Cases
  • Advanced non small cell lung cancer: response to microwave ablation and EGFR Status
    Objectives To verify the association between EGFR status and clinical response to microwave ablation (MWA) and survival. Methods NSCLC patients with known EGFR status and treated with MWA in combination with chemotherapy were retrospectively enrolled in the study. Results A total of 61 patients were recruited. EGFR mutations were found in 28 patients (39.4 %), and were more common in women (67.7 %) and nonsmokers (74.1 %). Complete ablation was achieved in 69.7 % of patients with EGFR mutant tumours and in 82.1 % of patients with EGFR wild-type tumours (p = 0.216). The median progression-free survival (PFS) and overall survival (OS) were 8.3 months and 27.2 months in patients with an EGFR mutant tumour. The corresponding values were 5.4 months (p = 0.162) and 17.8 months (p = 0.209) in patients with an EGFR wild-type tumour. Patients with complete ablation had longer PFS (7.8 months vs. 4.2 months, p = 0.024) and OS (28.1 months vs. 12.6 months, p = 0.001) than those with incomplete ablation. Multivariate analyses also showed that response toMWA was an independent prognostic factor for OS, but EGFR status was not, and that neither response to MWA nor EGFR status was a prognostic factor for PFS. Conclusions The EGFR status was not related to response to MWA, and response to MWAwas a predictor of survival..
  • Chemical ablation therapy of recurrent mediastinal nodal metastasis in post-radiotherapy cancer patients
    The aim of our study was to evaluate the treatment of post-radiotherapy recurrent mediastinal nodal metastasis. Post-radiotherapy esophageal cancer patients with mediastinal lymph node recurrence were enrolled in this study. Patients were randomized into the radiation (±chemotherapy) or the chemoablation group. Patients randomized to the chemoradiotherapy group received additional radiotherapy, second-line chemotherapy, or both. Patients randomized to the chemoablation group received CT-guided percutaneous chemical ablation. Clinical remission was assessed at 1 month by contrast CT. Reirradiation dose ranged from 2,200 to 3,600 cGy depending on dose-limiting constraints in consideration of prior radiotherapy dose. The RECIST criteria were used in the evaluation of response to therapy. The median length of follow-up is 6 months. Thirty-one patients were enrolled in the study. In the chemoradiation group, all patients underwent CT imaging at 1-month follow-up. Among these patients, seven had progressive disease, five had stable disease (SD), and four had partial response (PR). The 6-month survival rate was 12.5 %. In the chemoablation group at 1-month follow-up, 12 patients had SD and three patients had PR, and the 6-month survival rate was 46.6 %. Our results suggest that chemoablation therapy as salvage treatment after post-radiotherapy relapse is efficacious and safe.
  • Chinese expert consensus workshop report: Guidelines for thermal ablation of primary and metastatic lung tumors
    Although surgical resection is the primary means of curing both primary and metastatic lung cancers, about 80% of lung cancers cannot be removed by surgery. As most patientswith unresectable lung cancer receive only limited benefits fromtraditional radiotherapy and chemotherapy, many new local treatment methods have emerged, including local ablation therapy.The Minimally Invasive and Comprehensive Treatment of Lung Cancer Branch, Professional Committee of Minimally Invasive Treatment of Cancer of the Chinese Anti-Cancer Association has organized multidisciplinary experts to develop guidelines for this treatment modality. These guidelines aim at standardizing thermal ablation procedures and criteria for selecting treatment candidates and assessing outcomes; and for preventing and managing post-ablation complications. Thoracic Cancer ISSN 1759-7706 112
  • Computed tomography-guided percutaneous microwave ablation combined with osteoplasty for palliative treatment of painful extraspinal bone metastases from lung cancer
    Objective To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. Materials and methods From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. Results Mean VAS score and morphine dose pre-procedure were 7.4±1.6 (range, 5–10) and 47.7±30.1 mg (range, 20– 120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7±1.2 (p<0.001) and 29.6±16.1 mg (p=0.003); 7 days, 1.9±1.7 (p<0.001) and 16.1±12.0 mg (p<0.001); 1 month, 1.5±0.9 (p<0.001) and 10.8±10.9 (p<0.001); 3 months, 0.9±0.7 (p<0.001) and 8.4±9.2 mg (p<0.001); and 6 months, 1.2± 0.8 (p<0.001) and 9.2±12.3 mg (p<0.001). Complications were observed in eight patients (28 %); among these, major complications were reported in two (7.7 %) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1 % (6/26). Conclusion MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases.
