Safety and efficacy of microwave ablation for medically inoperable colorectal pulmonary metastases: Single‐centre experience

Luis, Chris R.; Steinke, Karin

doi:10.1111/1754-9485.12600

Cited by 15 publications

(17 citation statements)

References 31 publications

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“…MWA produces faster and more homogeneous lethal heating of larger tissue volumes with little susceptibility to heat-sink effects and without the need of grounding pads or other ancillary components (23). By virtue of its direct heating and more predictable heat profile, MWA is expected to produce more favourable outcomes than RFA, with quicker procedures, lower local recurrence rates and the option of successfully targeting larger lesions (24)(25)(26)(27)(28).…”

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confidence: 99%

The debate for thermal ablation of colorectal cancer pulmonary metastases is heating up

Steinke

2020

Quant Imaging Med Surg

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Colorectal cancer (CRC) is the third most common cancer worldwide and the fourth most common cause of cancer death. The number of deaths is expected to rise in all countries until 2035, for both colon and rectal cancer by 60% and 71% respectively, mainly due to population growth and ageing (1). The highest CRC incidence rates are in Australia, New Zealand, Europe, and North America, and the lowest rates are found in Africa and South-Central Asia. These geographic differences appear to be attributable to differences in socioeconomic status, and to dietary and environmental exposures imposed upon a background of genetically determined susceptibility (2).Death from CRC is usually a result of metastatic spread. Lung is the second most common site for metachronous CRC metastatic spread, liver being the first. About 20% of patients present with synchronous metastases, most commonly in the liver, and up to 60% of the remaining patients develop metastases within 5 years (3). Rectal cancer and left-sided colon cancer are associated with significantly higher rates of lung-only metastases, seen in 10-20% of patients (4,5). The prognosis of untreated stage IV disease is poor, with an average lifespan of 5-6 months (4). There is extensive data showing survival benefit for metastasectomy for CRC lung metastases, favourable factors being a maximum of 3 metastases, unilateral lesions, lack of thoracic nodal involvement, long disease-free interval (DFI) and no elevated carcinoembryonic antigen (CEA) pre thoracotomy (6). A history of resected liver metastases did not reach statistical significance for poorer outcome, provided there was no evidence of hepatic metastatic involvement at the time of pulmonary metastasectomy (6).Disease recurrence is common after pulmonary metastasectomy-with 69% of patients showing new metastases in lung, liver or both; repeat resection carries a better survival than other treatments or palliative care (7,8). The addition of targeted therapy to conventional chemotherapy has been a recent valuable adjunct to the neoadjuvant or adjuvant treatment of the primary colorectal site. However, pulmonary metastases do not respond well to chemotherapy (9).Recent data on stereotactic body radiation therapy (SBRT) of pulmonary oligometastatic disease shows a significantly lower local control rate for CRC primaries compared to other primary sites with 24-month cumulative incidence rates of local failure above 40% (10-12).Heat based thermal ablation for both primary and secondary lung malignancies has been performed since

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The debate for thermal ablation of colorectal cancer pulmonary metastases is heating up

Steinke

2020

Quant Imaging Med Surg

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“…The lung is one of the most common metastatic sites of CRC, affecting approximately 27% of patients with CRC ( 3 ). The 5-year survival of patients with distant disease is approximately 12% ( 4 ). While surgery is a common option for treating lung metastasis, ablation has emerged as a superior option that can retain more lung tissue and function while removing tumors ( 5 ).…”

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Microwave ablation induces abscopal effect via enhanced systemic antitumor immunity in colorectal cancer

et al. 2023

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BackgroundThermal ablation is the primary procedure for the local treatment of lung metastases. It is known that radiotherapy and cryoablation can stimulate an abscopal effect, while the occurrence of abscopal effect induced by microwave ablation is less; the cellular and molecular mechanisms involved in the abscopal effect after microwave ablation should be further elucidated.MethodsCT26 tumor-bearing Balb/c mice were treated with microwave ablation with several combinations of ablation power and time duration. The growth of primary or abscopal tumors and the survival of mice were both monitored; moreover, immune profiles in abscopal tumors, spleens, and lymph nodes were examined by flow cytometry.ResultsMicrowave ablation suppressed tumor growth in both primary and abscopal tumors. Both local and systemic T-cell responses were induced by microwave ablation. Furthermore, the mice exhibiting significant abscopal effect after microwave ablation markedly elevated Th1 cell proportion both in the abscopal tumors and spleens.ConclusionsMicrowave ablation at 3 w–3 min not only suppressed tumor growth in the primary tumors but also stimulated an abscopal effect in the CT26-bearing mice via the improvement of systemic and intratumoral antitumor immunity.

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“…Ablation has the advantage of being minimally invasive and tissue sparing, also in non-surgical candidates or those with underlying liver disease [19]. MWA seems to have several advantages over RFA including higher intra-tumoral temperatures, larger ablation volumes, shorter operation times and less dependence on the electrical conductivity of tissues [20,21].…”

Section: Introductionmentioning

confidence: 99%

The Role of Conventional and Stereotactic Microwave Ablation for Intrahepatic Cholangiocarcinoma

Kim-Fuchs

Candinas

Lachenmayer

2021

JCM

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Background: The incidence and mortality of intrahepatic cholangiocarcinoma (ICCA) is increasing worldwide and curative treatment options are limited due to the aggressive tumor biology and often late diagnosis. Resection of the primary tumor remains the only curative therapy available, as the benefit of palliative chemotherapy and radiotherapy is relatively small. In contrast to hepatocellular carcinoma, minimal-invasive thermal tumor ablation, and in particular stereotactic tumor ablation for small primary cancers or metastases, is not established and data are scarce. Methods: We conducted a literature review in the field of ICCA ablation and retrospective analysis of 10 patients treated by stereotactic microwave ablation (SMWA) for either primary ICCA or liver metastases of ICCA. Results: While current guidelines have no consensus for ablation of primary ICCA, some state that it might be an option in inoperable patients or those with recurrent disease. The literature review revealed 11 studies on microwave ablation for ICCA reporting that MWA for ICCA ≤ 5 cm might be safe and could be a treatment option for patients who are not candidates for surgery. No data has been published on stereotactic microwave ablation (SMWA) for ICCA. The analyses of our own data of 10 patients treated by SMWA for primary ICCA (n = 5) or recurrent ICCA (n = 5) show that the treatment is safe and efficient with short hospital stays and low complication rates. Conclusion: Although thermal ablation, and in particular SMWA, might be a minimally invasive and tissue-sparing curative treatment alternative for small ICCA in the diseased liver and ICCA metastases, the oncologic benefit still needs to be shown in larger studies with longer follow-up.

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Safety and efficacy of microwave ablation for medically inoperable colorectal pulmonary metastases: Single‐centre experience

Abstract: Microwave ablation is safe and efficacious in the local control of colorectal pulmonary metastases. The frequent systemic disease progression despite local control would favour a minimally invasive treatment option over invasive surgery in the setting of oligometastatic disease.

Cited by 15 publications

References 31 publications

The debate for thermal ablation of colorectal cancer pulmonary metastases is heating up

The debate for thermal ablation of colorectal cancer pulmonary metastases is heating up

Microwave ablation induces abscopal effect via enhanced systemic antitumor immunity in colorectal cancer

The Role of Conventional and Stereotactic Microwave Ablation for Intrahepatic Cholangiocarcinoma

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