Lung Ablation

Abstract

Lung cancer had an estimated incidence of 221,200 in 2015, making up 13% of all cancer diagnoses. Tumor ablation is an important treatment option for nonsurgical lung cancer and pulmonary metastatic patients. Radiofrequency ablation has been used for over a decade with newer modalities, microwave ablation, cryoablation, and irreversible electroporation presenting as additional and possibly improved treatment options for patients. This minimally invasive therapy is best for small primary lesions or favorably located metastatic tumors. These technologies can offer palliation and sometimes cure of thoracic malignancies. This article discusses the current available technologies and techniques available for tumor ablation.

Early lung cancer detection by low-dose CT screening: therapeutic implications

“…These techniques are relatively new in the area of lung cancer treatment, and were initially introduced for the percutaneous treatment of hepatic malignancies. The goals of tumor ablation are (1) ablation of the entire tumor and a margin of normal parenchyma surrounding it, (2) to quickly create this large ablation area, and (3) to avoid injury to critical structures [86]. Up to now, there are no randomized controlled trials comparing the different ablation techniques with each other, with SBRT, or with surgical resection.…”

“…Important contraindications for treatment with RFA are tumors surrounded by larger vessels and airways and centrally located tumors. Due to the so-called heat-sink effect, the phenomenon by which medium to large-sized blood vessels and airways dissipate the thermal and electrical energy away from adjacent tissue and target lesions [86], tumors near these structures may show less response than expected. Furthermore, RFA is discouraged for central nodules and nodules located in the lung apex or within 1 cm of major vessels, bronchus, nerves, and esophagus, because of the risk of thermal injuries.…”

“…MWA uses electromagnetical waves in the microwave energy spectrum that produce tissue-heating effects. By inducing kinetic energy within water molecules surrounding the probe, these molecules start rotating rapidly, and they transfer some of their kinetic energy to surrounding tissue leading to tissue heating [86]. It is a novel technique in the treatment of early stage lung cancer, with complications comparable with RFA although MWA is associated with less procedural pain.…”

“…When a pressurized gas, usually argon, reaches the end of the probe, located in the tumor under CT-guidance, the gas expands and reaches ultralow temperatures of as cold as −140°C. An ice-ball is formed in the tissue surrounding the probe, and cryogenic destruction occurs directly as a result of protein denaturation and cell rupture from ice crystals and osmotic shifts between intracellular and extracellular water, and indirectly as result of hypoxic tissue injury due to vasoconstriction, freezing of blood in small vessels or occluded blood vessels [86,94]. PCT is performed using an ablation scheme consisting of both freeze periods and thaw periods, to reduce the chance of air leaks and bleeding.…”

Navigated Percutaneous Lung Ablation under High-Frequency Jet Ventilation of a Metastasis from a Wilms’ Tumour: A Paediatric Case Report

“…Thermal ablation of lung tumours is more frequently used as a primary mode of treatment in adults, its efficacy having been proven in several studies [ 1 , 2 ]. The benefit of this technique is that it is less invasive and spares healthy lung tissue, reducing the overall complication rate and costs and allowing for repeated treatments.…”