Short-term efficacy of CT-guided microwave ablation for solitary pulmonary nodules_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Fen ¹ ,  YU Tongfu ¹ , ZHAO Xin ^1,2 , ZHANG Wei ¹ , XU Hai ¹ , ZHONG Yan ¹ , ZHANG Teng ¹ , LIU Xisheng ¹

1. Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, P.R.China;
2. Department of Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, P.R.China;

Corresponding author：

YU Tongfu, Email: yu.tongfu@163.com

Keywords：

Pulmonary nodules; computed tomography; microwave ablation; short-term efficacy

DOI：

10.7507/1007-4848.202010042

Video：

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Objective To evaluate the clinical feasibility and safety of CT-guided percutaneous microwave ablation for peripheral solitary pulmonary nodules.Methods The imaging and clinical data of 33 patients with pulmonary nodule less than 3 cm in diameter treated by CT-guided microwave ablation treatment (PMAT) in our hospital from July 2018 to December 2019 were retrospectively analyzed. There were 21 males and 12 females aged 38-90 (67.6±13.4) years. Among them, 26 patients were confirmed with lung cancer by biopsy and 7 patients were clinically considered as partial malignant lesions. The average diameter of 33 nodules was 0.6-3.0 (1.8±0.6) cm. The 3- and 6-month follow-up CT was performed to evaluate the therapy method by comparing the diameter and enhancement degree of lesions with 1-month CT manifestation. Short-term treatment analysis including complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) was calculated according to the WHO modified response evaluation criteria in solid tumor (mRECIST) for short-term efficacy evaluation. Eventually the result of response rate (RR) was calculated. Progression-free survival was obtained by Kaplan–Meier analysis.Results CT-guided percutaneous microwave ablation was successfully conducted in all patients. Three patients suffered slight pneumothorax. There were 18 (54.5%) patients who achieved CR, 9 (27.3%) patients PR, 4 (12.1%) patients SD and 2 (6.1%) patients PD. The short-term follow-up effective rate was 81.8%. Logistic analysis demonstrated that primary and metastatic pulmonary nodules had no difference in progression-free time (log-rank P=0.624).Conclusion PMAT is of high success rate for the treatment of solitary pulmonary nodules without severe complications, which can be used as an effective alternative treatment for nonsurgical candidates.

Citation： WANG Fen, YU Tongfu, ZHAO Xin, ZHANG Wei, XU Hai, ZHONG Yan, ZHANG Teng, LIU Xisheng. Short-term efficacy of CT-guided microwave ablation for solitary pulmonary nodules. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(8): 928-934. doi: 10.7507/1007-4848.202010042 Copy

