Updates on Current Role and Practice of Lung Ablation
Fereidoun AbtinThierry de BaèreDamian E. DupuyScott GenshaftTerrance T. HealeySarah KhanRobert D. Suh
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Abstract:
Interventional oncology and management of thoracic malignancies with ablative techniques are becoming ever more recognized therapeutic options. With increased understanding, development, and utility of the ablative techniques, the indications are expanding and efficacy improving. Lung cancer was among the first indications for lung ablation and remains most challenging with multiple therapeutic options. For inoperable patients, the current literature demonstrates equivalent survivals between ablation, sublobar resection, and stereotactic body radiation. Oligometastatic disease remains the most common indication for lung ablation and is gaining acceptance among the oncology community, as lung ablation provides limited patient downtime, repeatability, and minimal to no loss of respiratory function. Other indications for ablation are being explored, including recurrent mesothelioma, drop metastasis from thymoma, and limited pleural metastasis, with excellent local control of tumor and limited complications. Follow-up after ablation is essential to detect early complications, observe the natural evolution of the ablation zone, and detect recurrence. Standardized imaging follow-up allows for these goals to be achieved and provides a framework for oncology practice. In this article, the role of ablation in the management of thoracic neoplasms and postablation imaging features are reviewed. The radiologists, in particular, thoracic radiologists should be able to identify candidates who can benefit from ablation familiarize themselves with postablation imaging features, and recognize the evolution of the postablation zone and hence detect early recurrence.Keywords:
Cryoablation
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Interventional radiology
Image-guided ablation is safe and effective for the treatment of both primary and metastatic tumors in the lung. This article reviews the three most commonly used ablative options: radiofrequency ablation, microwave ablation, and cryoablation. We describe the advantages of each ablation modality in the lung and how to choose the most appropriate ablation device based on patient and tumor characteristics. The optimal technique for lung ablation is discussed and technical tips for improving clinical outcome are described.
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Background: To evaluate efficacy and safety of ablation procedures for the treatment of kidney lesions <7 cm. Method(s): 90 patients with single T1a and T1b lesions of the kidney, susceptible to ablative procedure, were retrospectively analyzed: 30 treated with radiofrequency (RFA), 30 with cryoablation (CRA) and 30 with microwave (MWA). All lesions have been biopticed. Complications rate, local control in terms of disease free survival (DFS) and renal function, and survival in terms of cancer specific survival (CSS) and overall survival (OS), were evaluated. Result(s): Mean age of patients was 68.8 years (29-94 years); mean tumor size was 26.51 mm (6-102 mm). Eighty-two lesions (91%) were T1a and 8 (9%) T1b. In 19 cases artificial dissection was performed. The treatment was effective in 96% of cases, with peri-procedural complications in 6 patients (5 hemorrhages and 1 hydro-ureteronephrosis). Seven patients (7.78%) reported a recurrence of disease (9 T1a and 1 T1b) (p> 0.05) in a mean time of 3 months: 4 underwent MWA, 2 RFA and 1 CRA (p <0.05). One case of renal failure in mono-kidney patient was observed. The only significant predictor of DFS in the multivariate analysis, was the histotype, with a higher recurrence rate in RCC (p <0.05). Overall, 9 (10%) patients died for other causes. Conclusion(s): The safety and efficacy in short and long-term control of the three procedures are comparable. However, long-term surveillance is required, especially after MWA. Patient selection, based on tumor characteristics (size and location), and patient comorbidities remain crucial.
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Abstract Image-guided percutaneous lung ablation has proven to be a valid treatment alternative in patients with early-stage non-small cell lung carcinoma or oligometastatic lung disease. Available ablative modalities include radiofrequency ablation, microwave ablation, and cryoablation. Currently, there are no sufficiently representative studies to determine significant differences between the results of these techniques. However, a common feature among them is their excellent tolerance with very few complications. For optimal treatment, radiologists must carefully select the patients to be treated, perform a refined ablative technique, and have a detailed knowledge of the radiological features following lung ablation. Although no randomized studies comparing image-guided percutaneous lung ablation with surgery or stereotactic radiation therapy are available, the current literature demonstrates equivalent survival rates. This review will discuss image-guided percutaneous lung ablation features, including available modalities, approved indications, possible complications, published results, and future applications.
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Local ablative techniques have been developed to enable local control of unresectable tumors. Ablation has been performed with several modalities including ethanol ablation, laser ablation, cryoablation, and radiofrequency ablation. Microwave technology is a new thermal ablation technique for different types of tumors, providing all the benefits of radiofrequency and substantial advantages. Microwave ablation has been applied to liver, lung, kidney and more rarely to bone, pancreas and adrenal glands. Preliminary works show that microwave ablation may be a viable alternative to other ablation techniques in selected patients. However further studies are necessary to confirm short- and long-term effectiveness of the methods and to compare it with other ablative techniques, especially RF.
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and effective therapies for patients with primary and secondary liver tumors who are not surgical candidates at the time of diagnosis.This article reviews the current literature and describes the techniques, complications and results for radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation.
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Three definitive treatment options are available for patients with hepatic tumors: hepatic resection, tumor ablation, and hepatic transplantation. Ablative techniques--including radiofrequency ablation (RFA) and cryoablation--have greatly improved physicians' ability to definitively treat patients with primary and secondary hepatic tumors. Both RFA and cryoablation are safe and well-tolerated, but the effectiveness for local tumor eradication depends on many factors, including tumor size, location, number, and type. The choice of ablation modality is based on user and institutional biases. Assessing outcome after ablation is difficult because few studies with good long-term follow-up have evaluated local recurrence, disease-free survival, and overall survival after ablation. This and other limitations make it difficult to draw meaningful conclusions.
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