  • Invasive pulmonary aspergillosis: A rare complication after microwave ablation
    Three cases are reported of invasive pulmonary aspergillosis (IPA) occurring after microwave ablation (MWA) for lung tumours. This is a rare complication that has not previously been described in the literature. The diagnosis of IPA was based on the following factors: host factors, clinical manifestations and mycological findings. The first case was a 63-year-old man treated for primary lung squamous carcinoma. Significant tumour regression was achieved by 18 days after MWA, medical treatment with itraconazole for 6 weeks, and postural drainage. The second case, a 65-year-old man, was confirmed with primary lung squamous cell carcinoma. Voriconazole administration using intravenous infusion combined with intracavitary lavage was therapeutically effective after MWA at 1 year follow-up. The third case was a 61-year-old woman with primary lung adenocarcinoma. Delayed pneumothorax and bronchopleural fistula secondary to IPA persisted. The patient died from secondary multiple organ function failure. Despite its very low incidence, the significance of early diagnosis and early administration of antifungal therapy should be highlighted because of the relentless severity of IPA in patients undergoing MWA.
  • Short-Term Outcomes and Safety of Computed Tomography-Guided Percutaneous Microwave Ablation of Solitary Adrenal Metastasis from Lung Cancer: A Multi-Center Retrospective Study
    Objective: To retrospectively evaluate the short-term outcomes and safety of computed tomography (CT)-guided percutaneous microwave ablation (MWA) of solitary adrenal metastasis from lung cancer. Materials and Methods: From May 2010 to April 2014, 31 patients with unilateral adrenal metastasis from lung cancer who were treated with CT-guided percutaneous MWA were enrolled. This study was conducted with approval from local Institutional Review Board. Clinical outcomes and complications of MWA were assessed. Results: Their tumors ranged from 1.5 to 5.4 cm in diameter. After a median follow-up period of 11.1 months, primary efficacy rate was 90.3% (28/31). Local tumor progression was detected in 7 (22.6%) of 31 cases. Their median overall survival time was 12 months. The 1-year overall survival rate was 44.3%. Median local tumor progression-free survival time was 9 months. Local tumor progression-free survival rate was 77.4%. Of 36 MWA sessions, two (5.6%) had major complications (hypertensive crisis). Conclusion: CT-guided percutaneous MWA may be fairly safe and effective for treating solitary adrenal metastasis from lung cancer.
  • Major Complications After Lung Microwave Ablation: A Single-Center Experience on 204 Sessions
    Background. The purpose of this study is to retrospectively evaluate the incidence of and risk factors for major complications after microwave ablation (MWA) of lung tumors. Methods. From January 2011 to May 2013 in 184 consecutive patients (67 women and 117 men; mean age, 61.5 years; range, 19 to 85 years), 204 sessions of MWA were performed on 253 lung tumor lesions. Records were reviewed to evaluate prevalence of major complications and risk factors, which were analyzed using univariate and multivariate analyses. Results. Major complications developed after 42 sessions (20.6%), including 32 cases (15.7%) of pneumothorax requiring chest tube placement which that were associated with emphysema (p [ 0 .001); 6 cases (2.9%) of pleural effusions requiring chest tube placement, which were associated with a distance of less than 1 cm from chest wall to target tumor (p [ 0.014); 6 cases (2.9%) of pneumonia which that were associated with target tumor maximal diameter (p [ 0.040); number of pleural punctures (p [ 0.001) and ablation time (p [ 0.006); and 1 case (0.5%) of pulmonary abscess. Two cases (1.0%) of the large pneumothorax occurred at the same time with extensive subcutaneous emphysema, including 1 case (0.5%) caused by bronchopleural fistula. Death related to the procedures occurred after 1 session (0.5%). Conclusions. As a relatively practical and safe modality, lung tumor MWA can induce serious complications. Enough attention should be paid to patients with emphysema, subpleural, or large target tumor, but the indications for lung MWA need not be limited as most major complications were easily managed.
