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Laeseke P, Ng C, Naghi A, Wright GWJ, Laxmanan B, Ghosh SK, Amos TB, Kalsekar I, Pritchett M. Response to letter: Microwave ablation for Early-Stage Non-Small cell Lung Cancer: Don't Put the Cart before the stereotactic Horse. Lung Cancer 2024; 189:107504. [PMID: 38368724 DOI: 10.1016/j.lungcan.2024.107504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/20/2024]
Affiliation(s)
- Paul Laeseke
- Radiology, University of Wisconsin, Madison, WI, United States.
| | - Calvin Ng
- Department of Surgery, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | | | | | - Balaji Laxmanan
- Lung Cancer Initiative, Johnson & Johnson, New Brunswick, NJ, United States.
| | - Sudip K Ghosh
- Health Economics and Market Access, Johnson & Johnson, Cincinnati, OH, United States.
| | - Tony B Amos
- Interventional Oncology at Johnson & Johnson, New Brunswick, NJ, United States.
| | - Iftekhar Kalsekar
- Lung Cancer Initiative, Johnson & Johnson, New Brunswick, NJ, United States.
| | - Michael Pritchett
- Pulmonary and Critical Care Medicine, FirstHealth Moore Regional Hospital, and Pinehurst Medical Clinic, Pinehurst, NC, United States.
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Fan H, Xie X, Pang Z, Zhang L, Ding R, Wan C, Li X, Yang Z, Sun J, Kan X, Tang B, Zheng C. Risk assessment of pneumothorax in colorectal lung metastases treated by percutaneous thermal ablation: a multicenter retrospective cohort study. Int J Surg 2024; 110:261-269. [PMID: 37755389 PMCID: PMC10793795 DOI: 10.1097/js9.0000000000000782] [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: 07/16/2023] [Accepted: 09/10/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE To evaluate the risk of pneumothorax in the percutaneous image-guided thermal ablation (IGTA) treatment of colorectal lung metastases (CRLM). METHODS Data regarding patients with CRLM treated with IGTA from five medical institutions in China from 2016 to 2023 were reviewed retrospectively. Pneumothorax and non-pneumothorax were compared using the Student's t -test, χ 2 test and Fisher's exact test. Univariate logistic regression analysis was conducted to identify potential risk factors, followed by multivariate logistic regression analysis to evaluate the predictors of pneumothorax. Interactions between variables were examined and used for model construction. Receiver operating characteristic curves and nomograms were generated to assess the performance of the model. RESULTS A total of 254 patients with 376 CRLM underwent 299 ablation sessions. The incidence of pneumothorax was 45.5%. The adjusted multivariate logistic regression model, incorporating interaction terms, revealed that tumour number [odds ratio (OR)=8.34 (95% CI: 1.37-50.64)], puncture depth [OR=0.53 (95% CI: 0.31-0.91)], pre-procedure radiotherapy [OR=3.66 (95% CI: 1.17-11.40)], peribronchial tumour [OR=2.32 (95% CI: 1.04-5.15)], and emphysema [OR=56.83 (95% CI: 8.42-383.57)] were significant predictive factors of pneumothorax (all P <0.05). The generated nomogram model demonstrated a significant prediction performance, with an area under the receiver operating characteristic curve of 0.800 (95% CI: 0.751-0.850). CONCLUSIONS Pre-procedure radiotherapy, tumour number, peribronchial tumour, and emphysema were identified as risk factors for pneumothorax in the treatment of CRLM using percutaneous IGTA. Puncture depth was found to be a protective factor against pneumothorax.
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Affiliation(s)
- Hongjie Fan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Xuancheng Xie
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming, Yunnan
| | - Zhenzhu Pang
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang
| | - Licai Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Rong Ding
- Department of Minimally Invasive Intervention, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University
| | - Cheng Wan
- Department of Minimally Invasive Intervention, The First Affiliated Hospital of Kunming Medical University, Kunming
| | - Xinghai Li
- Department of Minimally Invasive Intervention, Ganzhou People’s Hospital Hospital, Ganzhou
| | - Zebin Yang
- Department of Radiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang
| | - Jihong Sun
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang
| | - Xuefeng Kan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Bufu Tang
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
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Zhao Q, Wang J, Fu Y, Hu B. Radiofrequency ablation for stage <IIB non-small cell lung cancer: Opportunities, challenges, and the road ahead. Thorac Cancer 2023; 14:3181-3190. [PMID: 37740563 PMCID: PMC10643797 DOI: 10.1111/1759-7714.15114] [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: 07/26/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023] Open
Abstract
Pulmonary carcinoma represents the second common cancer for human race while its mortality rate ranked the first all over the world. Surgery remains the primary option for early-stage non-small cell lung cancer (NSCLC) in some surgical traditions. Nevertheless, only less than half of patients are operable subjected to the limited lung function and multiple primary/metastatic lesions. Recent improvements in minimally invasive surgical techniques have made the procedure accessible to more patients, but this percentage still does not exceed half. In recent years, radiofrequency ablation (RFA), one of the thermal ablation procedures, has gradually advanced in the treatment of lung cancer in addition to being utilized to treat breast and liver cancer. Several guidelines, including the American College of Chest Physicians (ACCP), include RFA as an option for some patients with NSCLC although the level of evidence is mostly limited to retrospective studies. In this review, we emphasize the use of the RFA technique in patients with early-stage NSCLC and provide an overview of the RFA indication population, prognosis status, and complications. Meanwhile, the advantages and disadvantages of RFA proposed in existing studies are compared with surgical treatment and radiotherapy. Due to the high rate of gene mutation and immunocompetence in NSCLC, there are considerable challenges to clinical translation of combining targeted drugs or immunotherapy with RFA that the field has only recently begun to fully appreciate.
