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EDITORIAL
Year : 2018  |  Volume : 14  |  Issue : 4  |  Page : 725-726

A valuable guideline for thermal ablation of primary and metastatic lung tumors


Department of Biomedical Sciences, Humanitas University, Milan, Italy

Date of Web Publication27-Jun-2018

Correspondence Address:
Luigi A Solbiati
Department of Biomedical Sciences, Humanitas University, Milan
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_223_18

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How to cite this article:
Solbiati LA. A valuable guideline for thermal ablation of primary and metastatic lung tumors. J Can Res Ther 2018;14:725-6

How to cite this URL:
Solbiati LA. A valuable guideline for thermal ablation of primary and metastatic lung tumors. J Can Res Ther [serial online] 2018 [cited 2019 Nov 13];14:725-6. Available from: http://www.cancerjournal.net/text.asp?2018/14/4/725/235082



Lung cancer, the “big killer,” is the number one cause of cancer death both in the Eastern and the Western world and its incidence continues to increase.

Surgical resection has been the mainstay of treatment for many years for non-small cell lung cancer (NSCLC), but only 70%–80% of patients with early stage disease (Stage I and Stage II) are potential candidates for surgery, while NSCLC is generally inoperable for its biologic characteristics.[1],[2] On the other hand, for certain tumors with favorable biologic characteristics (e.g., colorectal carcinoma, renal cell carcinoma, and breast carcinoma) and certain patients (in good performance status, with a finite number of metastatic deposits in the lung), resection is a viable treatment option that improves prognosis.

Mostly thanks to the increasing detection of smaller lung cancers and metastases by means of modern imaging modalities and to the continuous improvement of surgical techniques; in the last 50 years, limited surgical resections such as wedge resection and segmentectomy have progressively replaced pneumectomy and lobectomy, with similar, if not better, outcomes and dramatic decrease of complication rates. However, despite these surgical advancements, many patients with both non-small lung cancer and limited metastatic lung involvement are still today not surgical candidates because of their poor cardiopulmonary function, advanced age, or other medical comorbidities. Particularly for such patients at high surgical risk, less invasive treatments have been gradually introduced and clinically tested in the last 15 years such as stereotactic body radiotherapy (SBRT) and percutaneous image-guided tumor ablation.

Image-guided tumor ablation, initially applied to liver tumors, had a tremendous development and diffusion in the last 10–15 years, also in other organs (lung, kidney, and bone) being an effective, repeatable, low-cost, and safe treatment, either as a stand-alone therapy or in combination with chemotherapy or SBRT.

To the most historical and widely diffused ablative technique (radiofrequency ablation [RFA]), several other thermal techniques have been added and clinically tested in recent years such as microwave ablation (MWA), cryoablation, and laser ablation, and also a relatively nonthermal technique, i.e., irreversible electroporation. Each of these techniques has proper characteristics and consequently, specific advantages and limitations, indications, and contraindications.

In the field of lung malignancies, both primary and metastatic, currently, there are no randomized controlled trials (RCTs) that compare the outcomes of the different techniques in comparable populations of patients affected with the same oncologic disease in the same clinical stage, nor RCTs that compare thermal ablation therapies alone or in combination versus other more established treatments. Consequently, for all the “ablationists” who perform or start performing lung ablations, it is mandatory to know characteristics, indications, and contraindications of all the thermal and nonthermal ablative techniques, as well as the modalities of planning, targeting, intraprocedural monitoring, and imaging follow-up of each ablative technique. It is therefore particularly useful to have guidelines born from the consensus of top specialists and based on their experience and expertise.

This has been recently done for the ablation of colorectal liver metastases by an international panel of experts gathered for the “Interventional Oncology sans Frontières Meeting 2013” in Italy [3] and for the ablation of primary and metastatic lung tumors by the Chinese group of renowned experts led by Prof. Ye et al.[4] Now, an updated 2018 version of these guidelines on lung ablation has been produced by the same group of Chinese experts, with an even larger participation of specialists.[5] With respect to the first edition, several sections of the guidelines have been expanded and some new chapters have been added. In the first part dealing with the different ablative techniques, the indications for using MWA versus RFA are discussed, underlining the need for having more than one ablation system available in every center and the section on laser ablation has been included. Palliative indications for ablation, contraindications, pretreatment assessment of patients, use of anesthesia, and assessment of immediate and on follow-up treatment response have been more deeply investigated. In addition, new paragraphs describing complications such as cavitation and hemorrhage (with its management), the use of positron emission tomography-computed tomography on follow-up and of ablation in combination with other therapies have been included.

Such valuable guidelines as these will help define the exact subset of patients who will benefit the most from lung ablation favor a more scientifically correct and technically adequate use of lung ablation and keep complication rates (and possible related legal issues) as low as possible, hopefully leading to the achievement of a more widespread support in the oncology community. Further progress in molecular biology, genomics, and proteomics will further allow to select the best single or combined (ablation plus systemic therapy or SBRT) treatment for each patient, enabling to define a really personalized therapeutic strategy.[6]



 
 > References Top

1.
Dupuy DE. Image-guided thermal ablation of lung malignancies. Radiology 2011;260:633-55.  Back to cited text no. 1
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2.
Pereira PL, Masala S; Cardiovascular and Interventional Radiological Society of Europe (CIRSE). Standards of practice: Guidelines for thermal ablation of primary and secondary lung tumors. Cardiovasc Intervent Radiol 2012;35:247-54.  Back to cited text no. 2
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3.
Gillams A, Goldberg N, Ahmed M, Bale R, Breen D, Callstrom M, et al. Thermal ablation of colorectal liver metastases: A position paper by an international panel of ablation experts, the Interventional Oncology Sans Frontières Meeting 2013. Eur Radiol 2015;25:3438-54.  Back to cited text no. 3
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4.
Ye X, Fan W, Chen JH, Feng WJ, Gu SZ, Han Y, et al. Chinese expert consensus workshop report: Guidelines for thermal ablation of primary and metastatic lung tumors. Thorac Cancer 2015;6:112-21.  Back to cited text no. 4
[PUBMED]    
5.
Ye X, Fan W, Wang H, Wang J, Gu S, Feng W, et al. Expert Consensus Workshop Report: Guidelines for Thermal Ablation of Primary and Metastatic Lung Tumors. J Cancer Res Ther 2018. [In press].  Back to cited text no. 5
    
6.
de Baere T, Tselikas L, Gravel G, Deschamps F. Lung ablation: Best practice/results/response assessment/role alongside other ablative therapies. Clin Radiol 2017;72:657-64.  Back to cited text no. 6
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