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Chang LK, Su PK, Chan PS, Malwade S, Chung WY, Yang SM. Single-Stage Image-Guided Percutaneous Ablation with Thoracoscopic Resection for Multiple Pulmonary Lesions in a Hybrid Operating Room: A Retrospective Study. Cancers (Basel) 2024; 16:3512. [PMID: 39456606 PMCID: PMC11505936 DOI: 10.3390/cancers16203512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 10/05/2024] [Accepted: 10/15/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND Different approaches are required in treating patients with multiple pulmonary lesions. A multistage procedure may increase the risk of complications and patient discomfort. This study reports an initial experience with single-stage management of multiple lung lesions using percutaneous ablation with thoracoscopic resection in a hybrid operating room (HOR). METHODS We retrospectively evaluated patients who underwent combined ablation and resection in an HOR between May 2022 and July 2024. All patients received a single anesthesia via endotracheal tube intubation. The clinical data, operative findings, and pathological characteristics of the lung nodules were recorded. RESULTS A total of 22 patients were enrolled in this study. Twenty patients underwent unilateral procedures, while the other two patients underwent bilateral procedures. Ablations were performed before lung resection in 21 patients; only 1 patient underwent surgery first. The median global operating room time was 227.0 min. The median total radiation dose (dose area product) was 14,076 μGym2. The median hospital postoperative length of stay was 2 days. CONCLUSIONS The single-stage procedure of percutaneous ablation with thoracoscopic resection under general anesthesia in an HOR is feasible and safe. This procedure is an alternative method for managing multiple pulmonary lesions.
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Affiliation(s)
- Ling-Kai Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan; (L.-K.C.); (P.-K.S.); (P.-S.C.); (W.-Y.C.)
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan
| | - Po-Keng Su
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan; (L.-K.C.); (P.-K.S.); (P.-S.C.); (W.-Y.C.)
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan;
| | - Pak-Si Chan
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan; (L.-K.C.); (P.-K.S.); (P.-S.C.); (W.-Y.C.)
- Department of Anesthesiology, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan
| | - Shwetambara Malwade
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan;
- Department of Advanced Therapies, Siemens Healthcare Limited, Taipei City 11503, Taiwan
| | - Wen-Yuan Chung
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan; (L.-K.C.); (P.-K.S.); (P.-S.C.); (W.-Y.C.)
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan;
| | - Shun-Mao Yang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan; (L.-K.C.); (P.-K.S.); (P.-S.C.); (W.-Y.C.)
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan;
- Department of Traumatology, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu 300195, Taiwan
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Chang LK, Yang SM, Chung WY, Chen LC, Chang HC, Ho MC, Chang YC, Yu CJ. Cone-beam computed tomography image-guided percutaneous microwave ablation for lung nodules in a hybrid operating room: an initial experience. Eur Radiol 2024; 34:3309-3319. [PMID: 37926741 DOI: 10.1007/s00330-023-10360-5] [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: 01/03/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES The experience of thermal ablation of lung lesions is limited, especially performing the procedure under localisation by cone-beam CT in the hybrid operation room (HOR). Here, we present the experience of microwave ablation (MWA) of lung nodules in the HOR. METHODS We reviewed patients who underwent image-guide percutaneous MWA for lung nodules in the HOR under general anaesthesia between July 2020 and July 2022. The workflow in the HOR including the pre-procedure preparation, anaesthesia consideration, operation methods, and postoperative care was clearly described. RESULTS Forty lesions in 33 patients who underwent MWA under general anaesthesia (GA) in the HOR were analysed. Twenty-seven patients had a single pulmonary nodule, and the remaining six patients had multiple nodules. The median procedure time was 41.0 min, and the median ablation time per lesion was 6.75 min. The median global operation room time was 115.0 min. The median total dose area product was 14881 μGym2. The median ablation volume was 111.6 cm3. All patients were discharged from the hospital with a median postoperative stay of 1 day. Four patients had pneumothorax, two patients had pleural effusion during the first month of outpatient follow-up, and one patient reported intercostal neuralgia during the 3-month follow-up. CONCLUSIONS Thermal ablation of pulmonary nodules under GA in the HOR can be performed safely and efficiently if we follow the workflow provided. The procedure provides an alternative to managing pulmonary nodules in patients. CLINICAL RELEVANCE STATEMENT Thermal ablation of pulmonary nodules under GA in the HOR can be performed safely and efficiently if the provided workflow is followed. KEY POINTS • We tested the feasibility of microwave ablation of lung lesions performed in a hybrid operating room. • To this end, we provide a description of microwave ablation of the lung under cone-beam CT localisation. • We describe a workflow by which ablation of the pulmonary nodule can be performed safely under general anaesthesia.
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Affiliation(s)
- Ling-Kai Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Shun-Mao Yang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan.
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan.
| | - Wen-Yuan Chung
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan
| | - Lun-Che Chen
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Hao-Chun Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
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3
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Ye X, Fan W, Wang Z, Wang J, Wang H, Niu L, Fang Y, Gu S, Liu L, Liu B, Zhuang Y, Wei Z, Li X, Li X, Li Y, Li C, Yang X, Yang W, Yang P, Lin Z, Meng Z, Hu K, Liu C, Huang Y, Huang G, Huang K, Peng Z, Han Y, Jin Y, Lei G, Zhai B, Li H, Pan J, Filippiadis D, Kelekis A, Pua U, Futacsi B, Yumchinserchin N, Iezzi R, Tang A, Roy SH. Clinical practice guidelines on image-guided thermal ablation of primary and metastatic lung tumors (2022 edition). J Cancer Res Ther 2022; 18:1213-1230. [PMID: 36204866 DOI: 10.4103/jcrt.jcrt_880_22] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The main contents of the Clinical Practice Guidelines on Image-Guided Thermal Ablation (IGTA) of Primary and Metastatic Lung Tumors (2022 Edition) include the following: epidemiology of primary and metastatic lung tumors; the concepts of the IGTA and common technical features; procedures, indications, contraindications, outcomes evaluation, and related complications of IGTA on primary and metastatic lung tumors; and limitations and future development.
