Image-guided lung metastasis ablation: a literature review

Abstract

Purpose: To review the available options of percutaneous ablation of lung metastasis. Methods: General indications, prognostic factors, and image guidance of percutaneous lung ablations were reviewed. Specificities, technical aspects, advantages and limitations of each technic were highlighted. Complications and follow up where also reviewed. Results: Image-guided, percutaneous ablation is of interest for patients with a limit number (<3-5) small metastases (<2-3 cm). Other predictive factors have been reported such as the disease-free interval, the primary tumor, or the proximity with large vessels or bronchus. Radiofrequency ablation (RFA) is the most reported technic, with local control rate >90% for small tumors, and a very low complication rate. Microwave (MWA) and cryoablation are alternative technics developed in the last 15 years to overcome RFA limitations, with encouraging results. Larger ablations zones and less heat sink effect have been described with MWA. On the other hand, cryoablation allows painless treatments under conscious sedation and/or local anesthesia, high accessibility of difficult locations and promising results on prospective multicenter series. Although irreversible electroporation (IRE) could be used for lesions close to main blood vessels as it is not limited by the heat sink effect and does not have significant effects on connective tissue, allowing to treat lesions near to vital organs, preliminary results for lung metastasis are disappointing. Conclusion: Percutaneous ablation of lung metastases, whatever technic is used, is feasible, with high local control rate, and acceptable complication rate. Although indications seem clear enough, validation through controlled trials is mandatory.

Salvage treatment of NSCLC recurrence after first‐line chemotherapy failure: Iodine‐125 seed brachytherapy or microwave ablation?

“…In general, MWA is not recommended for tumors located near the hilum since a heat sink effect may decrease the local control rate and thermal destruction could increase the risk of bronchial fistula and hemorrhage . The study by Zhang et al .…”

“…In general, MWA is not recommended for tumors located near the hilum since a heat sink effect may decrease the local control rate 25 and thermal destruction could increase the risk of bronchial fistula and hemorrhage. 26 The study by Zhang et al demonstrated that brachytherapy, despite many punctures, does not add the possibility of hemorrhage, 27 which has also been demonstrated by our study without hemorrhage requiring intervention.…”

Independent prognostic value of HIF‑1α expression in radiofrequency ablation of lung cancer

“…Compared with radiotherapy and chemotherapy, RFA focuses exclusively on the tumor area without causing any damage to the normal surrounding tissue (37). In addition, compared with surgical treatment, RFA is a minimally-invasive method (38). In advanced lung cancers, RFA is extremely effective for palliative care (39); however, it induces several complications, including local recurrence, which severely affects the prognosis of patients.…”

The Yin and Yang of PDT and PTT

“…Competing approaches use radiofrequency (RF) or microwave (MW) irradiation, high‐intensity‐focused ultrasound (HIFU) and cryotherapy. The reader is referred to recent reviews for detailed discussion of the pros and cons of these competing modalities . None has become the established method of choice for any particular application and often many of the same technical, biophysical, biological and clinical issues are involved as in PTT.…”