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Affiliation(s)
- Qing Zhao
- Department of Thoracic Surgery, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Jing Wang
- Department of Thoracic Surgery, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Yi‐li Fu
- Department of Thoracic Surgery, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
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4
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Johnston EW, Basso J, Silva F, Haris A, Jones RL, Khan N, Lawrence H, Mathiszig-Lee J, McCall J, Cunningham DC, Fotiadis N. Robotic versus freehand CT-guided radiofrequency ablation of pulmonary metastases: a comparative cohort study. Int J Comput Assist Radiol Surg 2023; 18:1819-1828. [PMID: 37072657 PMCID: PMC10497639 DOI: 10.1007/s11548-023-02895-1] [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: 01/16/2023] [Accepted: 03/29/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Radiofrequency ablation (RFA) is a curative treatment option for small lung metastases, which conventionally involves multiple freehand manipulations until the treating electrode is satisfactorily positioned. Stereotactic and robotic guidance has been gaining popularity for liver ablation, although has not been established in lung ablation. The purpose of this study is to determine the feasibility, safety, and accuracy of robotic RFA for pulmonary metastases, and compare procedures with a conventional freehand cohort. METHODS A single center study with prospective robotic cohort, and retrospective freehand cohort. RFA was performed under general anesthesia using high frequency jet ventilation and CT guidance. Main outcomes were (i) feasibility/technical success (ii) safety using Common Terminology Criteria for Adverse Events (iii) targeting accuracy (iv) number of needle manipulations for satisfactory ablation. Robotic and freehand cohorts were compared using Mann-Whitney U tests for continuous variables, and Fisher's exact for categorical variables. RESULTS Thirty-nine patients (mean age 65 ± 13 years, 20 men) underwent ablation of 44 pulmonary metastases at single specialist cancer center between July 2019 and August 2022. 20 consecutive participants underwent robotic ablation, and 20 consecutive patients underwent freehand ablation. All 20/20 (100%) robotic procedures were technically successful, and none were converted to freehand procedures. There were 6/20 (30%) adverse events in the robotic cohort, and 15/20 (75%) in the freehand cohort (P = 0.01). Robotic placement was highly accurate with 6 mm tip-to-target distance (range 0-14 mm) despite out-of-plane approaches, with fewer manipulations than freehand placement (median 0 vs. 4.5 manipulations, P < 0.001 and 7/22, 32% vs. 22/22, 100%, P < 0.001). CONCLUSIONS Robotic radiofrequency ablation of pulmonary metastases with general anesthesia and high frequency jet ventilation is feasible and safe. Targeting accuracy is high, and fewer needle/electrode manipulations are required to achieve a satisfactory position for ablation than freehand placement, with early indications of reduced complications.
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Affiliation(s)
- Edward W Johnston
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK.
- Institute of Cancer Research, 123 Old Brompton Road, London, SW73RP, UK.
| | - Jodie Basso
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
| | - Francisca Silva
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
| | - Arafat Haris
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
| | - Robin L Jones
- Sarcoma Unit, Medical Oncology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
- Institute of Cancer Research, 123 Old Brompton Road, London, SW73RP, UK
| | - Nasir Khan
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
| | - Helen Lawrence
- Department of Anaesthesia and Perioperative Medicine, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
| | - Jakob Mathiszig-Lee
- Department of Anaesthesia and Perioperative Medicine, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
| | - James McCall
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
| | - David C Cunningham
- Gastrointestinal Unit, Medical Oncology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK
- Institute of Cancer Research, 123 Old Brompton Road, London, SW73RP, UK
| | - Nicos Fotiadis
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London, SW36JJ, UK.
- Institute of Cancer Research, 123 Old Brompton Road, London, SW73RP, UK.
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Ergun O, Birgi E, Hekimoğlu A, Eraslan Ö, Durmaz HA, Karaçin C, İmamoğlu Gİ, Eren T, Yazılıtaş D, Hekimoğlu B. Percutaneous ablation treatment in metastatic lung tumors: a single-center experience. Acta Radiol 2023; 64:2416-2423. [PMID: 37246396 DOI: 10.1177/02841851231175657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND In recent years, many studies have proven that percutaneous thermal ablation is an effective second-line treatment method with low complication rates in early-stage non-small cell lung carcinoma and lung metastases. Radiofrequency ablation and microwave ablation are commonly used for this purpose. PURPOSE To evaluate the factors affecting the success of the percutaneous thermal ablation treatment with technical success, complication rates, and long-term follow-up results in metastatic lung lesions. MATERIAL AND METHODS Computed tomography (CT)-guided percutaneous ablation was performed for 70 metastatic lung lesions in 35 patients (22 men, 13 women; mean age = 61.34 years; age range = 41-75 years). Radiofrequency ablation was performed in 53/70 (75.7%) lesions and microwave ablation in 17/70 (24.3%) lesions. RESULTS The technical success rate was 98.6%. Median overall survival, progression-free survival, and local recurrence-free survival of the patients were 33.9 months (range=25.6-42.1 months), 12 months (range=4.9-19.2 months), and 24.2 months (range=8.2-40.1 months), respectively. One- and two-year overall survival rates were 84% and 74%, respectively. Median progression-free survival times were 20.3 months and 11.4 months, respectively, according to the number of metastatic lung lesions being single and multiple, and the difference was statistically significant (P = 0.046). According to the number of lesions ≤3 and >3, the difference was also found statistically significant (P = 0.024) (14.3 months and 5.7 months, respectively). CONCLUSION In conclusion, CT-guided percutaneous thermal ablation is a safe and effective treatment method in metastatic lung lesions. The number of lesions is the most important factor in predicting treatment success.
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Affiliation(s)
- Onur Ergun
- Department of Radiology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
| | - Erdem Birgi
- Department of Radiology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Azad Hekimoğlu
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Önder Eraslan
- Department of Radiology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
| | - Hasan Ali Durmaz
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Cengiz Karaçin
- Department of Medical Oncology, Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Gökşen İnanç İmamoğlu
- Department of Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tülay Eren
- Department of Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Doğan Yazılıtaş
- Department of Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Baki Hekimoğlu
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Li X, Zhou H, Mou K, Zheng Y, Li H, Ren P, Ye H, Lin S, Pang H, Wu J, Xiang L. Risk Factors for Operation Complications of High Dose Rate 3-Dimensional Interstitial Brachytherapy for Lung Cancer. Clin Lung Cancer 2023:S1525-7304(23)00059-1. [PMID: 37149479 DOI: 10.1016/j.cllc.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/03/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND The risk factors for operation complications of high-dose-rate dimensional (3D) interstitial brachytherapy for lung malignant tumors are still unclear. We aimed to provide a reliable reference for the preoperative safety assessment of interstitial brachytherapy. PATIENTS AND METHODS We analyzed the degree and incidence of operational complications in 120 eligible patients with lung carcinoma who underwent computed tomography (CT)-guided HDR interstitial brachytherapy. Univariate and multivariate analyses were used to study the relationships between patient-related factors, tumor-related factors, operation-related factors, and operational complications. RESULTS The most frequent complications of CT-guided HDR interstitial brachytherapy were pneumothorax and hemorrhage. In univariate analysis, smoking, emphysema, distance of implanted needles through the normal lung tissue, number of implanted needle adjustments, and distance of the lesion from the pleura were the risk factors for pneumothorax; the tumor size, distance of the tumor from the pleura, number of implanted needle adjustments, and distance of the implanted needle through the normal lung tissue were risk factors for hemorrhage. In multivariate analysis, the depth of the implanted needle through the normal lung tissue and distance of the lesion from the pleura were independent risk factors for pneumothorax. Tumor size, number of implanted needle adjustments, and distance through normal lung tissue were independent risk factors for hemorrhage. CONCLUSION This study provides a reference for the clinical treatment of lung cancer by analyzing the risk factors for complications of interstitial brachytherapy.