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Affiliation(s)
- Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, Shandong, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Zhongmin Wang
- Department of Interventional Radiology, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Minhang, Shanghai, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Haidian, Beijing, China
| | - Hui Wang
- Interventional Center, Jilin Provincial Cancer Hospital, Changchun, Jilin, China
| | - Lizhi Niu
- Department of Oncology, Affiliated Fuda Cancer Hospital, Jinan University, China
| | - Yong Fang
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Shanzhi Gu
- Department of Interventional Radiology, Hunan Cancer Hospital, Hunan, China
| | - Lingxiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Shanghai Medical College of Fudan University, Xuhui, Shanghai, China
| | - Baodong Liu
- Department of Thoracic Surgery, Xuan Wu Hospital Affiliated to Capital Medical University, Xicheng, Beijing, China
| | - Yiping Zhuang
- Department of Interventional Therapy, Jiangsu Cancer Hospital, Jiangsu, China
| | - Zhigang Wei
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, Shandong, China
| | - Xiao Li
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, China
| | - Xiaoguang Li
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, Dongcheng, Beijing, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Chunhai Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Afliated to Shandong First Medical University, Jinan, Shandong, China
| | - Wuwei Yang
- Department of Oncology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Po Yang
- Interventionael and Vascular Surgery, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhengyu Lin
- Department of Intervention, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Zhiqiang Meng
- Minimally Invasive Therapy Center, Fudan University Shanghai Cancer Center, Dongan, Shanghai, China
| | - Kaiwen Hu
- Department of Oncology, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Chaoyang, China
| | - Chen Liu
- Department of Interventional Therapy, Beijing Cancer Hospital, Haidian, Beijing, China
| | - Yong Huang
- Department of Imaging, Affiliated Cancer Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Guanghui Huang
- Department of Oncology, Shandong Provincial Hospital Afliated to Shandong First Medical University, Jinan, Shandong, China
| | - Kaiwen Huang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Da'an District, Taipei, China
| | - Zhongmin Peng
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yue Han
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, China
| | - Yong Jin
- Interventionnal Therapy Department, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Guangyan Lei
- Department of Thoracic Surgery, Shanxi Provincial Cancer Hospital, Xinghualing, Taiyuan, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Minhang, Shanghai, China
| | - Hailiang Li
- Department of Interventional Radiology, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Jie Pan
- Department of Radiology, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing, China
| | - Dimitris Filippiadis
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexis Kelekis
- Radiology and Interventional Radiology at National and Kapodistrian University of Athens, Athens, Greece
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Balazs Futacsi
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - N Yumchinserchin
- The Intervention Radiology Department at Mongolia's National Cancer Center, Mongolia
| | - Roberto Iezzi
- Interventional Radiology Consultant at Fondazione Policlinico A. Gemelli IRCCS, Rome, Lazio, Italia
| | - Alex Tang
- Vascular and Interventional Radiology Centre, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | - Shuvro H Roy
- Choudhury Consultant in Diagnostic and Interventional Radiology, Naryana Health Group, India
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Lau KK, Steinke K, Reis S, Cherukuri SP, Cejna M. Current trends in image-guided chest interventions. Respirology 2022; 27:581-599. [PMID: 35758539 PMCID: PMC9545252 DOI: 10.1111/resp.14315] [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: 03/07/2022] [Accepted: 05/18/2022] [Indexed: 02/06/2023]
Abstract
Interventional radiology (IR) is a rapidly expanding medical subspecialty and refers to a range of image‐guided procedural techniques. The image guidance allows real‐time visualization and precision placement of a needle, catheter, wire and device to deep body structures through small incisions. Advantages include reduced risks, faster recovery and shorter hospital stays, lower costs and less patient discomfort. The range of chest interventional procedures keeps on expanding due to improved imaging facilities, better percutaneous assess devices and advancing ablation and embolization techniques. These advances permit procedures to be undertaken safely, simultaneously and effectively, hence escalating the role of IR in the treatment of chest disorders. This review article aims to cover the latest developments in some image‐guided techniques of the chest, including thermal ablation therapy of lung malignancy, targeted therapy of pulmonary embolism, angioplasty and stenting of mediastinal venous/superior vena cava occlusion, pulmonary arteriovenous malformation treatment and bronchial artery embolization for haemoptysis.
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Affiliation(s)
- Kenneth K Lau
- Monash Imaging, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Karin Steinke
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,University of Queensland School of Medicine, St Lucia, Queensland, Australia
| | - Stephen Reis
- Division of Interventional Radiology, Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Srinivas P Cherukuri
- Division of Interventional Radiology, Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Manfred Cejna
- Institute for Diagnostic and Interventional Radiology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
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Cilleruelo-Ramos A, Cladellas-Gutiérrez E, de la Pinta C, Quintana-Cortés L, Sosa-Fajardo P, Couñago F, Mielgo-Rubio X, Trujillo-Reyes JC. Advances and controversies in the management of early stage non-small cell lung cancer. World J Clin Oncol 2021; 12:1089-1100. [PMID: 35070733 PMCID: PMC8716990 DOI: 10.5306/wjco.v12.i12.1089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/20/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Complete resection continues to be the gold standard for the treatment of early-stage lung cancer. The landmark Lung Cancer Study Group trial in 1995 established lobectomy as the minimum intervention necessary for the management of early-stage non-small cell lung cancer, as it was associated with lower recurrence and metastasis rates than sublobar resection and lower postoperative morbidity and mortality than pneumonectomy. There is a growing tendency to perform sublobar resection in selected cases, as, depending on factors such as tumor size, histologic subtype, lymph node involvement, and resection margins, it can produce similar oncological results to lobectomy. Alternative treatments such as stereotactic body radiotherapy and radiofrequency ablation can also produce good outcomes in inoperable patients or patients who refuse surgery.
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Affiliation(s)
- Angel Cilleruelo-Ramos
- Department of Thoracic Surgery, Clinic Universitary Hospital, Valladolid 47005, Spain
- Department of Surgery, Universidad de Valladolid, Valladolid 47001, Spain
| | | | - Carolina de la Pinta
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Laura Quintana-Cortés
- Department of Medical Oncology, Hospital Don Benito-Villanueva, Badajoz 06400, Spain
| | - Paloma Sosa-Fajardo
- Department of Radiation Therapy, Complejo Hospitalario Universitario, Santiago de Compostela, La Coruña 15706, Spain
| | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28223, Spain
- Department of Medicine, School of Biomedical Sciences, Universidad Europea, Madrid 28223, Spain
| | - Xabier Mielgo-Rubio
- Department of Medical Oncology Unit, Hospital Universitario Fundación Alcorcón, Madrid 28922, Spain
| | - Juan Carlos Trujillo-Reyes
- Department of Thoracic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona 08029, Spain
- Department of Surgery, Universitat Autónoma, Barcelona 08029, Spain
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Dornbusch JA, Wavreille VA, Dent B, Fuerst JA, Green EM, Selmic LE. Percutaneous microwave ablation of solitary presumptive pulmonary metastases in two dogs with appendicular osteosarcoma. Vet Surg 2020; 49:1174-1182. [PMID: 32521058 DOI: 10.1111/vsu.13469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/08/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe percutaneous microwave ablation (MWA) of presumptive pulmonary metastases and the outcome of two dogs. ANIMALS Two dogs with pulmonary lesions after treatment of spontaneously occurring appendicular osteosarcoma. STUDY DESIGN Preliminary prospective clinical study. METHODS Two large-breed dogs were referred from tertiary veterinary hospitals 146 and 217 days after limb amputation to pursue MWA as an alternative therapy to metastasectomy. Both dogs had been receiving chemotherapy protocols at their respective referral centers. RESULTS A novel percutaneous approach for MWA with ultrasonographic or computed tomographic (CT) guidance was successfully performed. The only complications consisted of pneumothoraxes, requiring treatment in one dog. In the weeks after their procedures, both dogs were reported to do well at home. Dog 1 died and dog 2 was euthanized 82 and 19 days, respectively, after their MWA of confirmed (dog 1) or presumed (dog 2) metastatic disease. CONCLUSION Percutaneous MWA of pulmonary nodules was technically feasible in two dogs without major complications. CLINICAL SIGNIFICANCE Percutaneous MWA may provide a minimally invasive option for treatment of osteosarcoma pulmonary metastases. Additional studies are required to evaluate the benefits of MWA on survival and confirm histologic cell death within pulmonary neoplastic lesions.
