, USA
| | - Sachin S Saboo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, 78229, USA
| | - Michael Landay
- Department of Radiology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 75390, USA
| | - Asha Kandathil
- Department of Radiology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 75390, USA
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34
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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.
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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
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35
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Effectiveness and safety in radiofrequency ablation of pulmonary metastases from HCC: a five years study. Med Oncol 2020; 37:25. [PMID: 32166529 DOI: 10.1007/s12032-020-01352-2] [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: 02/26/2020] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is a frequent tumor that may be treated with radiofrequency thermal ablation (RFA). RFA has been used with success also in treatment of pulmonary metastases from a wide range of primitive tumors, especially colorectal. Previous studies have shown that RFA con be used in treating HCC pulmonary metastases. Purpose of our study was a retrospective evaluation of overall survival and complication rates of percutaneous CT-guided radiofrequency ablation of pulmonary metastases from hepatocellular carcinoma (HCC). Data were collected from 40 CT-guided ablation sessions performed on 42 lesions in 26 patients (16 M and 10 F; mean age 62.5 years) with pulmonary metastases from HCC (size range 0.3-4 cm, mean diameter 1.4 ± 0.98 cm) from February 2012 to December 2017. All patients, as in advanced stage of illness (stage C), were treated according to Barcelona Clinic Liver Cancer (BCLC) criteria, with Sorafenib. They had no active HCC foci in the liver and no more than three metastases in the lung. Patients did not discontinue medical therapy with Sorafenib and pulmonary relapses were treated up to three times. In two patients two lesions were treated during the same procedure. Each lesion was ablated under CT guidance. Follow-up contrast-enhanced CT at 1, 3, 6, 12-month and every 6 months after treatment were reviewed. A total of 42 metastatic lung lesions from HCC in 26 patients (57% male, 43% female) were treated with CT-guided radiofrequency thermal ablation procedures. Immediate radiofrequency ablation-related complications (subtle pneumothorax) were observed in 9 of 40 procedures (22.5%). Only one patient developed a pneumothorax requiring drainage tube insertion (2.5%). No other major complications occurred. Moreover, no significant worsening of pulmonary function was observed. In all patients the overall survival rates were 88.5% at 1 year, 69.8% at 3 years and 26.2% at 5 years. Our retrospective assessment confirmed that percutaneous CT-guided radiofrequency thermal ablation in 23 patients with pulmonary metastases from HCC represents an effective and safe alternative treatment option in patients not considerable as potential candidates to surgery.
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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: 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
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Hasegawa T, Takaki H, Kodama H, Yamanaka T, Nakatsuka A, Sato Y, Takao M, Katayama Y, Fukai I, Kato T, Tokui T, Tempaku H, Adachi K, Matsushima Y, Inaba Y, Yamakado K. Three-year Survival Rate after Radiofrequency Ablation for Surgically Resectable Colorectal Lung Metastases: A Prospective Multicenter Study. Radiology 2020; 294:686-695. [PMID: 31934829 DOI: 10.1148/radiol.2020191272] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Although radiofrequency ablation (RFA) is widely performed for the treatment of colorectal cancer (CRC) lung metastases, its efficacy for candidates with surgically resectable disease is unclear. Purpose To evaluate the prognosis after RFA in participants with resectable CRC lung metastases. Materials and Methods For this prospective multicenter study (ClinicalTrials.gov identifier: NCT00776399), participants with five or fewer surgically resectable lung metastases measuring 3 cm or less were included. Participants with CRC and a total of 100 lung metastases measuring 0.4-2.8 cm (mean, 1.0 cm ± 0.5) were chosen and treated with 88 sessions of RFA from January 2008 to April 2014. The primary end point was the 3-year overall survival (OS) rate, with an expected rate of 55%. The local tumor progression rate and safety were evaluated as secondary end points. The OS rates were generated by using the Kaplan-Meier method. Log-rank tests and Cox proportional regression models were used to identify the prognostic factors by means of univariable and multivariable analyses. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events, version 3.0. Results Seventy participants with CRC (mean age, 66 years ± 10; 49 men) were evaluated. The 3-year OS rate was 84% (59 of 70 participants; 95% confidence interval [CI]: 76%, 93%). In multivariable analysis, factors associated with worse OS included rectal rather than colon location (hazard ratio [HR] = 7.7; 95% CI: 2.6, 22.6; P < .001), positive carcinoembryonic antigen (HR = 5.8; 95% CI: 2.0, 16.9; P = .001), and absence of previous chemotherapy (HR = 9.8; 95% CI: 2.5, 38.0; P < .001). Local tumor progression was found in six of the 70 participants (9%). A grade 5 adverse event was seen in one of the 88 RFA sessions (1%), and grade 2 adverse events were seen in 18 (20%). Conclusion Lung radiofrequency ablation provided a favorable 3-year overall survival rate of 84% for resectable colorectal lung metastases measuring 3 cm or smaller. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Gemmete in this issue.
