Lung Ablation – How I Do It

Najafi, Arash; Baère, Thierry De; Madani, Khaled; Al-Ahmar, Marc; Roux, Charles; Delpla, Alexandre; Deschamps, Frédèric; Tselikas, Lambros

doi:10.1016/j.tvir.2020.100673

Cited by 5 publications

(5 citation statements)

References 21 publications

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“…(6) Patients with uncontrolled malignant pleural effusion in the ablation zone [26]. (7) Patients with pacemakers or implanted defibrillators are not suggested to undergo RFA [26,53].…”

Section: Contraindications Of Thermal Ablationmentioning

confidence: 99%

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Potential of Thermal Ablation Combined with Immunotherapy in Peripheral Lung Tumors: A Review and Prospect

Yang,

Gu,

Xie

et al. 2024

Respiration

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Background: Lung tumors are prevalent malignancies associated with a high mortality rate, imposing significant medical and societal burdens. Although immunotherapy shows promise in improving survival, response rates are relatively modest. Thermal ablation can not only eliminate tumor cells directly but also enhance antitumor immunity response, thus manifesting a remarkable propensity to synergize with immunotherapy. Summary: In this review, we provided a brief overview of the application of thermal ablation in peripheral lung tumors. We summarized the patient selection of thermal ablation. We highlighted the potential of thermal ablation to augment the antitumor immune response, offering a promising avenue for combined therapies. We summarized studies assessing the synergistic effects of thermal ablation and immunotherapy in preclinical and clinical settings. Lastly, we underscored the urgent issues that warrant in-depth exploration when applying thermal ablation and immunotherapy to lung tumor patients. Key Messages: This review emphasized the prospects of using thermal ablation combined with immunotherapy in patients with peripheral lung tumors. However, further research is needed to enhance and optimize this treatment strategy.

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“…(6) Patients with uncontrolled malignant pleural effusion in the ablation zone [26]. (7) Patients with pacemakers or implanted defibrillators are not suggested to undergo RFA [26,53].…”

Section: Contraindications Of Thermal Ablationmentioning

confidence: 99%

“…(2) Patients suffering from severe pulmonary fibrosis [52]. (3) Patients with a severe tendency for hemorrhage, ongoing anticoagulation therapy, or clopidogrel intake [53]. (4) Patients with severe dysfunction of vital organs and severe disorders of nutrition metabolism, which cannot be improved in the short term.…”

Section: Patient Selection Of Thermal Ablationmentioning

confidence: 99%

Potential of Thermal Ablation Combined with Immunotherapy in Peripheral Lung Tumors: A Review and Prospect

Yang,

Gu,

Xie

et al. 2024

Respiration

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“…3 Department of Radiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain. 4 Centre for Biomedical Research in the Respiratory Diseases Network (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. 5 Surgical Area Nursing Department, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain.…”

Section: Acknowledgementsmentioning

confidence: 99%

“…It is also the most frequently reported ablation technique for the treatment of lung cancer [ 3 ]. Pulmonary RFA is a high-risk interventional procedure because patient’ comorbidities and the potential hazards of the procedure itself [ 4 ]. Major complications range from 2% to 10%, occur mainly in the first month and can be life-threatening [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Continuous positive airway pressure is unsafe for radiofrequency ablation of lung cancer under sedation: a randomised controlled trial