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Affiliation(s)
- Josephine A Dornbusch
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Vincent A Wavreille
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Brian Dent
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Jason A Fuerst
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Eric M Green
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Laura E Selmic
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
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7
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Wei Z, Yang X, Ye X, Feng Q, Xu Y, Zhang L, Sun W, Dong Y, Meng Q, Li T, Wang C, Li G, Zhang K, Li P, Bi J, Xue G, Sun Y, Sheng L, Liu B, Yu G, Ren H, Wang J, Sun L, Chen S, Geng D, Zhang B, Xu X, Zhang L, Sun D, Xu X, Diao C, Huang G, Li W, Han X, Wang J, Meng M, Ni Y, Zheng A, Fan W, Li Y, Li F, Fan H, Zou Z, Li Q, Tian H. Microwave ablation plus chemotherapy versus chemotherapy in advanced non-small cell lung cancer: a multicenter, randomized, controlled, phase III clinical trial. Eur Radiol 2020; 30:2692-2702. [PMID: 32020400 DOI: 10.1007/s00330-019-06613-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/27/2019] [Accepted: 12/09/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This prospective trial was performed to verify whether microwave ablation (MWA) in combination with chemotherapy could provide superior survival benefit compared with chemotherapy alone. MATERIALS AND METHODS From March 1, 2015, to June 20, 2017, treatment-naïve patients with pathologically verified advanced or recurrent non-small cell lung cancer (NSCLC) were randomly assigned to MWA plus chemotherapy group or chemotherapy group. The primary endpoint was progression-free survival (PFS), while the secondary endpoints included overall survival (OS), time to local progression (TTLP), and objective response rate (ORR). The complications and adverse events were also reported. RESULTS A total of 293 patients were randomly assigned into the two groups. One hundred forty-eight patients with 117 stage IV tumors were included in the MWA plus chemotherapy group. One hundred forty-five patients with 113 stage IV tumors were included in the chemotherapy group. The median follow-up period was 13.1 months and 12.4 months, respectively. Median PFS was 10.3 months (95% CI 8.0-13.0) in the MWA plus chemotherapy group and 4.9 months (95% CI 4.2-5.7) in the chemotherapy group (HR = 0.44, 95% CI 0.28-0.53; p < 0.0001). Median OS was not reached in the MWA plus chemotherapy group and 12.6 months (95% CI 10.6-14.6) in the chemotherapy group (HR = 0.38, 95% CI 0.27-0.53; p < 0.0001) using Kaplan-Meier analyses with log-rank test. The median TTLP was 24.5 months, and the ORR was 32% in both groups. The adverse event rate was not significantly different in the two groups. CONCLUSIONS In patients with advanced NSCLC, longer PFS and OS can be achieved with the treatment of combined MWA and chemotherapy than chemotherapy alone. KEY POINTS • Patients treated with MWA plus chemotherapy had superior PFS and OS over those treated with chemotherapy alone. • The ORR of patients treated with MWA plus chemotherapy was similar to that of those treated with chemotherapy alone. • Complications associated with MWA were common but tolerable and manageable.
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Affiliation(s)
- Zhigang Wei
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, China
| | - Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, China.
| | - Qingliang Feng
- Department of Oncology, Liaocheng Cancer Hospital, Liaocheng, Shandong, China
| | - Yanjun Xu
- Department of Oncology, Liaocheng Cancer Hospital, Liaocheng, Shandong, China
| | - Licheng Zhang
- Department of Oncology, The People's Liberation Army 88 Hospital, Tai'an, Shandong, China
| | - Wenqiao Sun
- Department of Oncology, The People's Liberation Army 88 Hospital, Tai'an, Shandong, China
| | - Yuting Dong
- Department of Oncology, Dezhou People's Hospital, Dezhou, Shandong, China
| | - Qi Meng
- Department of Oncology, Dezhou People's Hospital, Dezhou, Shandong, China
| | - Tao Li
- Department of Oncology, Dezhou People's Hospital, Dezhou, Shandong, China
| | - Chuntang Wang
- Department of Thoracic Surgery, The Second People's Hospital of Dezhou, Dezhou, Shandong, China
| | - Guangxu Li
- Department of Thoracic Surgery, The Second People's Hospital of Dezhou, Dezhou, Shandong, China
| | - Kaixian Zhang
- Department of Oncology, Tengzhou Central People's Hospital, Zaozhuang, Shandong, China
| | - Peishun Li
- Department of Oncology, Tengzhou Central People's Hospital, Zaozhuang, Shandong, China
| | - Jingwang Bi
- Department of Oncology, Jinan Military General Hospital, Jinan, Shandong, China
| | - Guoliang Xue
- Department of Oncology, Jinan Military General Hospital, Jinan, Shandong, China
| | - Yahong Sun
- Department of Oncology, Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Lijun Sheng
- Department of Oncology, Liaocheng Cancer Hospital, Liaocheng, Shandong, China
| | - Bin Liu
- Department of Oncology, Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Guohua Yu
- Department of Oncology, Weifang People's Hospital, Weifang, Shandong, China
| | - Haipeng Ren
- Department of Oncology, Weifang People's Hospital, Weifang, Shandong, China
| | - Junye Wang
- Department of Oncology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Lijun Sun
- Department of Oncology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Shaoshui Chen
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Dianzhong Geng
- Department of Oncology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Benhua Zhang
- Department of Oncology, Affiliated Hospital of Taishan Medical University, Tai'an, Shandong, China
| | - Xin Xu
- Department of Oncology, Affiliated Hospital of Taishan Medical University, Tai'an, Shandong, China
| | - Liangming Zhang
- Department of Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Dengjun Sun
- Department of Oncology, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Xinglu Xu
- Department of Oncology, The People's Hospital of Pingyi Country, Linyi, Shandong, China
| | - Cunqi Diao
- Department of Oncology, The People's Hospital of Pingyi Country, Linyi, Shandong, China
| | - Guanghui Huang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, China
| | - Wenhong Li
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, China
| | - Xiaoying Han
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, China
| | - Jiao Wang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, China
| | - Min Meng
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, China
| | - Yang Ni
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, China
| | - Aimin Zheng
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, China
| | - Weijun Fan
- Department of Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Fan Li
- Department of Health Statistics, School of Preventive Medicine, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Hua Fan
- Public Health School, Taishan Medical University, Tai'an, Shandong, China
| | - Zhigeng Zou
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, China
| | - Qingyu Li
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, China
| | - Hui Tian
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, Shandong Province, China
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Tong ZMD, Wenzhao LMD, Yuanyuan SMD, Zhengmin WMD, Dezhi ZMD. US-CT Fusion Image-Guided Microwave Ablation of Lung Cancer----A New Mode of Image Guidance in Lung Cancer Ablation. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.190025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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9
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Zhao ZR, Lau RWH, Ng CSH. Catheter-based alternative treatment for early-stage lung cancer with a high-risk for morbidity. J Thorac Dis 2018; 10:S1864-S1870. [PMID: 30026973 DOI: 10.21037/jtd.2018.03.151] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The mainstream treatment modality for early stage non-small cell lung cancer (NSCLC) is surgery; however, many patients are deemed inoperable and warrant alternative therapeutic options. Several minimally invasive catheter-based therapies are emerging as viable alternatives. In this review, we evaluate the outcomes from radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CRA) and photodynamic therapy (PDT) for early-stage lung cancer. Novel technical developments have allowed for endobronchial thermal ablation to be conducted in a hybrid theatre setting, which may optimize treatment outcomes and minimise treatment-related complications.
