Bronchoscopically delivered microwave ablation in an<i>in vivo</i>porcine lung model

Šebek, Jan; Kramer, Steve; Rocha, Rob; Yu, Kun‐Chang; Bortel, Radoslav; Beard, Warren L.; Biller, David S.; Hodgson, David A.; Ganta, Charan; Wibowo, Henky; Yee, John; Myers, Renelle; Lam, Stephen; Prakash, Punit

doi:10.1183/23120541.00146-2020

Cited by 20 publications

(21 citation statements)

References 41 publications

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“…Most of the thermal ablative techniques in literature applied the electrode in a percutaneous manner. Lately, transbronchial ablation techniques using different energy source have been researched in animal lung models (24)(25)(26). In humans, bronchoscopy-guided transbronchial ablation have been attempted by a Japanese and a Chinese group, utilizing RFA energy with reported safety (27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

Transbronchial microwave ablation of lung nodules with electromagnetic navigation bronchoscopy guidance—a novel technique and initial experience with 30 cases

Chan¹,

Lau²,

Ngai³

et al. 2021

Transl Lung Cancer Res

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Background: Microwave ablation of lung nodules may provide a faster, larger and more predictable ablation zone than other energy sources, while bronchoscopic transbronchial ablation has theoretical advantage of fewer pleural-based complications than percutaneous approach. Our study aims to determine whether the novel combination of bronchoscopic approach and microwave ablation in management of lung nodules is technically feasible, safe and effective.Methods: This is a retrospective analysis of a single center experience in electromagnetic navigation bronchoscopy microwave ablation in hybrid operating room. Patients had high surgical risks while lung nodules were either proven malignant or radiologically suspicious. Primary endpoints include technical feasibility and safety.Results: Total of 30 lung nodules from 25 patients were treated. Mean nodule size was 15.1 mm, and bronchus directly leads to the nodules (bronchus sign positive) in only half of them. Technical success rate was 100%, although some nodules required double ablation for adequate coverage. Mean minimal ablation margin was 5.51 mm. The mean actual ablation zone volume was −21.4% compared to predicted, likely due to significant tissue contraction ranging from 0-43%. There was no significant heat sink effect.Mean hospital stay was 1.73 days, and only 1 patient stayed for more than 3 days. Complications included pain (13.3%), pneumothorax requiring drainage (6.67%), post-ablation reaction (6.67%), pleural effusion (3.33%) and hemoptysis (3.33%). After median follow up of 12 months, none of the nodules had evidence of progression.Conclusions: Bronchoscopic transbronchial microwave ablation is safe and feasible for treatment of malignant lung nodules. Prospective study on clinical application of this novel technique is warranted.

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Section: Discussionmentioning

confidence: 99%

Transbronchial microwave ablation of lung nodules with electromagnetic navigation bronchoscopy guidance—a novel technique and initial experience with 30 cases

Chan¹,

Lau²,

Ngai³

et al. 2021

Transl Lung Cancer Res

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“…In the present study, we limit applied power to the range 10 W < P < 70 W with 10 W sampling step, as assessed at the catheter tip, and ablation duration to the range 2 < t < 10 min with 1 min sampling step consistent with the anticipated use settings for bronchoscopic microwave ablation. 7 Furthermore, collateral damage values are computed with respect to the maximum evaluated minimum margin, which is 5 mm. The total number of simulations for each [P, t] combination was N = 20 to provide reasonable compromise between sufficient sampling of minimum margin statistical distribution and overall computation time.…”

Section: A Treatment Planning Methodologymentioning

confidence: 99%

“…The MWA applicator modeled in this study is similar to the flexible applicator described in. 7 Briefly, the applicator consists of a 2.45-GHz antenna with a balun, integrated within a custom catheter-extrusion through which chilled water is circulated. The outer diameter of the catheter is 2 mm, and it is suitable for deployment via the instrument channel of a flexible bronchoscope.…”

Section: B Microwave Ablation Applicatormentioning

confidence: 99%

“…[1][2][3] The most common serious complication associated 4,5 with transthoracic insertion of thermal ablation applicators is pneumothorax. Systems enabling delivery of flexible MWA applicators to lung tumor targets via a bronchoscopic approach are under development, [6][7][8] and offer the potential for reduced risk of pneumothorax.…”