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2.	陈万青, 郑荣寿, 张思维, 等. 2012 年中国恶性肿瘤发病和死亡分析. 中国肿瘤, 2016, 25(1): 1-8.
3.	Brace CL, Hinshaw JL, Laeseke PF, et al. Pulmonary thermal ablation: Comparison of radiofrequency and microwave devices by using gross pathologic and CT findings in a swine model. Radiology, 2009, 251(3): 705-711.
4.	Belfiore G, Ronza F, Belfiore MP, et al. Patients' survival in lung malignancies treated by microwave ablation: Our experience on 56 patients. Eur J Radiol, 2013, 82(1): 177-181.
5.	Bankier AA, MacMahon H, Goo JM, et al. Recommendations for measuring pulmonary nodules at CT: A statement from the Fleischner Society. Radiology, 2017, 285(2): 584-600.
6.	李宏伟, 蒋小凤, 张川, 等. 对比 CT 引导微波消融与冷冻消融治疗肺恶性肿瘤. 中国介入影像与治疗学, 2019, 16(2): 83-87.
7.	谢韬, 许军, 朱先海, 等. CT 引导下经皮肺穿刺微波消融治疗非小细胞肺癌(36 例临床疗效分析). 影像诊断与介入放射学, 2017, 26(4): 314-319.
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9.	李光骁, 陈晓明. 射频消融与微波消融治疗肺肿瘤的对比研究. 临床放射学杂志, 2017, 36(5): 724-727.
10.	Goldberg SN, Grassi CJ, Cardella JF, et al. Image-guided tumor ablation: Standardization of terminology and reporting criteria. J Vasc Interv Radiol, 2005, 16(6): 765-778.
11.	Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: Standardization of terminology and reporting criteria—A 10-year update. J Vasc Interv Radiol, 2014, 25(11): 1691-1705.
12.	Terzi A, Lonardoni A, Scanagatta P, et al. Lung resection for bronchogenic carcinoma after pneumonectomy: A safe and worthwhile procedure. Eur J Cardiothorac Surg, 2004, 25(3): 456-459.
13.	倪翔. CT 引导下经皮微波消融作为进展期非小细胞肺癌的维持治疗新手段. 山东: 山东大学, 2016.
14.	Simon CJ, Dupuy DE, DiPetrillo TA, et al. Pulmonary radiofrequency ablation: Long-term safety and efficacy in 153 patients. Radiology, 2007, 243(1): 268-275.
15.	钱建新, 顾小强, 焦晓栋, 等. 冷冻消融序贯化疗治疗晚期非小细胞肺癌的疗效观察. 介入放射学杂志, 2014, 23(7): 579-583.
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.	Anderson EM, Lees WR, Gillams AR. Early indicators of treatment success after percutaneous radiofrequency of pulmonary tumors. Cardiovasc Intervent Radiol, 2009, 32(3): 478-483.
18.	Takaki H, Imai N, Thomas CT, et al. Changes in peripheral blood T-cell balance after percutaneous tumor ablation. Minim Invasive Ther Allied Technol, 2017, 26(6): 331-337.
19.	Miao Y, Ni Y, Bosmans H, et al. Radiofrequency ablation for eradication of pulmonary tumor in rabbits. J Surg Res, 2001, 99(2): 265-271.
20.	Bojarski JD, Dupuy DE, Mayo-Smith WW. CT imaging findings of pulmonary neoplasms after treatment with radiofrequency ablation: Results in 32 tumors. AJR Am J Roentgenol, 2005, 185(2): 466-471.
21.	de Baere T, Tselikas L, Catena V, et al. Percutaneous thermal ablation of primary lung cancer. Diagn Interv Imaging, 2016, 97(10): 1019-1024.
22.	Yang X, Ye X, Zhang L, et al. Microwave ablation for lung cancer patients with a single lung: Clinical evaluation of 11 cases. Thorac Cancer, 2018, 9(5): 548-554.
23.	Little MW, Chung D, Boardman P, et al. Microwave ablation of pulmonary malignancies using a novel high-energy antenna system. Cardiovasc Intervent Radiol, 2013, 36(2): 460-465.
24.	王朝阳, 任振杰, 孙义, 等. 肺部肿瘤微波消融术后气胸的风险因素分析. 影像研究与医学应用, 2017, 1(4): 209-210.
25.	张亚楠, 吴献华, 仲楼, 等. CT 引导下肺癌微波消融后空洞形成的相关研究. 实用放射学杂志, 2019, 35(1): 106-109.

