Radiofrequency Ablation for Ground-Glass Opacity–Dominant Lung Adenocarcinoma

doi:10.1016/j.jvir.2013.11.035

Journal of Vascular and Interventional Radiology

Volume 25, Issue 3, March 2014, Pages 333-339

https://doi.org/10.1016/j.jvir.2013.11.035 Get rights and content

Abstract

Purpose

To evaluate retrospectively the clinical utility of lung radiofrequency (RF) ablation for the treatment of ground-glass opacity (GGO)–dominant lung adenocarcinoma.

Materials and Methods

From August 2004 through May 2012, 33 consecutive patients (14 men and 19 women; mean age, 71.1 y; age range, 46–84 y) with 42 lung tumors having ≥ 50% GGO component received lung RF ablation. The mean maximum tumor diameter was 1.6 cm ± 0.9 (range, 0.7–4.0 cm). Feasibility, safety, local tumor progression, and survival were evaluated.

Results

For the 42 RF sessions, after RF electrodes were placed in each target tumor, planned ablation protocols were completed in all sessions (100%; 42 of 42). No deaths related to the RF procedure occurred. Major and minor complication rates were 4.8% and 23.8%, respectively. Local tumor progression developed in 6 tumors (14.3%; 6 of 42) during a mean follow-up of 42 months ± 23 (range, 5–92 mo). Four of six tumors with local progression were controlled by repeated RF ablation. No evidence of disease was achieved in 31 of 33 patients (93.9%) at the end of the follow-up period. All but one patient (who died of brain hemorrhage) are alive today. Overall and cancer-specific survival rates were 100% and 100% at 1 year, 96.4% (95% confidence interval [CI], 77.5%–99.5%) and 100% at 3 years, and 96.4% (95% CI, 77.5%–99.5%) and 100% at 5 years, respectively.

Conclusions

Lung RF ablation is a feasible, safe, and useful therapeutic option to control GGO-dominant lung adenocarcinoma.

Section snippets

Study Design

This retrospective study was approved by our institutional review board. The necessity of informed consent for inclusion in this study was waived. Informed consent to perform lung RF ablation was obtained from all patients.

Patients

During August 2004 through May 2012, 33 consecutive patients with GGO-dominant primary lung cancer received curative lung RF ablation. Lung RF ablation was performed because of poor pulmonary function and difficulty in performing repeat surgery in 18 postoperative patients,

Feasibility and Safety

For 42 tumors, 42 RF sessions were performed (1.0 RF sessions/tumor). RF electrodes were placed into planned sites, and ablation was completed with planned protocol in all tumors. The technical success rate was 100% (42 of 42). In some instances, it was difficult to evaluate whether ablative zones completely covered tumors because both tumors and ablative zones had GGO character (15). In such cases, technical effectiveness was evaluated by referencing the anatomic landmark such as vessels.

Discussion

Results suggest that lung RF ablation is a safe and useful therapeutic option for the treatment of GGO-dominant primary lung cancer. A GGO lesion is a hazy opacity and less visible on CT fluoroscopic images compared with solid tumor. However, it was feasible to place the RF electrode at the planned site similar to CT fluoroscopic guided lung biopsy for GGO lesions (16). GGO-dominant tumors contain more air, so there might be a concern about anticancer effects of RF ablation because of less