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Affiliation(s)
- Xiaoyue Li
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Huan Zhou
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Kelin Mou
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yun Zheng
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hongxia Li
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Peirong Ren
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hua Ye
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Sheng Lin
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Haowen Pang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jingbo Wu
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Li Xiang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Wang J, Hu L, Yang X, Ye X, Ni Y, Meng M, Huang G, Zhang T, Li W, Han X, Wei Z, Dai J, Zou Z. A study of microwave ablation for small cell lung cancer. J Cancer Res Ther 2022; 18:399-404. [PMID: 35645106 DOI: 10.4103/jcrt.jcrt_1965_21] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE To reveal the survival and safety of percutaneous microwave ablation (MWA) combined with chemoradiotherapy (CRT) in treating small cell lung cancer (SCLC). MATERIALS AND METHODS Clinical data of 48 SCLC patients who underwent MWA were retrospectively collected; survival and incidence of major complications were analyzed. RESULTS Totally, 48 SCLC patients underwent 51 MWA procedures. The median overall survival (OS) for all SCLC was 27.0 months (95% confidence interval 22.4-31.6 months). The OS of limited-stage (LS-SCLC) was longer than the extensive-stage (ES-SCLC) (median 48.0 months vs. 25.0 months, P = 0.022). The OS of SCLC with tumor diameter ≤3.0 cm was longer than that of tumor diameter >3.0 cm (median 48.0 months vs. 27.0 months, P = 0.041). For LS-SCLC, the 1-, 2-, 3-, and 5-year survival rate was 91.67%, 72.22%, 66.67%, and 61.11%, respectively. For ES-SCLC, the 1-, 2-, and 3-year survival rates were 83.33%, 50.0%, and 8.33%. Major complications included pneumothorax needing tube placement (29.4%), rarely arrhythmia (2.0%), empyema (2.0%), pulmonary fungal infection (2.0%), and shingles (2.0%). CONCLUSION For SCLC patients, who received MWA combined with CRT, OS of LS-SCLC and tumor diameter ≤3.0 cm was better than that of the ES-SCLC and tumor diameter >3.0 cm. For inoperable SCLC, MWA was safe.
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Affiliation(s)
- Jiao Wang
- Department of Oncology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Likuan Hu
- Department of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xin Ye
- Department of Oncology, Shandong Lung Cancer Institute, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yang Ni
- Department of Oncology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University; Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Min Meng
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guanghui Huang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tiehong Zhang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Wenhong Li
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaoying Han
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhigang Wei
- Department of Oncology, Shandong Lung Cancer Institute, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jianjian Dai
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhigeng Zou
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Xu S, Bie ZX, Li YM, Li B, Guo RQ, Li XG. Computed tomography-guided microwave ablation for the treatment of non-small cell lung cancer patients with and without adjacent lobe invasion: A comparative study. Thorac Cancer 2021; 12:2780-2788. [PMID: 34427998 PMCID: PMC8520792 DOI: 10.1111/1759-7714.14125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of the study was to explore the outcomes of computed tomography-guided microwave ablation (MWA) in non-small cell lung cancer (NSCLC) patients with adjacent lobe invasion (ALI), and to compare the outcomes of ALI-NSCLC and non-ALI NSCLC patients after MWA. METHODS A total of 319 NSCLC patients and 366 tumors treated with MWA were included in the study, comprising 34 ALI-NSCLC patients and 285 non-ALI NSCLC patients. Complications, local recurrence rates, progression-free survival (PFS), and overall survival (OS) were compared. Logistic regression analyses were used to investigate the correlation between ALI and the occurrence of pneumothorax after MWA. RESULTS The mean tumor diameter of ablated tumors was 3.6 ± 2.2 cm. There were 95 (29.8%) NSCLC patients in which pneumothorax occurred after MWA, and all patients recovered. Of these, the ALI group had a significantly higher incidence rate of pneumothorax than the non-ALI group (52.9% vs. 27.0%, p = 0.002). The median PFS and OS for the ALI group were 12.0 ± 10.2 and 15.5 ± 9.5 months, respectively, and that of the non-ALI group were 13.0 ± 10.6 and 17.0 ± 11.1 months, respectively, and no significant difference was found in PFS (p = 0.329) nor OS (p = 0.394) between the two groups. Local recurrence rates for ALI and non-ALI groups were 29.4% and 20.7%, respectively, and no significant difference was found (p = 0.244). Logistic regression analyses revealed that ALI can increase the risk of pneumothorax (hazard ratio [HR], 2.867; p = 0.012). CONCLUSIONS MWA is an effective and safe approach for ALI-NSCLC treatment. Although ALI can increase the risk of pneumothorax, ALI-NSCLC patients reveal a comparable outcome to non-ALI NSCLC patients after MWA.
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Affiliation(s)
- Sheng Xu
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhi-Xin Bie
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuan-Ming Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Run-Qi Guo
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Guang Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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9
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Xu S, Qi J, Li B, Bie ZX, Li YM, Li XG. Risk prediction of pneumothorax in lung malignancy patients treated with percutaneous microwave ablation: development of nomogram model. Int J Hyperthermia 2021; 38:488-497. [PMID: 33754941 DOI: 10.1080/02656736.2021.1902000] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To develop effective nomograms for predicting pneumothorax and delayed pneumothorax after microwave ablation (MWA) in lung malignancy (LM) patients. METHODS LM patients treated with MWA were randomly allocated to a training or validation cohort at a ratio of 7:3. The predictors of pneumothorax identified by univariate and multivariate analyses in the training cohort were used to develop a predictive nomogram. The C-statistic was used to evaluate predictive accuracy in both cohorts. A second nomogram for predicting delayed pneumothorax was developed and validated using identical methods. RESULTS A total of 552 patients (training cohort: n = 402; validation cohort: n = 150) were included; of these patients, 27.9% (154/552) developed pneumothorax, with immediate and delayed pneumothorax occurring in 18.8% (104/552) and 9.1% (50/552), respectively. The predictors selected for the nomogram of pneumothorax were emphysema (hazard ratio [HR], 6.543; p < .001), history of lung ablation (HR, 7.841; p= .025), number of pleural punctures (HR, 1.416; p < .050), ablation zone encompassing pleura (HR, 10.225; p < .001) and pulmonary fissure traversed by needle (HR, 10.776; p < .001). The C-statistics showed good predictive performance in the training and validation cohorts (0.792 and 0.832, respectively). Another nomogram for delayed pneumothorax was developed based on emphysema (HR, 2.952; p= .005), ablation zone encompassing pleura (HR, 4.915; p < .001) and pulmonary fissure traversed by needle (HR, 4.348; p = .015). The C-statistics showed good predictive performance in the training cohort, and it had efficacy for prediction in the validation cohort (0.719 and 0.689, respectively). CONCLUSIONS The nomograms could effectively predict the risk of pneumothorax and delayed pneumothorax after MWA.