Carrero-Cardenal,

Vollmer-Torrubiano,

Torres-López

et al. 2024

Insights Imaging

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Objective To evaluate the safety of a minimum continuous positive airway pressure of 4 cmH2O (CPAP + 4) during computed tomography (CT)-guided radiofrequency ablation (RFA) for lung malignancies under procedural sedation and analgesia (PSA). Methods This was a prospective, randomised, single-blind, parallel-group, placebo-controlled trial with an open-label medical device conducted at a single tertiary university hospital in Barcelona, Spain. Forty-six patients over 18 years of age scheduled for CT-guided RFA of a malignant pulmonary tumour under PSA were randomised to receive either CPAP + 4 or a modified mask for placebo CPAP (Sham-CPAP). Exclusion criteria included contraindications for RFA, refusal to participate, inability to understand the procedure or tolerate the CPAP test, lung biopsy just prior to RFA, intercurrent diseases, or previous randomisation for additional pulmonary RFA. Primary outcomes were the percentage of patients reporting at least one serious adverse event (SAE), classification for complications from the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and Clavien-Dindo classifications for complications, hospital stay, and readmissions. Secondary outcomes included adverse events (AEs), respiratory parameters, airway management, and the local radiological efficacy of pulmonary ablation. Results CPAP + 4 prolonged hospital stay (1.5 ± 1.1 vs. 1.0 ± 0 inpatient nights, p = 0.022) and increased the risk of AE post-RFA (odds ratio (95% CI): 4.250 (1.234 to 14.637), p = 0.021 with more pneumothorax cases (n = 5/22, 22.7% vs. n = 0/24, 0%, p = 0.019). Per-protocol analysis revealed more SAEs and CIRSE grade 3 complications in the CPAP + 4 group (23.5% vs. 0%, p = 0.036). No significant differences were found in the effectiveness of oxygenation, ventilation, or pulmonary ablation. Conclusion CPAP is unsafe during CT-guided RFA for lung cancer under PSA even at the lowest pressure setting. Trial registration ClinicalTrials.Gov, ClinicalTrials.gov ID NCT02117908, Registered 11 April 2014, https://www.clinicaltrials.gov/study/NCT02117908 Critical relevance statement This study highlights the hazards of continuous positive airway pressure during radiofrequency ablation of lung cancer, even at minimal pressures, deeming it unsafe under procedural sedation and analgesia in pulmonary interventional procedures. Findings provide crucial insights to prioritise patient safety. Key Points No prior randomised controlled trials on CPAP safety in percutaneous lung thermo-ablation. Standardised outcome measures are crucial for radiology research. CPAP during lung RFA raises hospital stay and the risk of complications. CPAP is unsafe during CT-guided RFA of lung cancer under procedural sedoanalgesia. Graphical Abstract

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“…Based on the results of this review, previously published recommendations on lung metastases by Handy et al [30] and Najafi et al [104], and the recent Society of Thoracic Surgeons webinar on pulmonary metastasectomy [105], we propose an algorithm to help choose the optimal local ablation therapy among surgery, SBRT and TA, illustrated in Figure 2.…”

Section: Comparison To Other Lat Modalitiesmentioning

confidence: 99%

Current Management of Oligometastatic Lung Cancer and Future Perspectives: Results of Thermal Ablation as a Local Ablative Therapy

Ghosn

Solomon

2021

Cancers

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A growing body of evidence shows improved overall survival and progression-free survival after thermal ablation in non-small cell lung carcinoma (NSCLC) patients with a limited number of metastases, combined with chemotherapy or tyrosine kinase inhibitors or after local recurrence. Radiofrequency ablation and microwave ablation are the most evaluated modalities, and target tumor size <3 cm (and preferably <2 cm) is a key factor of technical success and efficacy. Although thermal ablation offers some advantages over surgery and radiotherapy in terms of repeatability, safety, and quality of life, optimal management of these patients requires a multidisciplinary approach, and further randomized controlled trials are required to help refine patient selection criteria. In this article, we present a comprehensive review of available thermal ablation modalities and recent results supporting their use in oligometastatic and oligoprogressive NSCLC disease along with their potential future implications in the emerging field of immunotherapy.

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Lung Ablation – How I Do It

Cited by 5 publications

References 21 publications

Potential of Thermal Ablation Combined with Immunotherapy in Peripheral Lung Tumors: A Review and Prospect

Potential of Thermal Ablation Combined with Immunotherapy in Peripheral Lung Tumors: A Review and Prospect

Continuous positive airway pressure is unsafe for radiofrequency ablation of lung cancer under sedation: a randomised controlled trial

Current Management of Oligometastatic Lung Cancer and Future Perspectives: Results of Thermal Ablation as a Local Ablative Therapy

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