ASO Author Reflections: Percutaneous Image-Guided Ablation and Multi-modality Management of Lung Metastases

Multimodality Management of Thoracic Tumors: Initial Experience With a Multidisciplinary Thoracic Ablation Conference

BACKGROUND

This study aimed to describe lesion-specific management of thoracic tumors referred for consideration of image-guided thermal ablation (IGTA) at a newly established multidisciplinary ablation conference.

METHODS

This retrospective single-center cohort study included consecutive patients with non-small cell lung cancer (NSCLC) or thoracic metastases evaluated from June 2020 to January 2022 in a multidisciplinary conference. Outcomes included the management recommendation, treatments received (IGTA, surgical resection, stereotactic body radiation therapy [SBRT], multimodality management), and number of tumors treated per patient. Pearson's chi-square test was used to assess for a change in management, and Poisson regression was used to compare the number of tumors by treatment received.

RESULTS

The study included 172 patients (58 % female; median age, 69 years; 56 % thoracic metastases; 27 % multifocal primary lung cancer; 59 % ECOG 0 [range, 0-3]) assessed in 206 evaluations. For the patients with NSCLC, IGTA was considered the most appropriate local therapy in 12 %, equal to SBRT in 22 %, and equal to lung resection in 3 % of evaluations. For the patients with thoracic metastases, IGTA was considered the most appropriate local therapy in 22 %, equal to SBRT in 12 %, and equal to lung resection in 3 % of evaluations. Although all patients were referred for consideration of IGTA, less than one third of patients with NSCLC or thoracic metastases underwent IGTA (p < 0.001). Multimodality management allowed for treatment of more tumors per patient than single-modality management (p < 0.01).

CONCLUSIONS

Multidisciplinary evaluation of patients with thoracic tumors referred for consideration of IGTA significantly changed patient management and facilitated lesion-specific multimodality management.

Comparison of Percutaneous Image-Guided Microwave and Cryoablation for Sarcoma Lung Metastases: 10-Year Experience

Background: Outcomes between percutaneous microwave (MWA) and cryoablation of sarcoma lung metastases have not been compared to our knowledge. Objective: To compare technical success, complications, local tumor control, and overall survival (OS) following MWA versus cryoablation of sarcoma lung metastases. Methods: This retrospective cohort study included 27 patients (16 women, 11 men; median age 64 years; Eastern Cooperative Oncology Group performance score 0-2) who underwent 39 percutaneous CT-guided ablation sessions (21 MWA, 18 cryoablation; 1-4 sessions per patient) to treat 65 sarcoma lung metastases (median 1 tumor per patient, range 1-12; median tumor diameter 11 mm, range 5-33 mm; 25% non-peripheral) from 2009 to 2021. We compared complications by ablation modality using generalized-estimating equations. We evaluated ablation modality, tumor size, and location (peripheral vs non-peripheral) in relation to local tumor progression using proportional Cox hazard models with death as competing risk. We estimated OS using the Kaplan-Meier method. Results: Primary technical success was 97% for both modalities. Median follow-up was 23 months (range: 1-102 months; interquartile range: 12, 44 months). A total of 7/61 (12%) tumors progressed. Estimated 1-year and 2-year local control rates were, for tumors >1 cm, 97% and 95% following MWA versus 99% and 98% following cryoablation, and for tumors ≤1 cm, 74% and 62% following MWA versus 86% and 79% following cryoablation. Tumor size ≤1 cm was associated with decreased cumulative incidence of local progression (p =.048); ablation modality and tumor location were not associated with progression (p =.86; p =.54). Complications (CTCAE grade ≤3) occurred in 17/39 sessions (44%), prompting chest tube placement in nine (23%). No complications with grade ≥4 occurred. OS at 1-, 2-, and 3-years was 100%, 89%, and 82%, respectively. Conclusion: High primary technical success, local control, and OS support MWA and cryoablation for treating sarcoma lung metastases. Ablation modality and tumor location did not affect local progression. Treatment failure was low, especially for small tumors. No life-threatening complications occurred. Clinical Impact: Percutaneous MWA and cryoablation are both suited for treatment of sarcoma lung metastases, especially for tumors ≤1 cm, whether peripheral or non-peripheral. Complications, if they occur, are not life-threatening.