Microwave Ablation in the Treatment of Primary Lung Tumors

 

 Buy Article Permissions and Reprints

ABSTRACT

Recent years have witnessed the refinement and significant growth of several new, minimally invasive approaches for the nonsurgical treatment of primary lung malignancies. For select patients, these technologies offer an attractive treatment option given their availability in the outpatient setting and low associated morbidity and mortality. Microwave ablation represents the most recent addition to the growing armamentarium of available ablative technologies. Administered in a manner similar to radiofrequency ablation, the lung tumor is localized under imaging guidance, and a microwave antenna is placed directly into the tumor bed. In contrast to existing thermoablative technologies, however, microwave treatment offers several key theoretical advantages. These include consistently higher intratumoral temperatures, larger ablation volumes, reduced treatment times, and improved convection profile. As a nascent technology, efficacy and outcomes data for microwave ablation of pulmonary malignancies remain relatively lacking compared with other thermoablative techniques; however, early trials have demonstrated promising results. It is hoped that further refinements in the clinical application of this technology will continue to improve the care of patients with lung cancer.

REFERENCES

• 1 American Cancer Society .Cancer Facts and Figures 2006. Atlanta; American Cancer Society 2006: 13-15
  Google Scholar
• 2 Jemal A, Siegel R, Ward E et al.. Cancer statistics 2007.  CA Cancer J Clin. 2007;  57 43-66
  CrossrefPubMedGoogle Scholar
• 3 Gauden S, Ramsay J, Tripcony L. The curative treatment by radiotherapy alone of stage I non-small cell carcinoma of the lung.  Chest. 1995;  108 1278-1282
  PubMedGoogle Scholar
• 4 Ginsberg R J, Hill L D, Eagen R T et al.. Modern thirty-day operative mortality for surgical resections in lung cancer.  J Thorac Cardiovasc Surg. 1983;  86 654-658
  CrossrefPubMedGoogle Scholar
• 5 Ghosh S, Sujendran V, Alexiou C, Beggs L, Beggs D. Long-term results of surgery versus continuous hyperfractionated accelerated radiotherapy (chart) in patients aged > 70 years with stage 1 non-small cell lung cancer.  Eur J Cardiothorac Surg. 2003;  24 1002-1007
  CrossrefPubMedGoogle Scholar
• 6 National Cancer Institute .Non-small cell lung cancer: treatment. National Cancer Institute Guidelines for Health Professionals. Retrieved on October 8, 2007, from http://www.cancer.gov/cancertopics/pdq/treatment/non-small-cell-lung/healthprofessional
  Google Scholar
• 7 Morita K, Fuwa N, Suzuki Y et al.. Radical radiotherapy for medically inoperable non-small cell lung cancer in clinical stage I: a retrospective analysis of 149 patients.  Radiother Oncol. 1997;  42 31-36
  CrossrefPubMedGoogle Scholar
• 8 Martini N, Bains M S, Burt M E et al.. Incidence of local recurrence and second primary tumors in resected stage I lung cancer.  J Thorac Cardiovasc Surg. 1995;  109 120-129
  CrossrefPubMedGoogle Scholar
• 9 Lagerwaard F J, Haasbeek C J, Smit E F, Slotman B J, Senan S. Outcomes of risk-adapted fractionated stereotactic radiotherapy for stage I non-small-cell lung cancer.  Int J Radiat Oncol Biol Physiol. 2007; 
  PubMedGoogle Scholar
• 10 Giovanella B C, Lohman W A, Heidelberger C. Effects of elevated temperatures and drugs on the viability of l1210 leukemia cells.  Cancer Res. 1970;  30 1623-1631
  PubMedGoogle Scholar
• 11 Dupuy D E, Mayo-Smith W W, Abbott G F, DiPetrillo T. Clinical applications of radio-frequency tumor ablation in the thorax.  Radiographics. 2002;  22(Spec No) S259-269
  CrossrefPubMedGoogle Scholar
• 12 Dupuy D E, Goldberg S N. Image-guided radiofrequency tumor ablation: challenges and opportunities—part II.  J Vasc Interv Radiol. 2001;  12 1135-1148
  CrossrefPubMedGoogle Scholar
• 13 Goldberg S N, Dupuy D E. Image-guided radiofrequency tumor ablation: challenges and opportunities—part I.  J Vasc Interv Radiol. 2001;  12 1021-1032
  PubMedGoogle Scholar
• 14 Simon C J, Dupuy D E, Mayo-Smith W W. Microwave ablation: principles and applications.  Radiographics. 2005;  25(Suppl 1) S69-S83
  CrossrefPubMedGoogle Scholar
• 15 Haemmerich D, Laeseke P F. Thermal tumour ablation: devices, clinical applications and future directions.  Int J Hyperthermia. 2005;  21 755-760
  CrossrefPubMedGoogle Scholar
• 16 Skinner M G, Iizuka M N, Kolios M C, Sherar M D. A theoretical comparison of energy sources—microwave, ultrasound and laser—for interstitial thermal therapy.  Phys Med Biol. 1998;  43 3535-3547
  CrossrefPubMedGoogle Scholar
• 17 Wright A S, Lee Jr F T, Mahvi D M. Hepatic microwave ablation with multiple antennae results in synergistically larger zones of coagulation necrosis.  Ann Surg Oncol. 2003;  10 275-283
  CrossrefPubMedGoogle Scholar
