Decision Making in Interventional Oncology: Ablative Options in the Lung

Abstract

Image-guided ablation is safe and effective for the treatment of both primary and metastatic tumors in the lung. This article reviews the three most commonly used ablative options: radiofrequency ablation, microwave ablation, and cryoablation. We describe the advantages of each ablation modality in the lung and how to choose the most appropriate ablation device based on patient and tumor characteristics. The optimal technique for lung ablation is discussed and technical tips for improving clinical outcome are described.

Cryoablation of Lung Metastases: Review of Recent Literature and Ablation Technique

“…Therefore, as with MWA, a tangential approach to peripheral lesions with a long path through normal lung is recommended. 12 Cryoablation generates a considerable amount of alveolar hemorrhage during thaw cycles. This lung opacification is generally greater with cryoablation than with heat-based modalities and can result in intraprocedural bronchial obstruction and postprocedural hemoptysis and hypoxia.…”

“…8,9 IGTA has several advantages over surgery and SBRT in the treatment of lung metastases, including repeatability and sparing of normal lung parenchyma. [10][11][12] Multiple studies have shown that patients undergoing local therapy for oligometastatic disease are likely to develop new foci of lung involvement after therapy, [5][6][7] so the ability to perform repeat treatments is essential. SBRT is limited in the number of lesions that can be treated due to accumulated toxicity to normal lung as well as cumulative skin and chest wall dose, while IGTA is repeatable with little impact on pulmonary function.…”

“…13,14 IGTA is not limited by the segmental anatomy of the lung and can be used to treat central lesions that would require lobectomy, and an accompanying unacceptable loss of lung parenchyma, to surgically excise. 12,15 To date, no controlled study has analyzed oncologic efficacy and outcomes among commonly used IGTA modalities (i.e., thermal vs. nonthermal, heat based vs. non-heat based). While cryoablation is more time consuming to perform and results in more radiation exposure than heat-based techniques (RFA or microwave ablation [MWA]) due to sequential computed tomography (CT) imaging during ice ball monitoring, advantages of cryoablation include the ability to visualize the ablation zone in near real time and reduced postprocedure pain relative to heat-based modalities.…”

“…While cryoablation is more time consuming to perform and results in more radiation exposure than heat-based techniques (RFA or microwave ablation [MWA]) due to sequential computed tomography (CT) imaging during ice ball monitoring, advantages of cryoablation include the ability to visualize the ablation zone in near real time and reduced postprocedure pain relative to heat-based modalities. [16][17][18] The most important advantage of cryoablation may be its flexibility, as cryoablation is considered safer than RFA or MWA for both central and subpleural lesions 12,19 (►Fig. 1).…”

Immunological Aspects of Cryoablation of Non–Small Cell Lung Cancer: A Comprehensive Review

“…Immunological Aspects of NSCLC Cryoablation treatment option for unresectable primary and secondary peripheral lung tumors. [28][29][30][31][32][33] In percutaneous cryoablation, rigid cryotherapy probes are inserted with transthoracic computed tomography guidance and the target tumor becomes completely engulfed in an ice ball. 28,29 In patients with early-stage lung cancer who are not candidates for surgery because of comorbidities or poor lung function, percutaneous cryoablation of a primary tumor is potentially curative.…”