  • Microwave Ablation in Combination with Chemotherapy for the Treatment of Advanced Non-Small Cell Lung Cancer
    Purpose To verify whether microwave ablation (MWA) used as a local control treatment had an improved outcome regarding advanced non-small cell lung cancer (NSCLC) when combined with chemotherapy. Methods Thirty-nine patients with histologically verified advanced NSCLC and at least one measurable site other than the ablative sites were enrolled. Primary tumors underwent MWA followed by platinum-based doublet chemotherapy. Modified response evaluation criteria in solid tumors (mRECIST) and RECIST were used to evaluate therapeutic response. Complications were assessed using the National Cancer Institute Common Toxicity Criteria (version 3.0). Results MWA was administered to 39 tumors in 39 patients. The mean and median diameters of the primary tumor were 3.84 cm and 3.30 cm, respectively, with a range of 1.00–9.00 cm. Thirty-three (84.6 %) patients achieved a partial response. No correlation was found between MWA efficacy and clinicopathologic characteristics. For chemotherapy, 11 patients (28.2 %) achieved a partial response, 18 (46.2 %) showed stable disease, and 10 (25.6 %) had progressive disease. The overall objective response rate and disease control rate were 28.2 and 74.4 %, respectively. The median progression-free survival time was 8.7 months (95 % CI 5.5–11.9). The median overall survival time was 21.3 months (95 % CI 17.0–25.4). Complications were observed in 22 (56.4 %) patients, and grade 3 adverse events were observed in 3 (7.9 %) patients. Conclusions Patients with advanced NSCLC could benefit from MWA in combination with chemotherapy. Complications associated with MWA were common but tolerable.
  • Microwave ablation plus chemotherapy improved progressionfree survival of advanced non-small cell lung cancer compared to chemotherapy alone
    Abstract The aim of the study was to determine survival benefit of the microwave ablation (MWA)/chemotherapy combination compared with chemotherapy alone. Patients with untreated, stage IIIB or IV NSCLC and at least one additional measurable site other than the ablative site were enrolled. They were divided intoMWA/chemotherapy group and chemotherapy group. The primary endpoint was progression- free survival (PFS); secondary endpoints included response, time to local progression (TTLP), overall survival (OS), and adverse events (AEs). Forty-six and twenty-eight patients were enrolled in the MWA/chemotherapy group and chemotherapy group, respectively. Complete ablation was observed in 84.8 % patients in the MWA/chemotherapy group. Median TTLP was 27.0 months. Objective response rate and disease control rate in MWA/chemotherapy group were 21.7 and 76.1 %, and in the chemotherapy group were 32.1 % (p = 0.320) and 75.0 % (p = 0.916), respectively. MWA/chemotherapy combination prolonged PFS [MWA/ chemotherapy group 10.9 (95 % CI 5.1–16.7) ms vs. chemotherapy group 4.8 (95 % CI 3.9–5.8) ms, p = 0.001] and tended to improve OS [MWA/chemotherapy group 23.9 (95 % CI 15.2–32.6) ms vs. chemotherapy group 17.3 (95 % CI 15.2–19.3) ms, p = 0.140]. Multivariate analyses showed that MWA was an independent prognostic factor of PFS and primary tumor size was an independent prognostic factor of OS. AEs of MWA were observed in 67.4 % patients. Chemotherapy- associated AEs were observed in 39.1 and 53.6 % of patients in the MWA/chemotherapy and chemotherapy group, respectively. MWA/chemotherapy combination improved PFS of advanced NSCLC compared to chemotherapy alone, and the combination did not increase the adverse events of chemotherapy.
  • Percutaneous Microwave Ablation of Stage I Medically Inoperable Non-Small Cell Lung Cancer: Clinical Evaluation of 47 Cases
    Purpose: To retrospectively evaluate safety and effectiveness of CT‐guided percutaneous microwave ablation (MWA) in 47 patients with medically inoperable stage I peripheral non‐small cell lung cancer (NSCLC). Methods: From February 2008 to October 2012, 47 patients with stage I medically inoperable NSCLC were treated in 47 MWA sessions. The clinical outcomes were evaluated. Complications after MWA were also summarized. Results: At a median follow‐up period of 30 months, the median time to the first recurrence was 45.5 months. The local control rates at 1, 3, 5 years afterMWAwere 96%, 64%, and 48%, respectively. The median cancer‐specific and median overall survivals were 47.4 and 33.8 months. The overall survival rates at 1, 2, 3, and 5 years after MWA were 89%, 63%, 43%, and 16%, respectively. Tumors 3.5 cm were associated with better survival than were tumors>3.5 cm. The complications afterMWAincluded pneumothorax (63.8%), hemoptysis (31.9%), pleural effusion (34%), pulmonary infection (14.9%), and bronchopleural fistula (2.1%). Conclusions: MWA is safe and effective for the treatment of medically inoperable stage I peripheral NSCLC.
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