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Affiliation(s)
- Takaaki Hasegawa
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Haruyuki Takaki
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Hiroshi Kodama
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Takashi Yamanaka
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Atsuhiro Nakatsuka
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Yozo Sato
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Motoshi Takao
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Yoshihiko Katayama
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Ichiro Fukai
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Toshio Kato
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Toshiya Tokui
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Hironori Tempaku
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Katsutoshi Adachi
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Yasushi Matsushima
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Yoshitaka Inaba
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Koichiro Yamakado
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
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Alexander ES, Xiong L, Baird GL, Fernando H, Dupuy DE. CT Densitometry and Morphology of Radiofrequency-Ablated Stage IA Non-Small Cell Lung Cancer: Results from the American College of Surgeons Oncology Group Z4033 (Alliance) Trial. J Vasc Interv Radiol 2020; 31:286-293. [PMID: 31902554 DOI: 10.1016/j.jvir.2019.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/26/2019] [Accepted: 09/02/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate tumor and ablation zone morphology and densitometry related to tumor recurrence in participants with Stage IA non-small cell lung cancer undergoing radiofrequency ablation in a prospective, multicenter trial. MATERIALS AND METHODS Forty-five participants (median 76 years old; 25 women; 20 men) from 16 sites were followed for 2 years (December 2006 to November 2010) with computed tomography (CT) densitometry. Imaging findings before and after ablation were recorded, including maximum CT attenuation (in Hounsfield units) at precontrast and 45-, 90-, 180-, and 300-s postcontrast. RESULTS Every 1-cm increase in the largest axial diameter of the ablation zone at 3-months' follow-up compared to the index tumor reduced the odds of 2-year recurrence by 52% (P = .02). A 1-cm difference performed the best (sensitivity, 0.56; specificity, 0.93; positive likelihood ratio of 8). CT densitometry precontrast and at 45 seconds showed significantly different enhancement patterns in a comparison among pretreated lung cancer (delta = +61.2 HU), tumor recurrence (delta = +57 HU), and treated tumor/ablation zone (delta [change in attenuation] = +16.9 HU), (P < .0001). Densitometry from 45 to 300 s was also different among pretreated tumor (delta = -6.8 HU), recurrence (delta = -11.2 HU), and treated tumor (delta = +12.1 HU; P = .01). Untreated and residual tumor demonstrated washout, whereas treated tumor demonstrated increased attenuation. CONCLUSIONS An ablation zone ≥1 cm larger than the initial tumor, based on 3-month follow-up imaging, is recommended to decrease odds of recurrence. CT densitometry can delineate tumor versus treatment zones.
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Affiliation(s)
- Erica S Alexander
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Lillian Xiong
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Grayson L Baird
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Hiran Fernando
- Department of Surgery, Inova Schar Cancer Institute, Fairfax, Virginia
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Moussa AM, Ziv E, Solomon SB, Camacho JC. Microwave Ablation in Primary Lung Malignancies. Semin Intervent Radiol 2019; 36:326-333. [PMID: 31680724 DOI: 10.1055/s-0039-1700567] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality worldwide. Eighty-five percent of cases correspond to non-small cell lung cancer (NSCLC) and pivotal nonsurgical options for early-stage disease include percutaneous ablation and stereotactic body radiation therapy (SBRT). Microwave Ablation (MWA) is a locoregional treatment option that has many advantages over radiofrequency ablation and has been able to overcome the limitations of this technique in the treatment of early-stage NSCLC. In this review article, we highlight the current evidence supporting the use of MWA in patients with early-stage NSCLC and discuss the technical considerations of the procedure, including optimal patient selection and planning strategies, as well as the potential complications and reported outcomes. Finally, we mention future trends involving ablation in NSCLC, including its role in combination with SBRT in central tumors, management of post-SBRT local recurrence, and its potential as an adjuvant treatment option for patients with resistance to systemic therapy or in combination with checkpoint inhibitors.