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Affiliation(s)
- Sheng Xu
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Jing Qi
- School of Medicine, Nankai University, Tianjin, PR China
| | - Bin Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Zhi-Xin Bie
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Yuan-Ming Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Xiao-Guang Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
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Kim MS, Hong HP, Ham SY, Koo DH, Kang DY, Oh TY. Complications after 100 sessions of cone-beam computed tomography-guided lung radiofrequency ablation: a single-center, retrospective experience. Int J Hyperthermia 2020; 37:763-771. [DOI: 10.1080/02656736.2020.1784472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Youn Ham
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Hoe Koo
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Du-Young Kang
- Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Yoon Oh
- Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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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: 42] [Impact Index Per Article: 8.4] [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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Hasegawa T, Kuroda H, Sato Y, Matsuo K, Sakata S, Yashiro H, Sakakura N, Mizuno T, Arimura T, Yamaura H, Murata S, Imai Y, Sakao Y, Inaba Y. The Utility of Indigo Carmine and Lipiodol Mixture for Preoperative Pulmonary Nodule Localization before Video-Assisted Thoracic Surgery. J Vasc Interv Radiol 2019; 30:446-452. [DOI: 10.1016/j.jvir.2018.08.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/17/2022] Open
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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: 11] [Impact Index Per Article: 1.6] [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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刘 宝, 叶 欣, 范 卫, 李 晓, 冯 威, 卢 强, 毛 宇, 林 征, 李 鲁, 庄 一, 倪 旭, 沈 加, 傅 毅, 韩 建, 李 忱, 柳 晨, 杨 武, 苏 志, 吴 志, 刘 磊. [Expert Consensus for Image-guided Radiofrequency Ablation of Pulmonary Tumors (2018 Version)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:76-88. [PMID: 29526174 PMCID: PMC5973020 DOI: 10.3779/j.issn.1009-3419.2018.02.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- 宝东 刘
- 100053 北京, 首都医科大学宣武医院胸外科Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - 欣 叶
- 250100 济南, 山东大学附属省立医院肿瘤科Department of Oncolog y, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250100, China
| | - 卫君 范
- 510060 广州, 中山大学肿瘤医院影像与微创介入中心Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - 晓光 李
- 100005 北京, 北京医院肿瘤微创中心Department of Tumor Minimally Invasive Therapy, Beijing Hospital, Beijing 100005, China
| | - 威建 冯
- 100038 北京, 首都医科大学附属复兴医院肿瘤科Department of Oncolog y, Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - 强 卢
- 710038 西安, 空军军医大学唐都医院胸外科Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China
| | - 宇 毛
- 010020 呼和浩特, 内蒙古自治区呼和浩特市第一医院胸外科Department of Thoracic Surgery, Hohhot First Hospital, Inner Mongolia, Hohhot 010020, China
| | - 征宇 林
- 350005 福州, 福建医科大学附属第一医院介入科Department of Interventional Therapy, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - 鲁 李
- 100101 北京, 解放军306医院胸外科Department of Thoracic Surgery, 306th Hospital of PLA, Beijing 100101, China
| | - 一平 庄
- 210009 南京, 江苏省肿瘤医院介入科Department of Interventional Therapy, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - 旭东 倪
- 200001 上海, 复旦大学附属中山医院胸外科Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200001, China
| | - 加林 沈
- 200001 上海, 上海交通大学医学院附属仁济医院南院肿瘤介入科Department of Tumor Interventional Therapy, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
| | - 毅立 傅
- 100020 北京, 首都医科大学附属北京朝阳医院胸外科Department of Thoracic Surgery, Chaoyang Hospital, Capital medical University, Beijing 100020, China
| | - 建军 韩
- 250117 济南, 山东省肿瘤医院微创介入科Department of Minimally Invasive Interventional Therapy, Shandong Provincial Tumor Hospital, Jinan 250117, China
| | - 忱瑞 李
- 100020 北京, 中国医学科学院肿瘤医院介入治疗科Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100020, China
| | - 晨 柳
- 100142 北京, 北京大学肿瘤医院介入治疗科Department of Interventional Therapy, Beijing Cancer Hospital, Beijing 100142, China
| | - 武威 杨
- 100071 北京, 解放军307医院肿瘤微创治疗科Department of Tumor Minimally Invasive Therapy, 307th Hospital of PLA, Beijing 100071, China
| | - 志勇 苏
- 024005 赤峰, 赤峰学院附属医院胸外科Affiliated Hospital of Chifeng University, Chifeng 024005, China
| | - 志远 吴
- 200025 上海, 上海交通大学医学院附属瑞金医院放射介入科Department of Interventional Radiolog y, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - 磊 刘
- 100053 北京, 首都医科大学宣武医院胸外科Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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The Role of Percutaneous Image-Guided Thermal Ablation for the Treatment of Pulmonary Malignancies. AJR Am J Roentgenol 2017; 209:740-751. [DOI: 10.2214/ajr.17.18368] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Akhan O, Güler E, Akıncı D, Çiftçi T, Köse IÇ. Radiofrequency ablation for lung tumors: outcomes, effects on survival, and prognostic factors. Diagn Interv Radiol 2017; 22:65-71. [PMID: 26611111 DOI: 10.5152/dir.2015.14378] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE We aimed to evaluate the survival benefit achieved with radiofrequency (RF) ablation of primary and metastatic lung tumors and determine significant prognostic factors for recurrence-free survival. METHODS Forty-nine patients with lung cancer (10 primary and 39 metastatic) underwent computed tomography-guided percutaneous RF ablation between June 2005 and October 2013. A total of 112 tumors (101 metastatic and 11 primary non-small cell lung cancer) were treated with RF ablation. Tumor diameter ranged from 0.6 to 4 cm (median 1.5 cm). Effectiveness of treatment, complications, and survival were analyzed. RESULTS Primary success rate was 79.5% and local tumor progression occurred in 23 tumors. Among tumors showing progression, 10 were re-treated with RF ablation and secondary success rate was 87.5%. One-, two-, and three-year overall survival rates of 10 patients with primary lung cancer were 100%, 86%, and 43%, respectively. One-, two-, three-, four-, and five-year overall survival rates for 39 patients with metastatic lung tumors were 90%, 73%, 59%, 55%, and 38%, respectively. One-, two-, three-, and four-year overall survival rates for 16 patients with colorectal pulmonary metastases were 94%, 80%, 68%, and 23%, respectively. Complications occurred in 30 sessions (24.6%). Pneumothorax occurred in 19 sessions with seven requiring image-guided percutaneous chest tube drainage. Tumor status (solitary or multiple) and presence of extrapulmonary metastasis at initial RF ablation were significant prognostic factors in terms of recurrence-free survival. CONCLUSION RF ablation is a safe and effective treatment with a survival benefit for selected patients with primary and secondary lung tumors.