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Affiliation(s)
- Ze-Rui Zhao
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Rainbow W H Lau
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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10
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Huang BY, Li XM, Song XY, Zhou JJ, Shao Z, Yu ZQ, Lin Y, Guo XY, Liu DJ, Li L. Long-term results of CT-guided percutaneous radiofrequency ablation of inoperable patients with stage Ia non-small cell lung cancer: A retrospective cohort study. Int J Surg 2018; 53:143-150. [DOI: 10.1016/j.ijsu.2018.03.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 03/03/2018] [Accepted: 03/09/2018] [Indexed: 12/29/2022]
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11
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Irreversible electroporation and thermal ablation of tumors in the liver, lung, kidney and bone: What are the differences? Diagn Interv Imaging 2017; 98:609-617. [DOI: 10.1016/j.diii.2017.07.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/20/2017] [Indexed: 12/18/2022]
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12
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叶 欣, 范 卫, 王 徽, 王 俊, 古 善, 冯 威, 庄 一, 刘 宝, 李 晓, 李 玉, 杨 坡, 杨 霞, 杨 武, 陈 俊, 张 嵘, 林 征, 孟 志, 胡 凯, 柳 晨, 彭 忠, 韩 玥, 靳 勇, 雷 光, 翟 博, 黄 广, 中国抗癌协会肿瘤微创治疗专业委员会肺癌微创治疗分会. [Expert Consensus for Thermal Ablation of Primary and Metastatic Lung Tumors
(2017 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:433-445. [PMID: 28738958 PMCID: PMC5972946 DOI: 10.3779/j.issn.1009-3419.2017.07.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- 欣 叶
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, 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
| | - 徽 王
- 130012 长春, 吉林省肿瘤医院介入治疗中心Interventional Treatment Center, Jilin Provincial Tumor Hospital, Changchun 130012, China
| | - 俊杰 王
- 100191 北京, 北京大学第三医院放射治疗科Department of Radiation Oncology, Peking University 3rd Hospital, Beijing 100191, China
| | - 善智 古
- 410013 长沙, 湖南省肿瘤医院放射介入科Department of Interventional Therapy, Hunan Provincial Tumor Hospital, Changsha 410013, China
| | - 威健 冯
- 100045 北京, 首都医科大学附属复兴医院肿瘤科Department of Oncology, Fuxing Hospital Affiliated to the Capital University of Medical Sciences, Beijing 100045, 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
| | - 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 Affiliated to the Capital University of Medical Sciences, Beijing 100053, 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
| | - 玉亮 李
- 250033 济南, 山东大学第二医院介入治疗中心Interventional Treatment Center, Shandong University Second Hospital, Ji'nan 250033, China
| | - 坡 杨
- 150001 哈尔滨, 哈尔滨医科大学第四人民医院介入放射科Department of Interventional Radiology, The Fourth Hospital of Harbin Medical University, Harbin 150001, China
| | - 霞 杨
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, 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, 307 Hospital, Beijing 100071, China
| | - 俊辉 陈
- 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
| | - 嵘 张
- 518036 深圳, 北京大学深圳医院微创介入科Department of Minimally Invasive Interventional Therapy, Shenzhen Hospital of Beijing University, Shenzhen 518036, 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
| | - 志强 孟
- 200032 上海, 复旦大学肿瘤医院微创治疗科Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - 凯文 胡
- 100078 北京, 北京中医药大学东方医院肿瘤科Department of Oncology, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100078, China
| | - 晨 柳
- 100083 北京, 北京肿瘤医院介入治疗科Department of Interventional Therapy, Beijing Cancer Hospital, Beijing 100083, China
| | - 忠民 彭
- 250014 济南, 山东省立医院胸外科Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - 玥 韩
- 100021 北京, 中国医学科学院肿瘤医院介入治疗科Department of Interventional Therapy, Tumor Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
| | - 勇 靳
- 215004 苏州, 苏州大学第二附属医院介入治疗科Department of Interventional Therapy, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - 光焰 雷
- 710061 西安, 陕西省肿瘤医院胸外科Department of Thoracic Surgery, Shanxi Provincial Tumor Hospital, Xi'an 710061, China
| | - 博 翟
- 200127 上海, 上海交通大学仁济医院肿瘤介入治疗科Tumor Interventional Therapy Center, Shanghai Renji Hospital, Shanghai 200127, China
| | - 广慧 黄
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
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Hou X, Zhuang X, Zhang H, Wang K, Zhang Y. Artificial pneumothorax: a safe and simple method to relieve pain during microwave ablation of subpleural lung malignancy. MINIM INVASIV THER 2017; 26:220-226. [PMID: 28281366 DOI: 10.1080/13645706.2017.1287089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Microwave ablation has been extensively used for eliminating pulmonary tumors; however, it is usually associated with severe pain under local anesthesia. Decreasing the power and shortening the ablation time can help to relieve the pain; however, this leads to incomplete ablation and an increasing recurrence rate. This research aims to employ an artificial pneumothorax to increase both the curative effect and pain relief during the ablation procedure. MATERIAL AND METHODS From July 2013 to January 2015, nine patients presenting with 10 subpleural lung tumors (age: 44-78 years) with a high possibility of severe pain underwent the artificial pneumothorax during microwave ablation. The pain assessment scores and complications induced by the artificial pneumothorax were recorded and analyzed by a CT scan follow-up. RESULTS The tumors of the nine patients were eliminated successfully using microwave ablation with artificial pneumothorax under local anesthesia. The pain caused by the ablation was relieved to a great extent with an average rate of 94.66% (range: 63.3%-100%) and all tumors were ablated completely. No severe complications occurred after the operation. CONCLUSIONS The artificial pneumothorax is a reliable therapy to improve the curative effect of microwave ablation under local anesthesia by relieving the pain of the patients.