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Affiliation(s)
- Amgad M Moussa
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Etay Ziv
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen B Solomon
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Juan C Camacho
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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Eiken PW, Welch BT. Cryoablation of Lung Metastases: Review of Recent Literature and Ablation Technique. Semin Intervent Radiol 2019; 36:319-325. [PMID: 31680723 DOI: 10.1055/s-0039-1697002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article reviews the current indications for image-guided thermal ablation of pulmonary metastatic disease. It also summarizes data regarding the efficacy and complications of lung cryoablation and present techniques for performing lung cryoablation as informed by the recent literature.
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Affiliation(s)
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Abstract
Conventional approaches to the treatment of early-stage lung cancer have focused on the use of surgical methods to remove the tumor. Recent progress in radiation therapy techniques and in the field of interventional oncology has seen the development of several novel ablative therapies that have gained widespread acceptance as alternatives to conventional surgical options in appropriately selected patients. Local control rates with stereotactic body radiation therapy for early-stage lung cancer now approach those of surgical resection, while percutaneous ablation is in widespread use for the treatment of lung cancer and oligometastatic disease for selected other malignancies. Tumors treated with targeted medical and ablative therapies can respond to treatment differently when compared with conventional therapies. For example, after stereotactic body radiation therapy, radiologic patterns of posttreatment change can mimic disease progression, and, following percutaneous ablation, the expected initial increase in the size of a treated lesion limits the utility of conventional size-based response assessment criteria. In addition, numerous treatment-related side effects have been described that are important to recognize, both to ensure appropriate treatment and to avoid misclassification as worsening tumor. Imaging plays a vital role in the assessment of patients receiving targeted ablative therapy, and it is essential that thoracic radiologists become familiar with these findings.
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Prud’homme C, Deschamps F, Moulin B, Hakime A, Al-Ahmar M, Moalla S, Roux C, Teriitehau C, de Baere T, Tselikas L. Image-guided lung metastasis ablation: a literature review. Int J Hyperthermia 2019; 36:37-45. [DOI: 10.1080/02656736.2019.1647358] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Clara Prud’homme
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Frederic Deschamps
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Benjamin Moulin
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Antoine Hakime
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Marc Al-Ahmar
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Salma Moalla
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Charles Roux
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Christophe Teriitehau
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Thierry de Baere
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Lambros Tselikas
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
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Tafti BA, Genshaft S, Suh R, Abtin F. Lung Ablation: Indications and Techniques. Semin Intervent Radiol 2019; 36:163-175. [PMID: 31435124 DOI: 10.1055/s-0039-1693981] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Lung ablation is ever more recognized since its initial report and use almost two decades ago. With technological advancements in thermal modalities, particularly microwave ablation and cryoablation, better identification of the cohort of patients who best benefit from ablation, and understanding the role of imaging after ablation, image-guided thermal ablation for primary and secondary pulmonary malignancies is increasingly recognized and accepted as a cogent form of local therapy.
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Affiliation(s)
- Bashir Akhavan Tafti
- Divisions of Interventional Radiology, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Scott Genshaft
- Thoracic Imaging at the Department of Radiological Sciences, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Robert Suh
- Divisions of Interventional Radiology, David Geffen School of Medicine, UCLA Health System, Los Angeles, California.,Thoracic Imaging at the Department of Radiological Sciences, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
| | - Fereidoun Abtin
- Divisions of Interventional Radiology, David Geffen School of Medicine, UCLA Health System, Los Angeles, California.,Thoracic Imaging at the Department of Radiological Sciences, David Geffen School of Medicine, UCLA Health System, Los Angeles, California
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Abstract
OBJECTIVE The purpose of this article is to summarize the clinical utility of 18F-FDG PET/CT in the evaluation of lung cancer recurrence with an emphasis on typical anatomic and metabolic patterns of recurrence, expected posttherapeutic changes, and common pitfalls of FDG PET/CT. FDG PET/CT is useful in assessing therapeutic response and in determining the extent of recurrent disease and provides a guide for targeted biopsy. CONCLUSION FDG PET/CT plays a crucial role in the evaluation of therapeutic response in lung cancer and guides management.