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Affiliation(s)
- Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
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17
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Callister MEJ, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, Franks K, Gleeson F, Graham R, Malhotra P, Prokop M, Rodger K, Subesinghe M, Waller D, Woolhouse I. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 2015; 70 Suppl 2:ii1-ii54. [PMID: 26082159 DOI: 10.1136/thoraxjnl-2015-207168] [Citation(s) in RCA: 646] [Impact Index Per Article: 64.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - D R Baldwin
- Nottingham University Hospitals, Nottingham, UK
| | - A R Akram
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Barnard
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle, UK
| | - P Cane
- Department of Histopathology, St Thomas' Hospital, London, UK
| | - J Draffan
- University Hospital of North Tees, Stockton on Tees, UK
| | - K Franks
- Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - F Gleeson
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - P Malhotra
- St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - M Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - K Rodger
- Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - M Subesinghe
- Department of Radiology, Churchill Hospital, Oxford, UK
| | - D Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - I Woolhouse
- Department of Respiratory Medicine, University Hospitals of Birmingham, Birmingham, UK
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18
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Welch BT, Brinjikji W, Schmit GD, Callstrom MR, Kurup AN, Cloft HJ, Woodrum DA, Nichols FC, Atwell TD. A National Analysis of the Complications, Cost, and Mortality of Percutaneous Lung Ablation. J Vasc Interv Radiol 2015; 26:787-91. [DOI: 10.1016/j.jvir.2015.02.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 02/22/2015] [Accepted: 02/23/2015] [Indexed: 02/07/2023] Open
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19
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Lee KS, Takaki H, Yarmohammadi H, Srimathveeravalli G, Luchins K, Monette S, Nair S, Kishore S, Erinjeri JP. Pleural puncture that excludes the ablation zone decreases the risk of pneumothorax after percutaneous microwave ablation in porcine lung. J Vasc Interv Radiol 2015; 26:1052-8. [PMID: 25753501 DOI: 10.1016/j.jvir.2015.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 01/11/2015] [Accepted: 01/12/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To test the hypothesis that the geometry of probe placement with respect to the pleural puncture site affects the risk of pneumothorax after microwave (MW) ablation in the lung. MATERIALS AND METHODS Computed tomography-guided MW ablation of the lung was performed in 8 swine under general anesthesia and mechanical ventilation. The orientation of the 17-gauge probe was either perpendicular (90°) or parallel (< 30°) with respect to the pleural puncture site, and the ablation power was 30 W or 65 W for 5 minutes. After MW ablation, swine were euthanized, and histopathologic changes were assessed. Frequency and factors affecting pneumothorax were evaluated by multivariate analysis. RESULTS Among 62 lung MW ablations, 13 (21%) pneumothoraces occurred. No statistically significant difference was noted in the rate of pneumothorax between the perpendicular and the parallel orientations of the probe (31% vs 14%; odds ratio [OR], 2.8; P = .11). The pneumothorax rate was equal for 65-W and 30-W ablation powers (21% and 21%; OR, 1.0; P = .94). Under multivariate analysis, 2 factors were independent positive predictors of pneumothorax: ablation zone inclusive of pleural insertion point (OR, 7.7; P = .02) and time since intubation (hours) (OR, 2.7; P = .02). CONCLUSIONS Geometries where the pleural puncture site excluded the ablation zone decreased pneumothorax in swine undergoing MW ablation in the lung. Treatment planning to ensure that the pleural puncture site excludes the subsequent ablation zone may reduce the rate of pneumothorax in patients undergoing MW ablation in the lung.
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Affiliation(s)
- Kyungmouk Steve Lee
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065
| | - Haruyuki Takaki
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065
| | - Hooman Yarmohammadi
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065
| | | | - Kerith Luchins
- Research Animal Resource Center Memorial, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065
| | - Sébastien Monette
- Laboratory of Comparative Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065
| | - Sreejit Nair
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065
| | - Sirish Kishore
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065
| | - Joseph P Erinjeri
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10065..
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Ye X, Fan W, Chen JH, Feng WJ, Gu SZ, Han Y, Huang GH, Lei GY, Li XG, Li YL, Li ZJ, Lin ZY, Liu BD, Liu Y, Peng ZM, Wang H, Yang WW, Yang X, Zhai B, Zhang J. Chinese expert consensus workshop report: Guidelines for thermal ablation of primary and metastatic lung tumors. Thorac Cancer 2015; 6:112-121. [PMID: 26273346 PMCID: PMC4448461 DOI: 10.1111/1759-7714.12152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/16/2014] [Indexed: 12/31/2022] Open
Abstract
Although surgical resection is the primary means of curing both primary and metastatic lung cancers, about 80% of lung cancers cannot be removed by surgery. As most patients with unresectable lung cancer receive only limited benefits from traditional radiotherapy and chemotherapy, many new local treatment methods have emerged, including local ablation therapy. The Minimally Invasive and Comprehensive Treatment of Lung Cancer Branch, Professional Committee of Minimally Invasive Treatment of Cancer of the Chinese Anti-Cancer Association has organized multidisciplinary experts to develop guidelines for this treatment modality. These guidelines aim at standardizing thermal ablation procedures and criteria for selecting treatment candidates and assessing outcomes; and for preventing and managing post-ablation complications.