• 18 Goldberg S N, Grassi C J, Cardella J F et al.. Image-guided tumor ablation: standardization of terminology and reporting criteria.  Radiology. 2005;  235 728-739
  CrossrefPubMedGoogle Scholar
• 19 Shibata T, Iimuro Y, Yamamoto Y et al.. Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy.  Radiology. 2002;  223 331-337
  CrossrefPubMedGoogle Scholar
• 20 Goldberg S N, Gazelle G S, Halpern E F et al.. Radiofrequency tissue ablation: importance of local temperature along the electrode tip exposure in determining lesion shape and size.  Acad Radiol. 1996;  3 212-218
  CrossrefPubMedGoogle Scholar
• 21 Goldberg S N, Gazelle G S, Compton C C, Mueller P R, Tanabe K K. Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic–pathologic correlation.  Cancer. 2000;  88 2452-2463
  CrossrefPubMedGoogle Scholar
• 22 Goldberg S N, Gazelle G S, Compton C C, McLoud T C. Radiofrequency tissue ablation in the rabbit lung: efficacy and complications.  Acad Radiol. 1995;  2 776-784
  PubMedGoogle Scholar
• 23 Wolf F J, Grand D J, Machan J T, Dipetrillo T A, Mayo-Smith W W, Dupuy D E. Microwave ablation of lung malignancies: effectiveness, CT findings, and safety in 50 patients.  Radiology. 2008;  247 871-879
  CrossrefPubMedGoogle Scholar
• 24 Grieco C A, Simon C J, Mayo-Smith W W et al.. Image-guided percutaneous thermal ablation for the palliative treatment of chest wall masses.  Am J Clin Oncol. 2007;  30 361-367
  CrossrefPubMedGoogle Scholar
• 25 Gillams A R, Lees W R. Analysis of the factors associated with radiofrequency ablation-induced pneumothorax.  Clin Radiol. 2007;  62 639-644
  CrossrefPubMedGoogle Scholar
• 26 El-Sherif A, Luketich J D, Landreneau R J, Fernando H C. New therapeutic approaches for early stage non-small cell lung cancer.  Surg Oncol. 2005;  14 27-32
  CrossrefPubMedGoogle Scholar
• 27 Lee J M, Jin G Y, Goldberg S N et al.. Percutaneous radiofrequency ablation for inoperable non-small cell lung cancer and metastases: preliminary report.  Radiology. 2004;  230 125-134
  CrossrefPubMedGoogle Scholar
• 28 Dodd III G D, Napier D, Schoolfield J D, Hubbard L. Percutaneous radiofrequency ablation of hepatic tumors: postablation syndrome.  AJR Am J Roentgenol. 2005;  185 51-57
  CrossrefPubMedGoogle Scholar
• 29 He W, Hu X, Wu D F et al.. Ultrasonography-guided percutaneous microwave ablation of peripheral lung cancer.  Clin Imaging. 2006;  30 234-241
  CrossrefPubMedGoogle Scholar
• 30 Yamamoto A, Nakamura K, Matsuoka T et al.. Radiofrequency ablation in a porcine lung model: correlation between ct and histopathologic findings.  AJR Am J Roentgenol. 2005;  185 1299-1306
  CrossrefPubMedGoogle Scholar
• 31 Jin G Y, Lee J M, Lee Y C, Han Y M, Lim Y S. Primary and secondary lung malignancies treated with percutaneous radiofrequency ablation: evaluation with follow-up helical CT.  AJR Am J Roentgenol. 2004;  183 1013-1020
  CrossrefPubMedGoogle Scholar
• 32 Nielsen O S, Munro A J, Tannock I F. Bone metastases: pathophysiology and management policy.  J Clin Oncol. 1991;  9 509-524
  PubMedGoogle Scholar
• 33 Cleeland C S, Gonin R, Hatfield A K et al.. Pain and its treatment in outpatients with metastatic cancer.  N Engl J Med. 1994;  330 592-596
  CrossrefPubMedGoogle Scholar
• 34 Zech D F, Grond S, Lynch J, Hertel D, Lehmann K A. Validation of world health organization guidelines for cancer pain relief: a 10-year prospective study.  Pain. 1995;  63 65-76
  CrossrefPubMedGoogle Scholar
• 35 Janjan N A. Radiation for bone metastases: conventional techniques and the role of systemic radiopharmaceuticals.  Cancer. 1997;  80 1628-1645
  CrossrefPubMedGoogle Scholar
• 36 Grieco C A, Simon C J, Mayo-Smith W W et al.. Image-guided percutaneous thermal ablation for the palliative treatment of chest wall masses.  Am J Clin Oncol. 2007;  30 361-367
  CrossrefPubMedGoogle Scholar
• 37 Woodward R M, Brown M L, Stewart S T, Cronin K A, Cutler D M. The value of medical interventions for lung cancer in the elderly: results from SEER-CMHSF.  Cancer. 2007;  110 2511-2518
  CrossrefPubMedGoogle Scholar
• 38 Wright A S, Sampson L A, Warner T F, Mahvi D M, Lee Jr F T. Radiofrequency versus microwave ablation in a hepatic porcine model.  Radiology. 2005;  236 132-139
  Google Scholar
• 39 Dupuy D E, DiPetrillo T, Gandhi S et al.. Radiofrequency ablation followed by conventional radiotherapy for medically inoperable stage I non-small cell lung cancer.  Chest. 2006;  129 738-745
  CrossrefPubMedGoogle Scholar
• 40 den Brok M H, Sutmuller R P, Nierkens S et al.. Synergy between in situ cryoablation and TLR9 stimulation results in a highly effective in vivo dendritic cell vaccine.  Cancer Res. 2006;  66 7285-7292
  CrossrefPubMedGoogle Scholar

Damian E DupuyM.D. 

Department of Diagnostic Imaging, Rhode Island Hospital

593 Eddy St., Providence, RI 02903

Email: ddupuy@lifespan.org