Percutaneous Ablation of Intrathoracic Malignancy
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INTERVENTIONAL PULMONOLOGY (G CHENG, SECTION EDITOR)
Percutaneous Ablation of Intrathoracic Malignancy Sanket Thakore 1
&
Juan Carlos Perez Lozada 2
Accepted: 12 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Lung cancer remains the number one cancer killer in both women and men. The primary treatment of choice for local, early-stage disease is surgical resection; however, up to 25% of patients are medically inoperable or refuse surgery. Most patients who are inoperable or refuse surgery are referred for stereotactic body radiotherapy (SBRT) or percutaneous ablative therapies. Recent Findings Percutaneous techniques include radiofrequency ablation, microwave ablation, cryoablation, or irreversible electroporation. These modalities can be used with an intent to cure, as well as palliative intent in various clinical scenarios of lung cancer and other thoracic malignancies. Studies have exhibited comparable overall survival with ablative techniques in comparison to SBRT and sublobar resection with different side effect profile. Summary The goal of this article is to review indications, techniques, post-ablation complications and image appearance, and clinical outcomes for image-guided percutaneous ablation. Keywords Lung cancer . Radiofrequency ablation . Cryoablation . Microwave ablation . Percutaneous thermal ablation
Introduction In 2020, an estimated 228,820 new cases of lung cancer will be diagnosed in the USA, and 135,720 people will die from the disease. Although the incidence and mortality rate has been declining for over a decade, it still remains the biggest cancer killer in both women and men [1]. Lung cancer includes two main types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). For early-stage NSCLC, surgical therapy, namely, lobectomy, is recommended as primary treatment. The comprehensive treatment algorithms for lung cancer and metastatic disease are beyond the scope of this article but are referenced for the reader [1–10].
This article is part of the Topical Collection on Interventional Pulmonology * Sanket Thakore [email protected] 1
2
Up to 25% of patients with stage 1 NSCLC are not lobectomy candidates because of severe medical comorbidities [11]. For these patients, the second line of therapy typically offered is stereotactic body radiotherapy (SBRT). The National Comprehensive Cancer Network® (NCCN®) guidelines (version 5.2020) for NSCLC recommend image-guided percutaneous thermal ablation as an option to SBRT in selected patients [10•]. Candidates include medically inoperable patients with early-stage lung cancer, those with multiple lung cancers, those with locoregional recurrence, and those with an isolated growing lesion on systemic therapy [10•]. Nonrandomized clinical data indicate comparable results in local tumor control compared to SBRT but with a different side effect profile. The objective of this article is to review current evidence of various percutaneous image-guided thermal ablative
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