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Affiliation(s)
- Xiaowei Hou
- a Department of Oncology , PLA 401 Hospital , Qingdao , China
| | - Xingjun Zhuang
- a Department of Oncology , PLA 401 Hospital , Qingdao , China
| | - Haiwen Zhang
- a Department of Oncology , PLA 401 Hospital , Qingdao , China
| | - Kai Wang
- a Department of Oncology , PLA 401 Hospital , Qingdao , China
| | - Yuanxin Zhang
- b Department of Anesthesiology , PLA 401 Hospital , Qingdao , China
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14
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Li Y, Ma JL, Chen X, Tang FW, Zhang XZ. 4DCT and CBCT based PTV margin in Stereotactic Body Radiotherapy(SBRT) of non-small cell lung tumor adhered to chest wall or diaphragm. Radiat Oncol 2016; 11:152. [PMID: 27846900 PMCID: PMC5111250 DOI: 10.1186/s13014-016-0724-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 10/31/2016] [Indexed: 12/21/2022] Open
Abstract
Background Large tumor motion often leads to larger treatment volumes, especially the lung tumor located in lower lobe and adhered to chest wall or diaphragm. The purpose of this work is to investigate the impacts of planning target volume (PTV) margin on Stereotactic Body Radiotherapy (SBRT) in non-small cell lung cancer (NSCLC). Methods Subjects include 20 patients with the lung tumor located in lower lobe and adhered to chest wall or diaphragm who underwent SBRT. Four-dimensional computed tomography (4DCT) were acquired at simulation to evaluate the tumor intra-fractional centroid and boundary changes, and Cone-beam Computer Tomography (CBCT) were acquired during each treatment to evaluate the tumor inter-fractional set-up displacement. The margin to compensate for tumor variations uncertainties was calculated with various margin calculated recipes published in the exiting literatures. Results The means (±standard deviation) of tumor centroid changes were 0.16 (±0.13) cm, 0.22 (±0.15) cm, and 1.37 (±0.81) cm in RL, AP, and SI directions, respectively. The means (±standard deviation) of tumor edge changes were 0.21 (±0.18) cm, 0.50 (±0.23) cm, and 0.19 (±0.44) cm in RL, AP, and SI directions, respectively. The means (±standard deviation) of tumor set-up displacement were 0.03 (±0.24) cm, 0.02 (±0.26) cm, and 0.02 (±0.43) cm in RL, AP, and SI directions, respectively. The PTV margin to compensate for lung cancer tumor variations uncertainties were 0.88, 0.98 and 2.68 cm in RL, AP and SI directions, which were maximal among all margin recipes. Conclusions 4DCT and CBCT imaging are appropriate to account for the tumor intra-fractional centroid, boundary variations and inter-fractional set-up displacement. The PTV margin to compensate for lung cancer tumor variations uncertainties can be obtained. Our results show that a conventional 1.0 cm margin in the SI plane dose not suffice to compensate the geometrical variety of the tumor located in lower lobe and adhered to chest wall and diaphragm.
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Affiliation(s)
- Yi Li
- Department of Radiation Oncology, The First Affiliated Hospital, Xi'an Jiaotong University of Medical College, Xi'an, Shaanxi, 710061, China
| | - Jing-Lu Ma
- Department of Radiation Oncology, The First Affiliated Hospital, Xi'an Jiaotong University of Medical College, Xi'an, Shaanxi, 710061, China
| | - Xin Chen
- Department of Radiation Oncology, The First Affiliated Hospital, Xi'an Jiaotong University of Medical College, Xi'an, Shaanxi, 710061, China
| | - Feng-Wen Tang
- Department of Radiation Oncology, The First Affiliated Hospital, Xi'an Jiaotong University of Medical College, Xi'an, Shaanxi, 710061, China
| | - Xiao-Zhi Zhang
- Department of Radiation Oncology, The First Affiliated Hospital, Xi'an Jiaotong University of Medical College, Xi'an, Shaanxi, 710061, China.
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15
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Moon TJ, Brace CL. Design of a dual slot antenna for small animal microwave ablation studies. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2016:348-351. [PMID: 28324928 DOI: 10.1109/embc.2016.7590711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study presents the development of a dual-slot antenna for small animal tumor ablation. By using a dual-slot design at 8 GHz, it was hypothesized that smaller and more spherical ablations can be produced. After computer-aided design optimization, antennas were fabricated and ablations performed at 5-20 W for 15-120 s with the objective of creating ablations with a diameter/length aspect ratio of at least 0.9. The new dual-slot design at 8 GHz created significantly more spherical ablations than a commercial antenna at 2.45 GHz in ex vivo liver tissue (Average Aspect Ratio 0.8081 vs. 0.4532, p <;<; 0.05). In vivo studies confirmed the highly spherical results ex vivo. Initial testing shows that the dual-slot antenna and 8 GHz generator can be used to ablate tumors in mice.
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16
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Pulmonary radiofrequency ablation (Part 1): Current state. RADIOLOGIA 2015. [DOI: 10.1016/j.rxeng.2014.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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17
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Jones GC, Kehrer JD, Kahn J, Koneru BN, Narayan R, Thomas TO, Camphausen K, Mehta MP, Kaushal A. Primary Treatment Options for High-Risk/Medically Inoperable Early Stage NSCLC Patients. Clin Lung Cancer 2015; 16:413-30. [PMID: 26027433 DOI: 10.1016/j.cllc.2015.04.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 12/25/2022]
Abstract
Lung cancer is among the most common cancers worldwide and is the leading cause of cancer death in both men and women. For patients with early stage (American Joint Committee on Cancer T1-2, N0) non-small-cell lung cancer, the current standard of care is lobectomy with systematic lymph node evaluation. Unfortunately, patients with lung cancer often have medical comorbities, which may preclude the option of surgical resection. In such cases, a number of minimally invasive to noninvasive treatment options have gained popularity in the treatment of these high-risk patients. These modalities provide significant advantages, including patient convenience, treatment in an outpatient setting, and acceptable toxicities, including reduced impact on lung function and a modest risk of postprocedure chest wall pain. We provide a comprehensive review of the literature, including reported outcomes, complications, and limitations of sublobar resection with or without intraoperative brachytherapy, radiofrequency ablation, microwave ablation, percutaneous cryoablation, photodynamic therapy, and stereotactic body radiotherapy.