Section: Introductionmentioning

confidence: 99%

“…We further applied this method to investigate the range of lung tumors of various sizes that could be ablated with an adequate treatment margin using a flexible microwave lung ablation catheter under development for bronchoscopic ablation of lung tumors. 7…”

Section: Introductionmentioning

confidence: 99%

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Microwave ablation of lung tumors: A probabilistic approach for simulation‐based treatment planning

Šebek

Taeprasartsit

Wibowo³

et al. 2021

Medical Physics

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Purpose: Microwave ablation (MWA) is a clinically established modality for treatment of lung tumors. A challenge with existing application of MWA, however, is local tumor progression, potentially due to failure to establish an adequate treatment margin. This study presents a robust simulation-based treatment planning methodology to assist operators in comparatively assessing thermal profiles and likelihood of achieving a specified minimum margin as a function of candidate applied energy parameters. Methods: We employed a biophysical simulation-based probabilistic treatment planning methodology to evaluate the likelihood of achieving a specified minimum margin for candidate treatment parameters (i.e., applied power and ablation duration for a given applicator position within a tumor). A set of simulations with varying tissue properties was evaluated for each considered combination of power and ablation duration, and for four different scenarios of contrast in tissue biophysical properties between tumor and normal lung. A treatment planning graph was then assembled, where distributions of achieved minimum ablation zone margins and collateral damage volumes can be assessed for candidate applied power and treatment duration combinations. For each chosen power and time combination, the operator can also visualize the histogram of ablation zone boundaries overlaid on the tumor and target volumes. We assembled treatment planning graphs for generic 1, 2, and 2.5 cm diameter spherically shaped tumors and also illustrated the impact of tissue heterogeneity on delivered treatment plans and resulting ablation histograms. Finally, we illustrated the treatment planning methodology on two example patient-specific cases of tumors with irregular shapes. Results: The assembled treatment planning graphs indicate that 30 W, 6 min ablations achieve a 5mm minimum margin across all simulated cases for 1-cm diameter spherical tumors, and 70 W, 10 min ablations achieve a 3-mm minimum margin across 90% of simulations for a 2.5-cm diameter spherical tumor. Different scenarios of tissue heterogeneity between tumor and lung tissue revealed 2 min overall difference in ablation duration, in order to reliably achieve a 4-mm minimum margin or larger each time for 2-cm diameter spherical tumor. Conclusions: An approach for simulation-based treatment planning for microwave ablation of lung tumors is illustrated to account for the impact of specific geometry of the treatment site, tissue property uncertainty, and heterogeneity between the tumor and normal lung.

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Development of A 3D Lung Tumor Model For Cell Death Assessment in Microwave Ablation

Gallagher,

Mitra,

Ward

et al. 2024

Adv Funct Materials

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Primary lung cancer is the leading cause of cancer‐related death worldwide. Recent statistics estimate 1.8 million new cases and 1.6 million deaths per year. Despite significant advances in surgery, chemotherapy, and radiotherapy, the 5‐year survival rate remains at just 18%. Thermal ablation is an established treatment that is safe and effective. It refers to the local application of controlled heat to induce irreversible cell injury and ultimately tumor apoptosis and necrosis. This approach is particularly suitable for the treatment of small tumors in patients who are not suitable for surgery. However, the lack of suitable benchtop models to assess ablation devices complicates prognostic prediction and the development of effective treatment strategies. In this context, the development of a 3D lung tumor model is presented using a cancer cell‐laden hydrogel composed of 2% hyaluronic acid–tyramine (HA‐TA) and 0.5% agarose, resulting in a tumor mimetic of clinically relevant size. This innovative model provides a valuable platform for testing ablation devices and provides insights that can significantly improve prognostic ability and refine treatment approaches for lung cancer patients.

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Bronchoscopically delivered microwave ablation in anin vivoporcine lung model

Cited by 20 publications

References 41 publications

Transbronchial microwave ablation of lung nodules with electromagnetic navigation bronchoscopy guidance—a novel technique and initial experience with 30 cases

Transbronchial microwave ablation of lung nodules with electromagnetic navigation bronchoscopy guidance—a novel technique and initial experience with 30 cases

Microwave ablation of lung tumors: A probabilistic approach for simulation‐based treatment planning

Development of A 3D Lung Tumor Model For Cell Death Assessment in Microwave Ablation

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