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They found that ablative therapy of metastatic lesions, in conjunction with ongoing EGFR-TKI therapy, was associated with an additional 10 months of disease control [103]. The NCCN clinical practice guidelines for NSCLC discuss the role of IGTA in locoregional recurrence [60,57], stating that IGTA can be considered in patients with disease progression on targeted therapy such as EGFR or ALK inhbitors. The Society of Interventional Radiology (SIR) position statement on IGTA endorses this recommendation [94].
Thermal ablation techniques have now been used for more than twenty years in the treatment of primary lung tumours, predominantly non-small cell lung cancer (NSCLC). Although primarily used for the treatment of early-stage disease in non-surgical patients, thermal ablation is now also being used in selected patients with oligometastatic and oligoprogressive disease. This review discusses the techniques available for thermal ablation, the evidence for use of thermal ablation in primary lung tumours in early- and advanced-stage disease and compares thermal ablation to alternative treatment strategies.
CT-Guided Percutaneous Cryoablation in Patients with Lung Nodules Mainly Composed of Ground-Glass Opacities
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The added necrosis developed from postoperative apoptosis; thus, the necrotic area was representative of the ice ball area during the procedure. Kodama et al (32) reported a local recurrence rate of 14.3% in a group of patients undergoing radiofrequency ablation for GGO nodules. The difficulty of judging the ablation boundary during thermal ablation leaves patients more prone to local recurrence.
To assess the safety and efficacy of cryoablation in patients with lung nodules mainly composed of ground-glass opacities (GGOs).
In this retrospective study, 50 patients (mean age, 65.0 years ± 12.3; 28 women) with a diagnosis of lung GGO nodules who underwent cryoablation were included (from June 2016 to June 2021). The local recurrence rate, incidence of regional metastases to lymph nodes, incidence of distant metastases, adverse events, and lung function condition were analyzed.
Follow-up computed tomography (CT) was performed at a mean of 33 months (range, 3–60 months) after the cryoablation procedure. Outcomes were only evaluated in 30 patients. A total of 20 patients were excluded. Of these 20 patients, 10 patients had no cancer detected by histopathological analysis and a diagnosis was made using CT or positron emission tomography (PET)-CT, The other 10 patients had nodules with a diameter of <10 mm and a consolidation-to-tumor ratio of >0.25; thus, histopathological analysis was not performed because of the small nodule size, and patients were diagnosed using CT or PET-CT. The local recurrence rate was 0% (0 of 30). Evidence of regional metastases of lymph nodes was not found in any patients (0%; 0 of 30), and the incidence of distant metastases was 0% (0 of 30). No major adverse events were noted. Lung function recovered to normal within 1 month after cryoablation in all patients.
Cryoablation may serve as a safe and feasible option for the treatment of lung nodules mainly composed of GGOs.
Treatment options for pulmonary multifocal ground glass opacity type adenocarcinoma: Surgery combine thermal ablation?
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Retrospective analysis revealed that GGO with a consolidation/tumor ratio (CTR) < 0.5 had no metastasis to the pulmonary hilus or mediastinal lymph node, 10% of GGOs with CTR ≥0.5 had metastasis, and AAH, AIS, MIA, and lepidic-dominant adenocarcinomas and invasive mucinous adenocarcinoma had no lymph node metastasis.12–14 These conclusions provided theoretical foundation for the treatment of pGGO and even mGGO (CTR <0.5) by thermal tumor ablation,15–18 specifically if the patient was not suitable for or refused operation, including the impossibility of reoperation due to poor pulmonary functions after main focus resection (9 case), combined cardiopulmonary diseases and advanced age (2 case), and presence of a deep focus and refusal to undergo operation (3 cases). One patient was found to have evident enlargement of two focuses (exceeding 2 mm) during follow-up.
To retrospectively analyze the clinical results of the treatment of pulmonary multifocal adenocarcinoma presenting as ground glass opacity (GGO) by surgery and thermal ablation.
87 GGO-type pulmonary adenocarcinomas of 48 patients (14 males and 34 females; mean age: 59.7 years old ±9.9, range: 33–79 years old) had been treated from March 2015 to March 2019. Treatment means included 43 wedge resections, 7 segmentectomy, 17 lobectomies, and 20 thermal ablations. The indication selected for treatment means, safety, and local tumor progression rate were evaluated.
No operation-related death occurred in all patients. 42 times of surgery were performed and 67 carcinomas were resected in 42 patients. 23 times of single-port Video-assisted thoracoscopic surgery (VATS), 8 times of two-port VATS and 11 times of three-port VATS were performed in total. There were 2 cases of air leak (exceeding 1 week), 1 case of chylothorax and 1 case of massive pleural effusion. Time duration of surgery was between 60 and 300mins (mean: 167mins). Intra-operative blood loss was between 5 and 300 mL (mean: 44 mL). Time of chest drainage was between 2 and 23d (mean 4.9d). Chest drainage volume was between 14 and 4633 mL (mean: 872 mL). Post-operation LOS (length of stay) was between 3 and 25d (mean: 6.2d). 15 times of thermal ablation were performed (1 case of air leak) and 20 carcinomas were ablated in 14 patients. The ablation time was between 30 and 120min (mean: 43min); post-operation LOS was between 1 and 10d (mean: 3.5d). During the mean follow-up period (16 months ± 13) (range: 5–60 months), no local tumor progression occurred.
Surgery and thermal ablation are safe and effective options for the treatment of pulmonary multifocal GGO-type adenocarcinoma.
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: None of the authors have identified a conflict of interest.

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Clinical StudyRadiofrequency Ablation for Ground-Glass Opacity–Dominant Lung Adenocarcinoma

Abstract

Purpose

Materials and Methods

Results

Conclusions

Section snippets

Study Design

Patients

Feasibility and Safety

Discussion

Chest

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Thorac Oncol

J Thorac Cardiovasc Surg

J Thorac Oncol

J Vasc Interv Radiol

J Vasc Interv Radiol

Eur J Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

J Thorac Oncol

Lung Cancer

Acad Radiol

Clinical Study
Radiofrequency Ablation for Ground-Glass Opacity–Dominant Lung Adenocarcinoma