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Liu B, Ye X, Fan W, Li X, Feng W, Lu Q, Mao Y, Lin Z, Li L, Zhuang Y, Ni X, Shen J, Fu Y, Han J, Li C, Liu C, Yang W, Su Z, Wu Z, Liu L. [Expert Consensus for Image-guided Radiofrequency Ablation of Pulmonary Tumors (2018 Version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018. [PMID: 29526174 PMCID: PMC5973020 DOI: 10.3779/j.issn.1009-3419.2018.02.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Baodong Liu
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250100, China
| | - Weijun Fan
- Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xiaoguang Li
- Department of Tumor Minimally Invasive Therapy, Beijing Hospital, Beijing 100005, China
| | - Weijian Feng
- Department of Oncology, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Qiang Lu
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - Yu Mao
- Department of Thoracic Surgery, Hohhot First Hospital, Inner Mongolia, Hohhot 010020, China
| | - Zhengyu Lin
- Department of Interventional Therapy, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Lu Li
- Department of Thoracic Surgery, 306th Hospital of PLA, Beijing 100101, China
| | - Yiping Zhuang
- Department of Interventional Therapy, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Xudong Ni
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200001, China
| | - Jialin Shen
- Department of Tumor Interventional Therapy, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
| | - Yili Fu
- Department of Thoracic Surgery, Chaoyang Hospital, Capital medical University, Beijing 100020, China
| | - Jianjun Han
- Department of Minimally Invasive Interventional Therapy, Shandong Provincial Tumor Hospital, Jinan 250117, China
| | - Chenrui Li
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100020, China
| | - Chen Liu
- Department of Interventional Therapy, Beijing Cancer Hospital, Beijing 100142, China
| | - Wuwei Yang
- Department of Tumor Minimally Invasive Therapy, 307th Hospital of PLA, Beijing 100071, China
| | - Zhiyong Su
- Affiliated Hospital of Chifeng University, Chifeng 024005, China
| | - Zhiyuan Wu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Lei Liu
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Meram E, Longhurst C, Brace CL, Laeseke PF. Comparison of Conventional and Cone-Beam CT for Monitoring and Assessing Pulmonary Microwave Ablation in a Porcine Model. J Vasc Interv Radiol 2018; 29:1447-1454. [PMID: 30217749 DOI: 10.1016/j.jvir.2018.04.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To compare cone-beam computed tomography (CT) with conventional CT for assessing the growth and postprocedural appearance of pulmonary microwave ablation zones. MATERIALS AND METHODS A total of 17 microwave ablations were performed in porcine lung in vivo by applying 65 W for 5 minutes through a single 17-gauge antenna. Either CT (n = 8) or CBCT (n = 9) was used for guidance and ablation zone monitoring at 1-minute intervals. Postprocedural noncontrast images were acquired with both modalities. Three independent readers measured the length, width, cross-sectional area, and circularity of the ablation zones on gross tissue samples and CT and cone-beam CT images. The measurements were compared via linear mixed-effects models for postprocedural appearance and with a polynomial mixed effects model for ablation zone growth curves. RESULTS On postprocedural images, the differences between cone-beam CT and CT in mean length (3.84 vs 3.86 cm; Δ = -0.02; P = .70), width (2.61 vs 2.56 cm; Δ = 0.06; P = .46), area (7.84 vs 7.65 cm2; Δ = 0.19; P = .35), and circularity (0.85 vs 0.85; Δ = 0.01; P = .62) were not statistically significant after accounting for intersubject and interrater variability. Also, there was no significant difference between CT and cone-beam CT growth curves of the ablation zones during monitoring in terms of length (pInt. = 1.00; pLin.Slope = 0.52; pQuad.Slope = 0.69); width (pInt. = 0.83; pLin.Slope = 0.98; pQuad.Slope = 0.79), area (pInt. = 0.47; pLin.Slope = 0.27; pQuad.Slope = 0.57), or circularity (pInt. = 0.54; pLin.Slope = 0.74; pQuad.Slope = 0.80). Both CT and cone-beam CT overestimated gross pathologic observations of ablation length, width, and area (P < .001 for all). CONCLUSIONS Cone-beam CT was similar to conventional CT when assessing the growth, final size, and shape of pulmonary microwave ablation zones and may be useful for monitoring and evaluating microwave ablations in the lung.