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Plasencia Martínez JM. Pulmonary radiofrequency ablation (Part 1): current state. RADIOLOGIA 2015; 57:275-86. [PMID: 25766072 DOI: 10.1016/j.rx.2014.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 12/11/2014] [Accepted: 12/13/2014] [Indexed: 02/08/2023]
Abstract
The risks involved in surgical treatment and conventional radiotherapy in patients with early lung cancer or lung metastases often make these treatments difficult to justify. However, on the other hand, it is also unacceptable to allow these lesions to evolve freely because, left untreated, these neoplasms will usually lead to the death of the patient. In recent years, alternative local therapies have been developed, such as pulmonary radiofrequency ablation, which has proven to increase survival with a minimal risk of complications. There are common recommendations for these treatments, and although the specific indications for using one technique or another have yet to be established, there are clearly defined situations that will determine the outcome of the treatment. It is important to know these situations, because appropriate patient selection is essential for therapeutic success. This article aims to describe the characteristics and constraints of pulmonary radiofrequency ablation and to outline its role in thoracic oncology in light of the current evidence.
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Affiliation(s)
- J M Plasencia Martínez
- Servicio de Radiología. Hospital General Universitario Morales Meseguer, Murcia, España.
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19
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Peulen H, Belderbos J, Guckenberger M, Hope A, Grills I, van Herk M, Sonke JJ. Target delineation variability and corresponding margins of peripheral early stage NSCLC treated with stereotactic body radiotherapy. Radiother Oncol 2015; 114:361-6. [DOI: 10.1016/j.radonc.2015.02.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/12/2015] [Accepted: 02/15/2015] [Indexed: 11/29/2022]
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Wei Z, Ye X, Yang X, Zheng A, Huang G, Li W, Ni X, Wang J, Han X. Microwave ablation in combination with chemotherapy for the treatment of advanced non-small cell lung cancer. Cardiovasc Intervent Radiol 2015; 38:135-142. [PMID: 24809754 DOI: 10.1007/s00270-014-0895-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 03/21/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To verify whether microwave ablation (MWA) used as a local control treatment had an improved outcome regarding advanced non-small cell lung cancer (NSCLC) when combined with chemotherapy. METHODS Thirty-nine patients with histologically verified advanced NSCLC and at least one measurable site other than the ablative sites were enrolled. Primary tumors underwent MWA followed by platinum-based doublet chemotherapy. Modified response evaluation criteria in solid tumors (mRECIST) and RECIST were used to evaluate therapeutic response. Complications were assessed using the National Cancer Institute Common Toxicity Criteria (version 3.0). RESULTS MWA was administered to 39 tumors in 39 patients. The mean and median diameters of the primary tumor were 3.84 cm and 3.30 cm, respectively, with a range of 1.00-9.00 cm. Thirty-three (84.6 %) patients achieved a partial response. No correlation was found between MWA efficacy and clinicopathologic characteristics. For chemotherapy, 11 patients (28.2 %) achieved a partial response, 18 (46.2 %) showed stable disease, and 10 (25.6 %) had progressive disease. The overall objective response rate and disease control rate were 28.2 and 74.4 %, respectively. The median progression-free survival time was 8.7 months (95 % CI 5.5-11.9). The median overall survival time was 21.3 months (95 % CI 17.0-25.4). Complications were observed in 22 (56.4 %) patients, and grade 3 adverse events were observed in 3 (7.9 %) patients. CONCLUSIONS Patients with advanced NSCLC could benefit from MWA in combination with chemotherapy. Complications associated with MWA were common but tolerable.
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Affiliation(s)
- Zhigang Wei
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwuweiqi Road, Jinan, 250021, Shandong, China,
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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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Yang X, Ye X, Zheng A, Huang G, Ni X, Wang J, Han X, Li W, Wei Z. Percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: clinical evaluation of 47 cases. J Surg Oncol 2014; 110:758-763. [PMID: 24965604 PMCID: PMC4198430 DOI: 10.1002/jso.23701] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 05/07/2014] [Indexed: 12/13/2022]
Abstract
PURPOSE To retrospectively evaluate safety and effectiveness of CT-guided percutaneous microwave ablation (MWA) in 47 patients with medically inoperable stage I peripheral non-small cell lung cancer (NSCLC). METHODS From February 2008 to October 2012, 47 patients with stage I medically inoperable NSCLC were treated in 47 MWA sessions. The clinical outcomes were evaluated. Complications after MWA were also summarized. RESULTS At a median follow-up period of 30 months, the median time to the first recurrence was 45.5 months. The local control rates at 1, 3, 5 years after MWA were 96%, 64%, and 48%, respectively. The median cancer-specific and median overall survivals were 47.4 and 33.8 months. The overall survival rates at 1, 2, 3, and 5 years after MWA were 89%, 63%, 43%, and 16%, respectively. Tumors ≤3.5 cm were associated with better survival than were tumors >3.5 cm. The complications after MWA included pneumothorax (63.8%), hemoptysis (31.9%), pleural effusion (34%), pulmonary infection (14.9%), and bronchopleural fistula (2.1%). CONCLUSIONS MWA is safe and effective for the treatment of medically inoperable stage I peripheral NSCLC.
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Affiliation(s)
- Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250001, Shandong, P. R. China
| | - Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250001, Shandong, P. R. China
| | - Aimin Zheng
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250001, Shandong, P. R. China
| | - Guanghui Huang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250001, Shandong, P. R. China
| | - Xiang Ni
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250001, Shandong, P. R. China
| | - Jiao Wang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250001, Shandong, P. R. China
| | - Xiaoying Han
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250001, Shandong, P. R. China
| | - Wenhong Li
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250001, Shandong, P. R. China
| | - Zhigang Wei
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250001, Shandong, P. R. China
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Ridge CA, Solomon SB, Thornton RH. Thermal ablation of stage I non-small cell lung carcinoma. Semin Intervent Radiol 2014; 31:118-24. [PMID: 25053863 DOI: 10.1055/s-0034-1373786] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ablation options for the treatment of localized non-small cell lung carcinoma (NSCLC) include radiofrequency ablation, microwave ablation, and cryotherapy. Irreversible electroporation is a novel ablation method with the potential of application to lung tumors in risky locations. This review article describes the established and novel ablation techniques used in the treatment of localized NSCLC, including mechanism of action, indications, potential complications, clinical outcomes, postablation surveillance, and use in combination with other therapies.