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Affiliation(s)
- Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Weijun Fan
- Imaging and Interventional Center, Sun Yat-sen University Cancer CenterGuangzhou, China
| | - Jun-hui Chen
- Department of Minimally Invasive Interventional Therapy, Shenzhen Hospital of Beijing UniversityShenzhen, China
| | - Wei-jian Feng
- Department of Oncology, Fuxing Hospital Affiliated to the Capital University of Medical SciencesBeijing, China
| | - Shan-zhi Gu
- Department of Interventional Therapy, Hunan Provincial Tumor HospitalChangsha, China
| | - Yue Han
- Department of Imaging, Tumor Institute and Hospital, Chinese Academy of Medical SciencesBeijing, China
| | - Guang-hui Huang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Guang-yan Lei
- Department of Thoracic Surgery, Shanxi Provincial Tumor HospitalXi'an, China
| | - Xiao-guang Li
- Department of Radiology, Peking Union Medical College HospitalBeijing, China
| | - Yu-liang Li
- Interventional Treatment Center, Shandong University Second HospitalJinan, China
| | - Zhen-jia Li
- Research Office of CT Diagnosis and Treatment, Shandong Provincial Institute of Medical ImagingJinan, China
| | - Zheng-yu Lin
- Department of Interventional Therapy, the First Affiliated Hospital of Fujian Medical UniversityFuzhou, China
| | - Bao-dong Liu
- Department of Thoracic Surgery, Xuanwu Hospital Affiliated to the Capital University of Medical SciencesBeijing, China
| | - Ying Liu
- Department of Oncology, Armed Police Hospital of Guangdong ProvinceGuangzhou, China
| | - Zhong-min Peng
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Hui Wang
- Interventional Treatment Center, Jilin Provincial Tumor HospitalChangchun, China
| | - Wu-wei Yang
- Department of Tumor Minimally Invasive Therapy, 307 HospitalBeijing, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Bo Zhai
- Tumor Interventional Therapy Center, Shanghai Renji HospitalShanghai, China
| | - Jun Zhang
- Center of Lung Cancer, the First Affiliated Hospital of China Medical UniversityShenyang, China
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Risk Factors for Pneumothorax Complicating Radiofrequency Ablation for Lung Malignancy: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2014; 25:1671-81.e1. [DOI: 10.1016/j.jvir.2014.07.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/13/2014] [Accepted: 07/23/2014] [Indexed: 11/23/2022] Open
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22
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Chung DYF, Tse DML, Boardman P, Gleeson FV, Little MW, Scott SH, Anderson EM. High-frequency jet ventilation under general anesthesia facilitates CT-guided lung tumor thermal ablation compared with normal respiration under conscious analgesic sedation. J Vasc Interv Radiol 2014; 25:1463-9. [PMID: 24819833 DOI: 10.1016/j.jvir.2014.02.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 02/10/2014] [Accepted: 02/21/2014] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To determine whether technical difficulty of computed tomography (CT)-guided percutaneous lung tumor thermal ablations is altered with the use of high-frequency jet ventilation (HFJV) under general anesthesia (GA) compared with procedures performed with normal respiration (NR) under conscious sedation (CS). MATERIALS AND METHODS Thermal ablation treatment sessions performed with NR under CS or HFJV under GA with available anesthesia records and CT fluoroscopic images were retrospectively reviewed; 13 and 33 treatment sessions, respectively, were identified. One anesthesiologist determined the choice of anesthesiologic technique independently. Surrogate measures of procedure technical difficulty--time duration, number of CT fluoroscopic acquisitions, and radiation dose required for applicator placement for each tumor--were compared between anesthesiologic techniques. The anesthesiologist time and complications were also compared. Parametric and nonparametric data were compared by Student independent-samples t test and χ(2) test, respectively. RESULTS Patients treated with HFJV under GA had higher American Society of Anesthesiologists classifications (mean, 2.66 vs 2.23; P = .009) and smaller lung tumors (16.09 mm vs 27.38 mm; P = .001). The time duration (220.30 s vs 393.94 s; P = .008), number of CT fluoroscopic acquisitions (10.31 vs 19.13; P = .023), and radiation dose (60.22 mGy·cm vs 127.68 mGy·cm; P = .012) required for applicator placement were significantly lower in treatment sessions performed with HFJV under GA. There was no significant differences in anesthesiologist time (P = .20), rate of pneumothorax (P = .62), or number of pneumothoraces requiring active treatment (P = .19). CONCLUSIONS HFJV under GA appears to reduce technical difficulty of CT-guided percutaneous applicator placement for lung tumor thermal ablations, with similar complication rates compared with treatment sessions performed with NR under CS. The technique is safe and may facilitate treatment of technically challenging tumors.
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Affiliation(s)
- Daniel Yiu Fai Chung
- Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom
| | - Donald Man Lap Tse
- Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom
| | - Philip Boardman
- Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom
| | - Fergus Vincent Gleeson
- Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom
| | - Mark William Little
- Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom
| | - Shaun Haig Scott
- Nuffield Department of Anaesthesia, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Ewan Mark Anderson
- Department of Radiology, Churchill Hospital, Oxford University Hospitals, Surgery and Diagnostic Building, Old Road, Headington, Oxford OX3 7LE, United Kingdom.
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23
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Zheng A, Wang X, Yang X, Wang W, Huang G, Gai Y, Ye X. Major complications after lung microwave ablation: a single-center experience on 204 sessions. Ann Thorac Surg 2014; 98:243-248. [PMID: 24793688 DOI: 10.1016/j.athoracsur.2014.03.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/19/2014] [Accepted: 03/05/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND The purpose of this study is to retrospectively evaluate the incidence of and risk factors for major complications after microwave ablation (MWA) of lung tumors. METHODS From January 2011 to May 2013 in 184 consecutive patients (67 women and 117 men; mean age, 61.5 years; range, 19 to 85 years), 204 sessions of MWA were performed on 253 lung tumor lesions. Records were reviewed to evaluate prevalence of major complications and risk factors, which were analyzed using univariate and multivariate analyses. RESULTS Major complications developed after 42 sessions (20.6%), including 32 cases (15.7%) of pneumothorax requiring chest tube placement which that were associated with emphysema (p=0.001); 6 cases (2.9%) of pleural effusions requiring chest tube placement, which were associated with a distance of less than 1 cm from chest wall to target tumor (p=0.014); 6 cases (2.9%) of pneumonia which that were associated with target tumor maximal diameter (p=0.040); number of pleural punctures (p=0.001) and ablation time (p=0.006); and 1 case (0.5%) of pulmonary abscess. Two cases (1.0%) of the large pneumothorax occurred at the same time with extensive subcutaneous emphysema, including 1 case (0.5%) caused by bronchopleural fistula. Death related to the procedures occurred after 1 session (0.5%). CONCLUSIONS As a relatively practical and safe modality, lung tumor MWA can induce serious complications. Enough attention should be paid to patients with emphysema, subpleural, or large target tumor, but the indications for lung MWA need not be limited as most major complications were easily managed.
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Affiliation(s)
- Aimin Zheng
- Institute of Oncology, Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, China
| | - Xiuwen Wang
- Department of Clinical Oncology, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Xia Yang
- Institute of Oncology, Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, China
| | - Weibo Wang
- Institute of Oncology, Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, China
| | - Guanghui Huang
- Institute of Oncology, Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, China
| | - Yonghao Gai
- Department of Radiology, Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, China
| | - Xin Ye
- Institute of Oncology, Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, China.