1. Hutchinson BD, Shroff GS, Truong MT, et al. Spectrum of lung adenocarcinoma. Semin Ultrasound CT MR, 2019, 40(3): 255-264.
2. 陈万青, 郑荣寿, 张思维, 等. 2012 年中国恶性肿瘤发病和死亡分析. 中国肿瘤, 2016, 25(1): 1-8.
3. Brace CL, Hinshaw JL, Laeseke PF, et al. Pulmonary thermal ablation: Comparison of radiofrequency and microwave devices by using gross pathologic and CT findings in a swine model. Radiology, 2009, 251(3): 705-711.
4. Belfiore G, Ronza F, Belfiore MP, et al. Patients' survival in lung malignancies treated by microwave ablation: Our experience on 56 patients. Eur J Radiol, 2013, 82(1): 177-181.
5. Bankier AA, MacMahon H, Goo JM, et al. Recommendations for measuring pulmonary nodules at CT: A statement from the Fleischner Society. Radiology, 2017, 285(2): 584-600.
6. 李宏伟, 蒋小凤, 张川, 等. 对比 CT 引导微波消融与冷冻消融治疗肺恶性肿瘤. 中国介入影像与治疗学, 2019, 16(2): 83-87.
7. 谢韬, 许军, 朱先海, 等. CT 引导下经皮肺穿刺微波消融治疗非小细胞肺癌(36 例临床疗效分析). 影像诊断与介入放射学, 2017, 26(4): 314-319.
8. 叶欣, 范卫君, 王徽, 等. 热消融治疗原发性和转移性肺部肿瘤专家共识(2017 年版). 中国肺癌杂志, 2017, 20(7): 433-445.
9. 李光骁, 陈晓明. 射频消融与微波消融治疗肺肿瘤的对比研究. 临床放射学杂志, 2017, 36(5): 724-727.
10. Goldberg SN, Grassi CJ, Cardella JF, et al. Image-guided tumor ablation: Standardization of terminology and reporting criteria. J Vasc Interv Radiol, 2005, 16(6): 765-778.
11. Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: Standardization of terminology and reporting criteria—A 10-year update. J Vasc Interv Radiol, 2014, 25(11): 1691-1705.
12. Terzi A, Lonardoni A, Scanagatta P, et al. Lung resection for bronchogenic carcinoma after pneumonectomy: A safe and worthwhile procedure. Eur J Cardiothorac Surg, 2004, 25(3): 456-459.
13. 倪翔. CT 引导下经皮微波消融作为进展期非小细胞肺癌的维持治疗新手段. 山东: 山东大学, 2016.
14. Simon CJ, Dupuy DE, DiPetrillo TA, et al. Pulmonary radiofrequency ablation: Long-term safety and efficacy in 153 patients. Radiology, 2007, 243(1): 268-275.
15. 钱建新, 顾小强, 焦晓栋, 等. 冷冻消融序贯化疗治疗晚期非小细胞肺癌的疗效观察. 介入放射学杂志, 2014, 23(7): 579-583.
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. Anderson EM, Lees WR, Gillams AR. Early indicators of treatment success after percutaneous radiofrequency of pulmonary tumors. Cardiovasc Intervent Radiol, 2009, 32(3): 478-483.
18. Takaki H, Imai N, Thomas CT, et al. Changes in peripheral blood T-cell balance after percutaneous tumor ablation. Minim Invasive Ther Allied Technol, 2017, 26(6): 331-337.
19. Miao Y, Ni Y, Bosmans H, et al. Radiofrequency ablation for eradication of pulmonary tumor in rabbits. J Surg Res, 2001, 99(2): 265-271.
20. Bojarski JD, Dupuy DE, Mayo-Smith WW. CT imaging findings of pulmonary neoplasms after treatment with radiofrequency ablation: Results in 32 tumors. AJR Am J Roentgenol, 2005, 185(2): 466-471.
21. de Baere T, Tselikas L, Catena V, et al. Percutaneous thermal ablation of primary lung cancer. Diagn Interv Imaging, 2016, 97(10): 1019-1024.
22. Yang X, Ye X, Zhang L, et al. Microwave ablation for lung cancer patients with a single lung: Clinical evaluation of 11 cases. Thorac Cancer, 2018, 9(5): 548-554.
23. Little MW, Chung D, Boardman P, et al. Microwave ablation of pulmonary malignancies using a novel high-energy antenna system. Cardiovasc Intervent Radiol, 2013, 36(2): 460-465.
24. 王朝阳, 任振杰, 孙义, 等. 肺部肿瘤微波消融术后气胸的风险因素分析. 影像研究与医学应用, 2017, 1(4): 209-210.
25. 张亚楠, 吴献华, 仲楼, 等. CT 引导下肺癌微波消融后空洞形成的相关研究. 实用放射学杂志, 2019, 35(1): 106-109.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short-term efficacy of CT-guided microwave ablation for solitary pulmonary nodules

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