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Affiliation(s)
- Carol A Ridge
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raymond H Thornton
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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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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Jahangeer S, Forde P, Soden D, Hinchion J. Review of current thermal ablation treatment for lung cancer and the potential of electrochemotherapy as a means for treatment of lung tumours. Cancer Treat Rev 2013; 39:862-71. [DOI: 10.1016/j.ctrv.2013.03.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/08/2013] [Accepted: 03/16/2013] [Indexed: 12/21/2022]
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Garetto I, Busso M, Sardo D, Filippini C, Solitro F, Grognardi ML, Veltri A. Radiofrequency ablation of thoracic tumours: lessons learned with ablation of 100 lesions. Radiol Med 2013; 119:33-40. [PMID: 24234185 DOI: 10.1007/s11547-013-0308-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/02/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE Our aim was to analyse the results of our first 100 radiofrequency ablation (RFA) procedures, of primary (nonsmall-cell lung cancers, NSCLC) and secondary (MTS) lung cancers to assess what lessons could be learned from our experience. MATERIALS AND METHODS We analysed 100 lesions (mean size 23 mm) in 81 patients (25 NSCLC/56 MTS). On the basis of the clinical-radiological evolution, we analysed complete ablation (CA) versus partial ablation (PA) at the first computed tomography (CT) scan and during the follow-up (mean 23 months), time to progression (TTP) and survival. Possible predictive factors for local effectiveness and survival were sought. RESULTS At the first CT scan CA was obtained in 88 %; the difference between the mean diameter of lesions achieving CA and PA was significant (20 versus 38 mm; p = 0.0001). A threshold of 30 mm (p = 0.0030) and the histological type (NSCLC 75 %/MTS 94 %; p = 0.0305) were also predictive of CA. A total of 18.4 % of the CA recurred (average TTP 19 months). Survival at 1, 2 and 3 years was 84.5, 65.4 and 51.5 %, respectively. The predictors of survival at 3 years were the coexistence of other MTS (p = 0.0422) and a diameter <20 mm (p = 0.0323), but not the local effectiveness of RFA. CONCLUSION RFA for thoracic malignancies is accurate for lesions up to 30 mm, especially if metastatic; survival is more closely related to staging factors than to the local effectiveness of RFA.
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Affiliation(s)
- Irene Garetto
- Dipartimento di Oncologia, Istituto di Radiologia, Università di Torino, Regione Gonzole 10, 10043, Orbassano, TO, Italy
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Liu H, Steinke K. High-powered percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: A preliminary study. J Med Imaging Radiat Oncol 2013; 57:466-74. [DOI: 10.1111/1754-9485.12068] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 04/04/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Howard Liu
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane; Queensland; Australia
| | - Karin Steinke
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane; Queensland; Australia
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Arya S, Hadjievangelou N, Lei S, Kudo H, Goldin RD, Darzi AW, Elson DS, Hanna GB. Radiofrequency-induced small bowel thermofusion: an ex vivo study of intestinal seal adequacy using mechanical and imaging modalities. Surg Endosc 2013; 27:3485-96. [PMID: 23572219 DOI: 10.1007/s00464-013-2935-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 03/12/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bipolar radiofrequency (RF) induced tissue fusion is believed to have the potential to seal and anastomose intestinal tissue thereby providing an alternative to current techniques which are associated with technical and functional complications. This study examines the mechanical and cellular effects of RF energy and varying compressive pressures when applied to create ex vivo intestinal seals. METHODS A total of 299 mucosa-to-mucosa fusions were formed on ex vivo porcine small bowel segments using a prototype bipolar RF device powered by a closed-loop, feedback-controlled RF generator. Compressive pressures were increased at 0.05 MPa intervals from 0.00 to 0.49 MPa and RF energy was applied for a set time period to achieve bowel tissue fusion. Seal strength was subsequently assessed using burst pressure and tensile strength testing, whilst morphological changes were determined through light microscopy. To further identify the subcellular tissue changes that occur as a result of RF energy application, the collagen matrix in the fused area of a single bowel segment sealed at an optimal pressure was examined using transmission electron microscopy (TEM). RESULTS An optimal applied compressive pressure range was observed between 0.10 and 0.25 MPa. Light microscopy demonstrated a step change between fused and unfused tissues but was ineffective in distinguishing between pressure levels once tissues were sealed. Non uniform collagen damage was observed in the sealed tissue area using TEM, with some areas showing complete collagen denaturation and others showing none, despite the seal being complete. This finding has not been described previously in RF-fused tissue and may have implications for in vivo healing. CONCLUSIONS This study shows that both bipolar RF energy and optimal compressive pressures are needed to create strong intestinal seals. This finding suggests that RF fusion technology can be effectively applied for bowel sealing and may lead to the development of novel anastomosis tools.
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Affiliation(s)
- Shobhit Arya
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, 10th Floor, QEQM Building, South Wharf Road, London W2 1NY, UK.
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29
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Ganai S, Ferguson MK. Quality of Life in the High-Risk Candidate for Lung Resection. Thorac Surg Clin 2012; 22:497-508. [DOI: 10.1016/j.thorsurg.2012.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Takeda A, Kunieda E, Ohashi T, Aoki Y, Koike N, Takeda T. Stereotactic body radiotherapy (SBRT) for oligometastatic lung tumors from colorectal cancer and other primary cancers in comparison with primary lung cancer. Radiother Oncol 2012; 101:255-9. [PMID: 21641064 DOI: 10.1016/j.radonc.2011.05.033] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 05/08/2011] [Accepted: 05/12/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyze local control of oligometastatic lung tumors (OLTs) compared with that of primary lung cancer after stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS Retrospective record review of patients with OLTs who received SBRT with 50Gy in 5 fractions. Local control rates (LCRs), toxicities, and factors of prognostic significance were assessed. RESULTS Twenty-one colorectal OLTs, 23 OLTs from other origins, and 188 primary lung cancers were included. Multivariate analysis revealed only tumor origin was prognostically significant (p<0.05). The 1-year/2-year LCRs in colorectal OLTs and OLTs from other origins were 80%/72% and 94%/94%, respectively. The LCR in colorectal OLTs was significantly worse than that in OLTs from the other origins and primary lung cancers with pathological and clinical diagnosis (p<0.05, p<0.0001 and p<0.005). Among 44 OLT patients, Grades 2 and 3 radiation pneumonitis were identified in 2 and 1 patients, respectively. No other toxicities of more than Grade 3 occurred. CONCLUSION SBRT for OLTs is tolerable. The LCR for OLTs from origins other than colorectal cancer is excellent. However, LCR for colorectal OLTs is worse than that from other origins. Therefore dose escalation should be considered to achieve good local control for colorectal OLTs.