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Hiraki T, Gobara H, Fujiwara H, Ishii H, Tomita K, Uka M, Makimoto S, Kanazawa S. Lung cancer ablation: complications. Semin Intervent Radiol 2014; 30:169-75. [PMID: 24436533 DOI: 10.1055/s-0033-1342958] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although radiofrequency ablation for lung cancer is generally safe (with a mortality rate <1%), it may cause various complications. Common complications include pneumothorax, pleural effusion, and parenchymal hemorrhage. Although most complications can be treated conservatively or with minimal therapy, physicians should be aware of rare but serious complications. Potentially fatal complications include massive hemorrhage, intractable pneumothorax due to bronchopleural fistula, pulmonary artery pseudoaneurysm, systemic air embolism, and pneumonitis. Other serious complications include injury to the nearby tissues (e.g., brachial nerve plexus, phrenic nerve, diaphragm, and chest wall), needle tract seeding, lung abscess, empyema, and skin burn. Although cavitation of the ablation zone is usually insignificant clinically, such a cavity occasionally ruptures, leading to pneumothorax and bleeding. Cavities may also serve as a scaffold for fungal colonization. Precautions to minimize risk should be taken whenever possible. Nevertheless, serious complications may occur, and thus physicians should be aware of the appropriate treatments for these complications. This article reviews complications associated with lung cancer ablation.
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Affiliation(s)
- Takao Hiraki
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Hiroyasu Fujiwara
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Hiroaki Ishii
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Satoko Makimoto
- Department of Radiology, Okayama University Medical School, Okayama, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, Okayama, Japan
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25
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叶 欣, 中国抗癌协会肿瘤微创治疗专业委员会肺癌微创综合治疗分会. [Expert consensus for thermal ablation of primary and metastatic lung tumors]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:294-301. [PMID: 24758903 PMCID: PMC6000017 DOI: 10.3779/j.issn.1009-3419.2014.04.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 03/24/2014] [Indexed: 02/07/2023]
Affiliation(s)
- 欣 叶
- 510060 广州,中山大学肿瘤防治中心影像介入中心Department of Oncology, Shandong Provincial Hospital Affliated to Shandong University, Ji'nan 250014, China
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26
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Lee KS, Pua BB. Alternative to surgery in early stage NSCLC-interventional radiologic approaches. Transl Lung Cancer Res 2013; 2:340-53. [PMID: 25806253 DOI: 10.3978/j.issn.2218-6751.2013.10.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/24/2013] [Indexed: 12/22/2022]
Abstract
Interventional radiologists have a variety of techniques in their armamentarium to treat pulmonary tumors. While most therapies are targeted to metastasis or palliation, percutaneous thermal ablation represents a potential therapy for not only palliation, but to treat inoperable early stage disease. Although radiofrequency ablation (RFA) is the most studied of these ablative techniques, newer technologies of thermal ablation, such as microwave and cryoablation have emerged as additional options. In this article, we will review the three different thermal ablative modalities, including patient selection, technique, outcomes, complications, and imaging follow-up. A brief discussion of state of the art techniques such as irreversible electroporation (IRE) and catheter directed therapies will also be included.
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Affiliation(s)
- Kyungmouk Steve Lee
- Division of Interventional Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Bradley B Pua
- Division of Interventional Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA
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Healey TT, Ward RC, Dupuy DE. Ask the Experts: How important is radiofrequency ablation in lung cancer? Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Terrance T Healey is the director of Thoracic Radiology at Rhode Island Hospital (RI, USA) and an Assistant Professor of Diagnostic Imaging at the Alpert Medical School of Brown University (RI, USA). Healey received his medical degree from the combined Dartmouth Medical School–Brown Medical School Program in 2003, completed his residency in radiology at Brown University in 2008 and a thoracic radiology fellowship at the Massachusetts General Hospital (MA, USA) in 2009. He joined the faculty staff at Rhode Island Hospital and Brown University in 2009. Robert C Ward is one of the chief residents within the Department of Diagnostic Imaging at Rhode Island Hospital (RI, USA) and the Alpert Medical School of Brown University (RI, USA). Ward received his medical degree from the George Washington University (Washington, DC, USA) in 2010. Damian E Dupuy is the director of Tumor Ablation at Rhode Island Hospital (RI, USA) and a Professor of Diagnostic Imaging at The Warren Alpert Medical School of Brown University (RI, USA). Dupuy received his medical degree from the University of Massachusetts Medical School (MA, USA) in 1988 and completed his residency in radiology at The New England Deaconess Hospital (MA, USA) and Harvard Medical School (MA, USA) in 1993. After residency, Dupuy joined the staff at Massachusetts General Hospital (MA, USA) where he worked in the Abdominal Imaging and Bone and Joint Divisions. In 1997, Dupuy joined the Department of Diagnostic Imaging at Rhode Island Hospital and Brown University. Dupuy, a pioneer in the use of image-guided ablation, helped broaden clinical applications to successfully combat cancer involving the kidney, liver, lung, head and neck, adrenal gland and skeleton. Other newer technologies, such as percutaneous microwave ablation, cryoablation and combination therapies using radiofrequency ablation with external radiation or brachytherapy, have been pioneered by Dupuy who has been the principal investigator of two National Cancer Institute-funded multicenter trials. Dupuy has received national awards for research and teaching from the American College of Radiology Imaging Network and the Radiological Society of North America where he is currently the Chair of the Interventional Oncology Symposium featured at the Annual Meeting of the Radiological Society of North America and a Fellow of the American College of Radiology. Dupuy is a member of the Radiological Society of North America, The New England Roentgen Ray Society, The American College of Radiology, Rhode Island Radiological Society and the Society of Interventional Radiology. Dupuy has published over 150 publications and given over 120 invited lectures in the field of radiology and image-guided ablation, both nationally and internationally.
