Clinical analysis of 31 lung metastases patients by percutaneous thermal ablation in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIANG Xi , GUAN Xin , WANG Feng , JI Guangyu ,  WANG Mingsong

Department of Thoracic Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P.R.China;

Corresponding?author：

WANG Mingsong, Email: 13764517021@163.com

Keywords：

Lung metastases; thermal ablation; accuracy; intervention treatment

DOI：

10.7507/1007-4848.202102057

Video：

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Objective To explore the factors that affect the accuracy of percutaneous thermal ablation of lung metastases and coping strategies.Methods We retrospectively analyzed the clinical data of 31 patients who met the conditions for thermal ablation of lung metastases in Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine between October 2019 and December 2020. There were 19 males and 12 females with a mean age of 40-81 (62.8±10.3) years. A total of 33 metastases tumors were thermally ablated, 12 were radiofrequency ablation and 19 were microwave ablation.Results Of the 33 metastatic tumors, 5 targets showed significant puncture deviation, 4 of them completed the ablation after adjustment and 1 failed. The result of the univariate logistic regression showed the distance within the lung parenchyma (P=0.043) and the maximum diameter of the tumor (P=0.025) were independent risk factors for the accuracy of percutaneous thermal ablation. In terms of correlation, there was a positive correlation between the accuracy of percutaneous thermal ablation and the distance within the lung parenchyma (P=0.033), and a negative correlation between the maximum diameter of metastases tumor (P=0.004) and hemoptysis (P=0.015). Complete ablation rate was 87.8% (29/33).Conclusion When we perform CT-guided percutaneous thermal ablation of lung metastases, we must fully prepare the deviation plan for the small diameter tumor, the long travel distance in the lung parenchyma, and hemoptysis during puncture. Complete ablation can be achieved by fully identifying the anatomical features of the tumor and its surrounding structures, shortening the travel distance in the lung parenchyma and increasing the ablation range.

Citation： LIANG Xi, GUAN Xin, WANG Feng, JI Guangyu, WANG Mingsong. Clinical analysis of 31 lung metastases patients by percutaneous thermal ablation in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(11): 1322-1329. doi: 10.7507/1007-4848.202102057 Copy

