Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation of Non–Small Cell Lung Cancer and Metastatic Disease to the Lungs

Abstract

Purpose: To provide guidance on quality improvement thresholds for outcomes and complications of image-guided thermal ablation for the treatment of early stage non-small cell lung cancer, recurrent lung cancer, and metastatic disease.Materials and Methods: A multidisciplinary writing group conducted a comprehensive literature search to identify studies on the topic of interest. Data were extracted from relevant studies and thresholds were derived from a calculation of 2 standard deviations from the weighted mean of each outcome. A modified Delphi technique was used to achieve consensus agreement on the thresholds. Results: Data from 29 studies, including systematic reviews and meta-analyses, retrospective cohort studies, and single-arm trials were extracted for calculation of the thresholds. The expert writing group agreed on thresholds for local control, overall survival and adverse events associated with image-guided thermal ablation. Conclusion: SIR recommends utilizing the indicator thresholds to review and assess the efficacy of ongoing quality improvement programs. When performance falls above or below specific thresholds, consideration of a review of policies and procedures to assess for potential causes, and to implement changes in practices, may be warranted.

Drug-Eluting Bead Bronchial Arterial Chemoembolization With and Without Microwave Ablation for the Treatment of Advanced and Standard Treatment-Refractory/Ineligible Non-Small Cell Lung Cancer: A Comparative Study

“…The MWA indications and procedures followed the Society of Interventional Radiology (SIR) guidelines ( 21 ). As described previously ( 22 ), an MTC-3C MWA system (Vison Medical Inc., China) or an ECO-100A1 MWA system (ECO, China) was used, with a microwave emission frequency of 2,450 ± 50 MHz and an adjustable continuous wave output power of 20–80 W. The MWA antenna (Vison or ECO) was 15–18 cm in effective length and 15–17 G in outside diameter according to the tumor location and distance to the pleura, with a 15-mm active tip.…”

“…MWA- or DEB-BACE-related complications were evaluated according to criteria from the SIR ( 21 , 23 ). Enhanced CT was routinely performed every 3 months.…”

Computed tomography-guided microwave ablation for non-small cell lung cancer patients on antithrombotic therapy: a retrospective cohort study

“…There were no specific definitions of hemorrhagic and thromboembolic complications based on SIR criteria (22). Hemorrhagic complications in this study were defined as hemoptysis and hemothorax, as per expert consensus in China (23).…”

“…In addition, thromboembolic complications were defined as ischemic heart disease, cerebral infarction, or pulmonary embolism after MWA (19). The severity of complications was classified as per the SIR criteria (22). Tumor adjacency to vessels ≥2 mm was defined as the tumors having direct contact with vessels ≥2 mm or the distance between tumors and vessels being ≤5 mm and was evaluated using transverse images or/and multiplanar reformation on CT images.…”

State-of-the-art combination treatment strategies for advanced stage non–small cell lung cancer

“…Lung cancer classification, 2021, by World Health Organization (WHO) is based on histopathological and molecular subtypes into the following categories: precursor glandular and squamous precursor lesions, squamous cell, adeno-, adeno-squamous, large-cell, and sarcomatoid carcinomas; lung neuroendocrine neoplasm, tumors, and carcinomas; and salivary gland–type tumors ( 7 ) ( Figure 1 ). For advanced NSCLC ( 9 ), owing to metastasis of the disease, NSCLC is rather aggressive and metastasizes early, involving the liver and brain, and is characterized by rapid tumor growth ( 10 ).…”