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Affiliation(s)
- Terrance T Healey
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, USA.
| | - Robert C Ward
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, USA
| | - Damian E Dupuy
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, USA
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Radiofrequency ablation for non-small-cell lung cancer in a single-lung patient: Case report and review of the literature. Lung Cancer 2013; 80:341-3. [DOI: 10.1016/j.lungcan.2013.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/30/2013] [Accepted: 02/03/2013] [Indexed: 11/18/2022]
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Factors influencing local tumor control in patients with neoplastic pulmonary nodules treated with microwave ablation: a risk-factor analysis. AJR Am J Roentgenol 2013; 200:665-72. [PMID: 23436860 DOI: 10.2214/ajr.12.8721] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study was performed to evaluate risk factors predictive of local tumor control after microwave ablation of primary and secondary lung malignancies up to 3 cm in maximal diameter. MATERIALS AND METHODS The single-antenna microwave ablation treatment of 91 index tumors in 57 patients was studied retrospectively. Time to local tumor progression was monitored on CT scans over the follow-up period. Estimation of overall time to local tumor progression was performed with the Cox regression model. Factors hypothesized to correlate with ablation response included tumor diameter, tumor shape (round or oval versus irregular), clear versus ill-defined tumor margin, adjacency to the pleura, adjacency to bronchi, presence of vessels at least 3 mm in diameter a maximum of 5 mm from the index tumor, energy applied to the index tumor, and the occurrence of cavernous formations after ablation. A logistic regression model was used to correlate the data. RESULTS Thirty of 91 (33.0%) index tumors, found in 21 of 57 (36.8%) patients, underwent local progression. The mean time to local tumor progression was 8.3 ± 5.5 months (range 2.1-25.2 months), and the estimated median time to local tumor progression was 22.6 ± 12.4 months. The risk factors that correlated significantly with local tumor progression were a maximal diameter greater than 15.5 mm (p < 0.01), irregular shape of the index tumor (p < 0.01), pleural contact (p = 0.02), and less than 26.7 J/mm(3) applied to the index tumor (p < 0.001). After regression analysis, shape of the index tumor (p = 0.03) and energy deployed per unit volume of the index tumor (p = 0.001) were found to be independent risk factors. Conversely, tumor margin definition (p = 0.06) and proximity of cavernous formations (p = 0.19), juxtatumoral vessels (p = 0.08), and bronchi (p = 0.89) did not affect tumor progression after ablation. CONCLUSION The independent predictive factors for local tumor progression in primary and secondary lung neoplasms up to 3 cm in diameter observed in this study were irregular shape of the index tumor and energy application of less than 26.7 J/mm(3) to the index tumor.
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He T, Xue Z, Lu K, Valdivia y Alvarado M, Wong KK, Xie W, Wong ST. A minimally invasive multimodality image-guided (MIMIG) system for peripheral lung cancer intervention and diagnosis. Comput Med Imaging Graph 2012; 36:345-55. [PMID: 22483054 DOI: 10.1016/j.compmedimag.2012.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 03/07/2012] [Accepted: 03/08/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death in the United States, with more than half of the cancers are located peripherally. Computed tomography (CT) has been utilized in the last decade to detect early peripheral lung cancer. However, due to the high false diagnosis rate of CT, further biopsy is often necessary to confirm cancerous cases. This renders intervention for peripheral lung nodules (especially for small peripheral lung cancer) difficult and time-consuming, and it is highly desirable to develop new, on-the-spot earlier lung cancer diagnosis and treatment strategies. PURPOSE The objective of this study is to develop a minimally invasive multimodality image-guided (MIMIG) intervention system to detect lesions, confirm small peripheral lung cancer, and potentially guide on-the-spot treatment at an early stage. Accurate image guidance and real-time optical imaging of nodules are thus the key techniques to be explored in this work. METHODS The MIMIG system uses CT images and electromagnetic (EM) tracking to help interventional radiologists target the lesion efficiently. After targeting the lesion, a fiber-optic probe coupled with optical molecular imaging contrast agents is used to confirm the existence of cancerous tissues on-site at microscopic resolution. Using the software developed, pulmonary vessels, airways, and nodules can be segmented and visualized for surgical planning; the segmented results are then transformed onto the intra-procedural CT for interventional guidance using EM tracking. Endomicroscopy through a fiber-optic probe is then performed to visualize tumor tissues. Experiments using IntegriSense 680 fluorescent contrast agent labeling αvβ3 integrin were carried out for rabbit lung cancer models. Confirmed cancers could then be treated on-the-spot using radio-frequency ablation (RFA). RESULTS The prototype system is evaluated using the rabbit VX2 lung cancer model to evaluate the targeting accuracy, guidance efficiency, and performance of molecular imaging. Using this system, we achieved an average targeting accuracy of 3.04 mm, and the IntegriSense signals within the VX2 tumors were found to be at least two-fold higher than those of normal tissues. The results demonstrate great potential for applying the system in human trials in the future if an optical molecular imaging agent is approved by the Food and Drug Administration (FDA). CONCLUSIONS The MIMIG system was developed for on-the-spot interventional diagnosis of peripheral lung tumors by combining image-guidance and molecular imaging. The system can be potentially applied to human trials on diagnosing and treating earlier stage lung cancer. For current clinical applications, where a biopsy is unavoidable, the MIMIG system without contrast agents could be used for biopsy guidance to improve the accuracy and efficiency.
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Affiliation(s)
- Tiancheng He
- Department of Systems Medicine and Bioengineering, The Methodist Hospital Research Institute, Weill Cornell Medical College, Houston, TX, United States
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Abstract
Primary and secondary lung malignancies are often treated with surgery. Many patients are poor surgical candidates owing to advanced age or medical comorbidities. Alternatives to surgery for localized disease include radiation therapy and the newer treatments known as image-guided thermal ablation. Image-guided thermal ablation involves the use of needlelike applicators that are placed directly into tumors by using imaging guidance. Tumors are destroyed by the application of either intense heat or cold. The specific ablative modalities of radiofrequency ablation, microwave ablation, laser ablation, and cryoablation are reviewed with respect to the various clinical indications for treatment of both primary and secondary lung malignancies.
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Affiliation(s)
- Damian E Dupuy
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903, USA.
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Vogl TJ, Naguib NNN, Gruber-Rouh T, Koitka K, Lehnert T, Nour-Eldin NEA. Microwave Ablation Therapy: Clinical Utility in Treatment of Pulmonary Metastases. Radiology 2011; 261:643-651. [DOI: 10.1148/radiol.11101643] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Nour-Eldin NE, Naguib NN, Tawfik AM, Koitka K, Saeed AS, Vogl TJ. Outcomes of an Algorithmic Approach to Management of Pneumothorax Complicating Thermal Ablation of Pulmonary Neoplasms. J Vasc Interv Radiol 2011; 22:1279-86. [DOI: 10.1016/j.jvir.2011.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 05/24/2011] [Accepted: 05/31/2011] [Indexed: 11/17/2022] Open
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Pulmonary hemorrhage complicating radiofrequency ablation, from mild hemoptysis to life-threatening pattern. Eur Radiol 2010; 21:197-204. [DOI: 10.1007/s00330-010-1889-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 05/26/2010] [Accepted: 06/10/2010] [Indexed: 10/19/2022]
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Bronchopleural Fistula After Radiofrequency Ablation of Lung Tumours. Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S171-4. [DOI: 10.1007/s00270-010-9826-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 01/29/2010] [Indexed: 10/19/2022]
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