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Toxicity after reirradiation of pulmonary tumours with stereotactic body radiotherapy. Radiother Oncol 2011; 101:260-6. [DOI: 10.1016/j.radonc.2011.09.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 09/15/2011] [Accepted: 09/19/2011] [Indexed: 01/20/2023]
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32
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Brace CL. Dual-slot antennas for microwave tissue heating: parametric design analysis and experimental validation. Med Phys 2011; 38:4232-40. [PMID: 21859025 DOI: 10.1118/1.3601019] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Design and validate an efficient dual-slot coaxial microwave ablation antenna that produces an approximately spherical heating pattern to match the shape of most abdominal and pulmonary tumor targets. METHODS A dual-slot antenna geometry was utilized for this study. Permutations of the antenna geometry using proximal and distal slot widths from 1 to 10 mm separated by 1-20 mm were analyzed using finite-element electromagnetic simulations. From this series, the most optimal antenna geometry was selected using a two-term sigmoidal objective function to minimize antenna reflection coefficient and maximize the diameter-to-length aspect ratio of heat generation. Sensitivities to variations in tissue properties and insertion depth were also evaluated in numerical models. The most optimal dual-slot geometry of the parametric analysis was then fabricated from semirigid coaxial cable. Antenna reflection coefficients at various insertion depths were recorded in ex vivo bovine livers and compared to numerical results. Ablation zones were then created by applying 50 W for 2-10 min in simulations and ex vivo livers. Mean zone diameter, length, aspect ratio, and reflection coefficients before and after heating were then compared to a conventional monopole antenna using ANOVA with post-hoc t-tests. Statistical significance was indicated for P <0.05. RESULTS Antenna performance was highly sensitive to dual-slot geometry. The best-performing designs utilized a proximal slot width of 1 mm, distal slot width of 4 mm +/- 1 mm and separation of 8 mm +/- 1 mm. These designs were characterized by an active choking mechanism that focused heating to the distal tip of the antenna. A dual-band resonance was observed in the most optimal design, with a minimum reflection coefficient of -20.9 dB at 2.45 and 1.25 GHz. Total operating bandwidth was greater than 1 GHz, but the desired heating pattern was achieved only near 2.45 GHz. As a result, antenna performance was robust to changes in insertion depth and variations in relative permittivity of the surrounding tissue medium. In both simulations and ex vivo liver, the dual-slot antenna created ablations greater in diameter than a coaxial monopole (35 mm +/- 2 mm versus 31 mm +/- 2 mm; P<0.05), while also shorter in length (49 mm +/- 2 mm versus 60 mm +/- 6 mm; P < 0.001) after 10 min. Similar results were obtained after 2 and 5 min as well. CONCLUSIONS Dual-slot antennas can produce more spherical ablation zones while retaining low reflection coefficients. These benefits are obtained without adding to the antenna diameter. Further evaluation for clinical microwave ablation appears warranted.
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Affiliation(s)
- Christopher L Brace
- Departments of Radiology and Biomedical Engineering, University of Wisconsin, Madison, Wisconsin 53792, USA.
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Radiofrequency ablation of lung tumours. Insights Imaging 2011; 2:567-576. [PMID: 22347976 PMCID: PMC3259330 DOI: 10.1007/s13244-011-0110-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 03/17/2011] [Accepted: 06/08/2011] [Indexed: 12/17/2022] Open
Abstract
Pulmonary radiofrequency ablation (RFA) has become an increasingly adopted treatment option for primary and metastatic lung tumours. It is mainly performed in patients with unresectable or medically inoperable lung neoplasms. The immediate technical success rate is over 95%, with a low periprocedural mortality rate and 8–12% major complication rate. Pneumothorax represents the most frequent complication, but requires a chest tube drain in less than 10% of cases. Sustained complete tumour response has been reported in 85–90% of target lesions. Lesion size represents the most important risk factor for local recurrence. Survival data are still scarce, but initial results are very promising. In patients with stage I non-small-cell lung cancer, 1- and 2-year survival rates are within the ranges of 78–95% and 57–84%, respectively, with corresponding cancer-specific survival rates of 92% and 73%. In selected cases, the combination of RFA and radiotherapy could improve these results. In patients with colorectal lung metastasis, initial studies have reported survival data that compare favourably with the results of metastasectomy, with up to a 45% 5-year survival rate. Further studies are needed to understand the potential role of RFA as a palliative treatment in more advanced disease and the possible combination of RFA with other treatment options.
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Zacharoulis D, Lazoura O, Rountas C, Katsimboulas M, Mantzianas G, Tzovaras G, Habib N. Experimental animal study of a novel radiofrequency endovascular occlusion device. Am J Surg 2011; 202:103-9. [PMID: 21741521 DOI: 10.1016/j.amjsurg.2010.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 08/10/2010] [Accepted: 08/17/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to present a radiofrequency (RF) endovascular occlusion device (ie, Habib VesCoag Catheter; EMcision Ltd, London, UK) and to evaluate safety and efficacy of the device for complete occlusion of normal porcine vessels. METHODS The study included 20 pigs. In each pig, a segmental branch of the right hepatic artery, a branch of the splenic artery, and a branch of one of the renal arteries were catheterized. A single or multiple applications of RF energy were performed until vessel occlusion was achieved. Fifteen days later, angiography was repeated to assess vessel patency. The vessels were then excised for pathological analysis. RESULTS Vessels 2.5 to 6 mm in diameter were treated. Complete occlusion with a single attempt was achieved using a mean amount of energy of 110.67 J in vessels 2.5 to 3 mm, 111.67 J in vessels 3.5 to 4 mm, and 116.63 J in vessels 5 to 6 mm in diameter and was confirmed by angiography at the 15-day follow-up. CONCLUSIONS Vascular occlusion can be effectively and safely achieved by endovascular application of RF energy to normal porcine arteries using the Habib VesCoag catheter.
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Jiang TY, Wang XL, Suo W, He QH, Xiao HY. Radiofrequency ablation technique eradicating palpebral margin neoplasm. Int J Ophthalmol 2011; 4:186-9. [PMID: 22553639 DOI: 10.3980/j.issn.2222-3959.2011.02.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 02/28/2011] [Indexed: 11/02/2022] Open
Abstract
AIM To report the study on radiofrequency ablation technique for eradication of palpebral margin neoplasm and its clinical effects. METHODS One hundred and six cases with the palpebral margin neoplasm were performed surgical removal with radiofrequency ablation technique. The 1-2 months postoperative follow-up was investigated and the lost cases were excluded from statistics. The continuing follow-up lasted about 6-16months. RESULTS One hundred cases underwent one treatment and 6 cases underwent two treatments. Six cases were missed. All the cases followed up healed well without pigmentation or scar left, nor eyelash loss or palpebral margin deformation. No case was recurrent. CONCLUSION Radiofrequency ablation has significant efficiency in eradicating the palpebral margin neoplasm.
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Affiliation(s)
- Tian-Yu Jiang
- Department of Physical Therapy, Chinese PLA General Hospital, Beijing, 100853, China
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36
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Zhang Y, Li X. [Clinical application and advances in radiofrequency ablation of lung neoplasms]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2010; 13:1064-9. [PMID: 21081050 PMCID: PMC6000495 DOI: 10.3779/j.issn.1009-3419.2010.11.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
肺癌是全世界因肿瘤死亡的首位原因。近年来，射频消融作为一种微创治疗方法在原发性和继发性肺部肿瘤治疗中得到越来越多的应用，并取得了较大进展。射频消融术后的疗效评价并不简单，推荐使用CT、MRI和PET综合评价。本文对其原理、基础研究、临床应用、疗效、进展等方面进行综述。
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Affiliation(s)
- Yong Zhang
- Department of Interventional Radiology, Zhongshan City Peoples' Hospital, Zhongshan 528403, China
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Alternatives to Surgery for Early Stage Non-Small Cell Lung Cancer-Ready for Prime Time? Curr Treat Options Oncol 2010; 11:24-35. [DOI: 10.1007/s11864-010-0119-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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