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Current Readings: Percutaneous Ablation for Pulmonary Metastatic Disease

https://doi.org/10.1053/j.semtcvs.2014.09.003Get rights and content

Percutaneous image-guided ablation is a technique for maintaining local control of metastatic lung lesions that may, in selected patients, confer a survival benefit over no treatment or systemic therapy alone. Although the currently accepted treatment for oligometastatic pulmonary disease is surgical resection, the existing body of literature, including the recent investigations reviewed within this article, supports a role for percutaneous ablation as an important and relatively safe therapeutic option for nonsurgical and in carefully selected surgical patients, conferring survival benefits competitive with surgical metastasectomy. Continued clinical investigations are needed to further understand the nuances of thermal technologies and applications to treat lung primary and secondary pulmonary malignancy, directly compare available therapeutic options and further define the role of percutaneous image-guided ablation in the treatment of pulmonary metastatic disease.

Section snippets

Introduction and General Principles

The traditional treatment for metastatic cancer has been systemic medical therapy. However, for certain patients with metastases confined to one or few sites, termed oligometastatic disease, local means of controlling these sites of disease may prolong survival and palliate symptoms, and in some cases may result in long-term disease-free survival.1 The treatment of oligometastatic disease to the lung demands a case-by-case, multidisciplinary approach. In properly selected patients without

Complications After 1000 Lung Radiofrequency Ablation Sessions in 420 Patients: A Single Center’s Experiences

Kashima M, Yamakado K, Takaki H, et al. Am J Roentgenol 197:W576, 2011

Percutaneous ablation is minimally invasive and is generally safe and well tolerated, with low rates of morbidity and very low procedure-related mortality. By far the most frequent complication is pneumothorax, occurring in approximately 30%-50% of patients. Most postablation pneumothoraces are asymptomatic or mildly symptomatic and can be managed with observation. However, chest tube placement may be required in

Treatment of Pulmonary Colorectal Metastases by Radiofrequency Ablation

Petre EN, Jia X, Thornton RH, et al. Clin Colorectal Cancer 12:37-44, 2013

Metastatic colorectal cancer is among the most frequent and best studied indications for percutaneous ablation.18, 19 Of the approximately 20% of colorectal cancer patients who have metastatic disease at presentation, as many as 17% have lung metastases.20 Recurrent disease after primary resection occurs in the lung approximately 5% of the time, second only to the liver as the most common site.20, 21 Expected survival in

Outcome After Radiofrequency Ablation of Sarcoma Lung Metastases

Koelblinger C, Strauss S, Gillams A. Cardiovasc Intervent Radiol 37(1):147-153, 2014

Metastatic sarcoma carries a poor prognosis. The expected survival with best systemic medical therapy is only 8-12 months.31 The lung is the most common organ involved by metastatic sarcoma, and survival can be improved with surgical resection. However, not all patients are suitable surgical candidates, and there is a limit to how much lung tissue can be resected because of a decrease in pulmonary reserve

Local Progression After Radiofrequency Ablation for Pulmonary Metastases

Von Meyenfeldt EM, Prevoo W, Peyrot D, et al. Cancer 117:3781-3787, 2011

Fewer data exist specific to other primary tumor types, but outcomes have been described in smaller series of patients with metastatic renal cell carcinoma,35, 36 hepatocellular carcinoma,37 melanoma,38, 39, 40 and esophageal squamous cell carcinoma.41 Von Meyenfeldt et al10 analyzed data from 90 consecutive RFAs performed in 46 patients. In total, 14 patients had metastatic colorectal cancer, 12 had metastatic sarcoma, 4

Factors Affecting Local Progression After Percutaneous Cryoablation of Lung Tumors

Yashiro H, Nakatsuka S, Inoue M, et al. J Vasc Interv Radiol 24:813, 2013

There has recently been interest in the identification of risk factors for local recurrence following percutaneous ablation. The size of the target lesion has been well described as such a risk factor, with lesions larger than 3 cm demonstrating poorer outcomes.42 However, if additional robust risk factors can be established, it may allow better selection of ideal lesions for treatment with ablation, and inform

Factors Influencing Local Tumor Control in Patients With Neoplastic Pulmonary Nodules Treated With Microwave Ablation: A Risk Factor Analysis

Vogl TJ, Worst TS, Naguib NN, et al. Am J Roentgenol 200:665, 2013

Vogl et al12 recently reported results of 91 tumor microwave ablations in 57 patients. Of the 91 ablated lesions, 76 were metastases from extrathoracic primary tumors, all of them smaller than 3 cm. Local progression occurred in 30 tumors (33%) after a mean time of 8.3 months. Candidate risk factors included in their analysis were shape of the index tumor (round or oval vs irregular), margin (clear vs ill-defined), pleural

Commentary

Percutaneous ablation of thoracic malignancies is a relatively recently developed procedure, with the first human cases reported in 2000,43 and data concerning its safety and efficacy in treating pulmonary metastatic disease are still forthcoming. In multiple studies, including the large series by Kashima et al7 reviewed earlier, the safety profile of percutaneous ablation has been well characterized. It is a safe procedure overall, with very low expected mortality. Pneumothorax is a relatively

Conclusion

Percutaneous image-guided ablation is a technique for maintaining local control of metastatic lung lesions that may, in selected patients, confer a survival benefit over no treatment or systemic therapy alone. Although the currently accepted treatment for oligometastatic pulmonary disease is surgical resection, the existing body of literature, including the recent investigations reviewed earlier, supports a role for percutaneous ablation as an important therapeutic option for nonsurgical and

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