1.	Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol, 1995, 13(1): 8-10.
2.	Tselikas L, Garzelli L, Mercier O, et al. Radiofrequency ablation versus surgical resection for the treatment of oligometastatic lung disease. Diagn Interv Imaging, 2021, 102(1): 19-26.
3.	Hasegawa T, Kuroda H, Sakakura N, et al. Novel strategy to treat lung metastases: Hybrid therapy involving surgery and radiofrequency ablation. Thorac Cancer, 2021, 12(14): 2085-2092.
4.	de Baère T, Aupérin A, Deschamps F, et al. Radiofrequency ablation is a valid treatment option for lung metastases: Experience in 566 patients with 1037 metastases. Ann Oncol, 2015, 26(5): 987-991.
5.	Genshaft SJ, Suh RD, Abtin F, et al. Society of Interventional Radiology Multidisciplinary Position Statement on percutaneous ablation of non-small cell lung cancer and metastatic disease to the lungs: Endorsed by the Canadian Association for Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology. J Vasc Interv Radiol, 2021, 32(8): 1241.e1-1241.e12.
6.	Matsui Y, Hiraki T, Gobara H, et al. Long-term survival following percutaneous radiofrequency ablation of colorectal lung metastases. J Vasc Interv Radiol, 2015, 26(3): 303-310.
7.	Vogl TJ, Eckert R, Naguib NN, et al. Thermal ablation of colorectal lung metastases: Retrospective comparison among laser-induced thermotherapy, radiofrequency ablation, and microwave ablation. AJR Am J Roentgenol, 2016, 207(6): 1340-1349.
8.	Chen J, Lin ZY, Wu ZB, et al. Magnetic resonance imaging evaluation after radiofrequency ablation for malignant lung tumors. J Cancer Res Ther, 2017, 13(4): 669-675.
9.	Cazzato RL, Battistuzzi JB, Catena V, et al. Cone-beam computed tomography (CBCT) versus CT in lung ablation procedure: Which is faster? Cardiovasc Intervent Radiol, 2015, 38(5): 1231-1236.
10.	Li XQ, Zhang Y, Huang DB, et al. Value of C-arm computed tomography in radiofrequency ablation of small lung lesions. Genet Mol Res, 2014, 13(3): 6027-6036.
11.	Vogl TJ, Naguib NNN, Gruber-Rouh T, et al. Microwave ablation therapy: Clinical utility in treatment of pulmonary metastases. Radiology, 2011, 261(2): 643-651.
12.	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(2): 247-254.
13.	Boyer MJ, Ricardi U, Ball D, et al. Ablative approaches for pulmonary metastases. Thorac Surg Clin, 2016, 26(1): 19-34.
14.	Ibrahim T, Tselikas L, Yazbeck C, et al. Systemic versus local therapies for colorectal cancer pulmonary metastasis: What to choose and when? J Gastrointest Cancer, 2016, 47(3): 223-231.
15.	Treasure T. Surgery and ablative techniques for lung metastases in the pulmonary metastasectomy in colorectal cancer (PulMiCC) trial: Is there equivalence? J Thorac Dis, 2016, 8(Suppl 9): 49-51.
16.	Lee JM, Jin GY, Goldberg SN, et al. Percutaneous radiofrequency ablation for inoperable non-small cell lung cancer and metastases: Preliminary report. Radiology, 2004, 230(1): 125-134.
17.	Hiraki T, Matsuno T, Kamegawa, et al. Robotic insertion of various ablation needles under computed tomography huidance: Accuracy in animal rxperiments. Eur J Radiol, 2018, 105: 162-167.
18.	Ye X, Fan WJ, Wang ZM, et al. Expert consensus for thermal ablation of pulmonary subsolid nodules (2021 Edition). Zhongguo Fei Ai Za Zhi, 2021, 24(5): 305-322.
19.	Habert P, Di Bisceglie M, Bartoli A, et al. Description of morphological evolution of lung tumors treated by percutaneous radiofrequency ablation: Long term follow-up of 100 lesions with chest CT. Int J Hyperthermia, 2021, 38(1): 786-794.
20.	Spyropoulos AC, Al-Badri A, Sherwood MW, et al. Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery. J Thromb Haemost, 2016, 14(5): 875-885.
21.	Malloy PC, Grassi CJ, Kundu S, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol, 2009, 20(Suppl 7): S240-S249.
22.	Clasen S, Krober SM, Kosan B, et al. Pathomorphologic evaluation of pulmonary radiofrequency ablation: Proof of cell death is characterized by DNA fragmentation and apoptotic bodies. Cancer, 2008, 113(11): 3121-3129.
23.	de Baère T. Lung tumor radiofrequency ablation: Where do we stand? Cardiovasc Interv Radiol, 2011, 34(2): 241-251.
24.	Zheng A, Yang X, Ye X, et al. Bronchopleural fistula after lung ablation: Experience in two cases and literature review. Indian J Cancer, 2015, 52(Suppl 2): e41-e46.
25.	Tomiyama N, Yasuhara Y, Nakajima Y, et al. CT-guided needle biopsy of lung lesions: A survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol, 2006, 59(1): 60-64.
26.	Kashima M, Yamakado K, Takaki H, et al. Complications after 1000 lung radiofrequency ablation sessions in 420 patients: A single center's experiences. AJR Am J Roentgenol, 2011, 197(4): W576-W580.
27.	Nour-Eldin NE, Naguib NN, Mack M, et al. Pulmonary hemorrhage complicating radiofrequency ablation, from mild hemoptysis to life-threatening pattern. Eur Radiol, 2011, 21(1): 197-204.

1. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol, 1995, 13(1): 8-10.
2. Tselikas L, Garzelli L, Mercier O, et al. Radiofrequency ablation versus surgical resection for the treatment of oligometastatic lung disease. Diagn Interv Imaging, 2021, 102(1): 19-26.
3. Hasegawa T, Kuroda H, Sakakura N, et al. Novel strategy to treat lung metastases: Hybrid therapy involving surgery and radiofrequency ablation. Thorac Cancer, 2021, 12(14): 2085-2092.
4. de Baère T, Aupérin A, Deschamps F, et al. Radiofrequency ablation is a valid treatment option for lung metastases: Experience in 566 patients with 1037 metastases. Ann Oncol, 2015, 26(5): 987-991.
5. Genshaft SJ, Suh RD, Abtin F, et al. Society of Interventional Radiology Multidisciplinary Position Statement on percutaneous ablation of non-small cell lung cancer and metastatic disease to the lungs: Endorsed by the Canadian Association for Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology. J Vasc Interv Radiol, 2021, 32(8): 1241.e1-1241.e12.
6. Matsui Y, Hiraki T, Gobara H, et al. Long-term survival following percutaneous radiofrequency ablation of colorectal lung metastases. J Vasc Interv Radiol, 2015, 26(3): 303-310.
7. Vogl TJ, Eckert R, Naguib NN, et al. Thermal ablation of colorectal lung metastases: Retrospective comparison among laser-induced thermotherapy, radiofrequency ablation, and microwave ablation. AJR Am J Roentgenol, 2016, 207(6): 1340-1349.
8. Chen J, Lin ZY, Wu ZB, et al. Magnetic resonance imaging evaluation after radiofrequency ablation for malignant lung tumors. J Cancer Res Ther, 2017, 13(4): 669-675.
9. Cazzato RL, Battistuzzi JB, Catena V, et al. Cone-beam computed tomography (CBCT) versus CT in lung ablation procedure: Which is faster? Cardiovasc Intervent Radiol, 2015, 38(5): 1231-1236.
10. Li XQ, Zhang Y, Huang DB, et al. Value of C-arm computed tomography in radiofrequency ablation of small lung lesions. Genet Mol Res, 2014, 13(3): 6027-6036.
11. Vogl TJ, Naguib NNN, Gruber-Rouh T, et al. Microwave ablation therapy: Clinical utility in treatment of pulmonary metastases. Radiology, 2011, 261(2): 643-651.
12. 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(2): 247-254.
13. Boyer MJ, Ricardi U, Ball D, et al. Ablative approaches for pulmonary metastases. Thorac Surg Clin, 2016, 26(1): 19-34.
14. Ibrahim T, Tselikas L, Yazbeck C, et al. Systemic versus local therapies for colorectal cancer pulmonary metastasis: What to choose and when? J Gastrointest Cancer, 2016, 47(3): 223-231.
15. Treasure T. Surgery and ablative techniques for lung metastases in the pulmonary metastasectomy in colorectal cancer (PulMiCC) trial: Is there equivalence? J Thorac Dis, 2016, 8(Suppl 9): 49-51.
16. Lee JM, Jin GY, Goldberg SN, et al. Percutaneous radiofrequency ablation for inoperable non-small cell lung cancer and metastases: Preliminary report. Radiology, 2004, 230(1): 125-134.
17. Hiraki T, Matsuno T, Kamegawa, et al. Robotic insertion of various ablation needles under computed tomography huidance: Accuracy in animal rxperiments. Eur J Radiol, 2018, 105: 162-167.
18. Ye X, Fan WJ, Wang ZM, et al. Expert consensus for thermal ablation of pulmonary subsolid nodules (2021 Edition). Zhongguo Fei Ai Za Zhi, 2021, 24(5): 305-322.
19. Habert P, Di Bisceglie M, Bartoli A, et al. Description of morphological evolution of lung tumors treated by percutaneous radiofrequency ablation: Long term follow-up of 100 lesions with chest CT. Int J Hyperthermia, 2021, 38(1): 786-794.
20. Spyropoulos AC, Al-Badri A, Sherwood MW, et al. Periprocedural management of patients receiving a vitamin K antagonist or a direct oral anticoagulant requiring an elective procedure or surgery. J Thromb Haemost, 2016, 14(5): 875-885.
21. Malloy PC, Grassi CJ, Kundu S, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol, 2009, 20(Suppl 7): S240-S249.
22. Clasen S, Krober SM, Kosan B, et al. Pathomorphologic evaluation of pulmonary radiofrequency ablation: Proof of cell death is characterized by DNA fragmentation and apoptotic bodies. Cancer, 2008, 113(11): 3121-3129.
23. de Baère T. Lung tumor radiofrequency ablation: Where do we stand? Cardiovasc Interv Radiol, 2011, 34(2): 241-251.
24. Zheng A, Yang X, Ye X, et al. Bronchopleural fistula after lung ablation: Experience in two cases and literature review. Indian J Cancer, 2015, 52(Suppl 2): e41-e46.
25. Tomiyama N, Yasuhara Y, Nakajima Y, et al. CT-guided needle biopsy of lung lesions: A survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol, 2006, 59(1): 60-64.
26. Kashima M, Yamakado K, Takaki H, et al. Complications after 1000 lung radiofrequency ablation sessions in 420 patients: A single center's experiences. AJR Am J Roentgenol, 2011, 197(4): W576-W580.
27. Nour-Eldin NE, Naguib NN, Mack M, et al. Pulmonary hemorrhage complicating radiofrequency ablation, from mild hemoptysis to life-threatening pattern. Eur Radiol, 2011, 21(1): 197-204.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical analysis of 31 lung metastases patients by percutaneous thermal ablation in a single center

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