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Affiliation(s)
- Ece Meram
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin, 600 Highland Avenue, D4-352, Madison, WI 53792.
| | - Colin Longhurst
- Department of Radiology, and Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Chris L Brace
- Tumor Ablation Laboratory, University of Wisconsin, Madison, Wisconsin
| | - Paul F Laeseke
- Section of Interventional Radiology, University of Wisconsin, Madison, Wisconsin
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48
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Takeuchi A, Kanemitsu Y, Takakuwa O, Ito K, Kitamura Y, Inoue Y, Takeda N, Fukumitsu K, Asano T, Fukuda S, Ohkubo H, Takemura M, Maeno K, Ito Y, Oguri T, Niimi A. A suspected case of inflammatory bronchial polyp induced by bronchial thermoplasty but resolved spontaneously. J Thorac Dis 2018; 10:E678-E681. [PMID: 30416815 DOI: 10.21037/jtd.2018.08.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Akira Takeuchi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yoshihiro Kanemitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Osamu Takakuwa
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Keima Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yuki Kitamura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yoshitsugu Inoue
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Norihisa Takeda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Kensuke Fukumitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Takamitsu Asano
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Satoshi Fukuda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Hirotsugu Ohkubo
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Masaya Takemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Ken Maeno
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yutaka Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Tetsuya Oguri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
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Liu B, Ye X, Fan W, Li X, Feng W, Lu Q, Mao Y, Lin Z, Li L, Zhuang Y, Ni X, Shen J, Fu Y, Han J, Li C, Liu C, Yang W, Su Z, Wu Z, Liu L. Expert consensus on image-guided radiofrequency ablation of pulmonary tumors: 2018 edition. Thorac Cancer 2018; 9:1194-1208. [PMID: 30039918 PMCID: PMC6119618 DOI: 10.1111/1759-7714.12817] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 12/28/2022] Open
Abstract
Lung cancer ranks first in incidence and mortality in China. Surgery is the primary method to cure cancer, but only 20-30% of patients are eligible for curative resection. In recent years, in addition to surgery, other local therapies have been developed for patients with numerous localized primary and metastatic pulmonary tumors, including stereotactic body radiation therapy and thermal ablative therapies through percutaneously inserted applicators. Percutaneous thermal ablation of pulmonary tumors is minimally invasive, conformal, repeatable, feasible, cheap, has a shorter recovery time, and offers reduced morbidity and mortality. Radiofrequency ablation (RFA), the most commonly used thermal ablation technique, has a reported 80-90% rate of complete ablation, with the best results obtained in tumors < 3 cm in diameter. Because the clinical efficacy of RFA of pulmonary tumors has not yet been determined, this clinical guideline describes the techniques used in the treatment of localized primary and metastatic pulmonary tumors in nonsurgical candidates, including mechanism of action, devices, indications, techniques, potential complications, clinical outcomes, post-ablation surveillance, and use in combination with other therapies. In the future, the role of RFA in the treatment of localized pulmonary tumors should ultimately be determined by evidence from prospective randomized controlled trials comparing sublobar resection or stereotactic body radiation therapy.
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Affiliation(s)
- Bao‐Dong Liu
- Department of Thoracic Surgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xin Ye
- Department of OncologyProvincial Hospital of Shandong UniversityJinanChina
| | - Wei‐Jun Fan
- Imaging and Interventional DepartmentSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Xiao‐Guang Li
- Minimally Invasive Department of CancerBeijing HospitalBeijingChina
| | - Wei‐Jian Feng
- Department of Oncology, Fuxing HospitalCapital Medical UniversityBeijingChina
| | - Qiang Lu
- Department of Thoracic Surgery, Tangdu HospitalAir Force Medical UniversityXi'anChina
| | - Yu Mao
- Department of Thoracic SurgeryHohhot No.1 Hospital of Inner Mongolia Autonomous RegionHohhotChina
| | - Zheng‐Yu Lin
- Intervention DepartmentThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Lu Li
- Department of Thoracic SurgeryThe 306th Hospital of PLABeijingChina
| | - Yi‐Ping Zhuang
- Minimally Invasive Intervention Department of Jiangsu Cancer HospitalNanjingChina
| | - Xu‐Dong Ni
- Department of Thoracic SurgeryShanghai Zhongshan HospitalShanghaiChina
| | - Jia‐Lin Shen
- Cancer Intervention DepartmentSouth Hospital of Shanghai Renji HospitalShanghaiChina
| | - Yi‐Li Fu
- Department of Thoracic SurgeryBeijing Chao Yang Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Jian‐Jun Han
- Minimally Invasive Department of Shandong Cancer HospitalJinanChina
| | - Chen‐Rui Li
- Intervention DepartmentCancer Hospital of Chinese Academy of Medical SciencesBeijingChina
| | - Chen Liu
- Intervention Department, Cancer HospitalPeking UniversityBeijingChina
| | - Wu‐Wei Yang
- Minimally Invasive Department of CancerThe 307th Hospital of PLABeijingChina
| | - Zhi‐Yong Su
- Department of Thoracic SurgeryAffiliated Hospital of Chifeng University of Inner Mongolia Autonomous RegionChifengChina
| | - Zhi‐Yuan Wu
- Radiation Intervention DepartmentShanghai Ruijin HospitalShanghaiChina
| | - Lei Liu
- Department of Thoracic Surgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
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50
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Palussière J, Chomy F, Savina M, Deschamps F, Gaubert JY, Renault A, Bonnefoy O, Laurent F, Meunier C, Bellera C, Mathoulin-Pelissier S, de Baere T. Radiofrequency ablation of stage IA non-small cell lung cancer in patients ineligible for surgery: results of a prospective multicenter phase II trial. J Cardiothorac Surg 2018; 13:91. [PMID: 30143031 PMCID: PMC6109264 DOI: 10.1186/s13019-018-0773-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/26/2018] [Indexed: 12/19/2022] Open
Abstract
Background A prospective multicenter phase II trial to evaluate the survival outcomes of percutaneous radiofrequency ablation (RFA) for patients with stage IA non-small cell lung cancer (NSCLC), ineligible for surgery. Methods Patients with a biopsy-proven stage IA NSCLC, staging established by a positron emission tomography-computed tomography (PET-CT), were eligible. The primary objective was to evaluate the local control of RFA at 1-year. Secondary objectives were 1- and 3-year overall survival (OS), 3-year local control, lung function (prior to and 3 months after RFA) and quality of life (prior to and 1 month after RFA). Results Of the 42 patients (mean age 71.7 y) that were enrolled at six French cancer centers, 32 were eligible and assessable. Twenty-seven patients did not recur at 1 year corresponding to a local control rate of 84.38% (95% CI, [67.21–95.72]). The local control rate at 3 years was 81.25% (95% CI, [54.35–95.95]). The OS rate was 91.67% (95% CI, [77.53–98.25]) at 1 year and 58.33% (95% CI, [40.76–74.49]) at 3 years. The forced expiratory volume was stable in most patients apart from two, in whom we observed a 10% decrease. There was no significant change in the global health status or in the quality of life following RFA. Conclusion RFA is an efficient treatment for medically inoperable stage IA NSCLC patients. RFA is well tolerated, does not adversely affect pulmonary function and the 3-year OS rate is comparable to that of stereotactic body radiotherapy, in similar patients. Trial registration ClinicalTrials.gov Identifier NCT01841060 registered in November 2008.
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Affiliation(s)
- J Palussière
- Department of Interventional Radiology, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France.
| | - F Chomy
- Department of Medical Oncology, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - M Savina
- Department of Clinical and Epidemiological Research, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - F Deschamps
- Department of Interventional Imaging, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, Paris, France
| | - J Y Gaubert
- Department of Imaging, CHU Timone, 264 Rue Saint-Pierre, 13385, Marseille, France
| | - A Renault
- Department of Imaging, CHU Pau, 4 Boulevard Hauterive, 64000, Pau, France
| | - O Bonnefoy
- Department of Imaging, CHU Pau, 4 Boulevard Hauterive, 64000, Pau, France
| | - F Laurent
- Department of Imaging, CHU Haut Lévêque, Avenue Magellan, 33600, Pessac, France
| | - C Meunier
- Department of Imaging, CHU Rennes, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - C Bellera
- Department of Clinical and Epidemiological Research, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - S Mathoulin-Pelissier
- Department of Clinical and Epidemiological Research, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - T de Baere
- Department of Interventional Imaging, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, Paris, France
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