Research advances in thermal ablation for lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HONG Ziqiang ^1,2 , JIN Dacheng ² , BAI Xiangdou ^1,2 , CUI Baiqiang ^1,2 ,  GOU Yunjiu ²

1. First Clinical Medical School, Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;

Corresponding author：

GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Lung cancer; metastatic cancer; thermal ablation; radiofrequency ablation; microwave ablation; argon-helium cryoablation; review

DOI：

10.7507/1007-4848.202203061

Video：

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Although surgical resection remains to be the best treatment strategy for stageⅠnon-small cell lung cancer (NSCLC), percutaneous thermal ablation offers an important option for patients who are unable to undergo surgical resection. Currently, there are three main thermal ablation methods used in the treatment of lung cancer, including radiofrequency ablation (RFA), microwave ablation (MWA) and argon-helium cryoablation (AHC). With the improvement of technique and the accumulation of experience in the treatment of lung cancer, some limitations are disclosed in the initial application of RFA, such as heat sink effect, skin burns and rapid carbonization. These shortcomings have been overcome in the development of MWA and AHC. The feasibility and safety of thermal ablation for the treatment of lung cancer has been demonstrated and its efficacy has been significantly improved (especially for the tumour diameter≤3 cm). This article will focus on the application and recent research developments of these ablation techniques in the treatment of lung cancer.

Citation： HONG Ziqiang, JIN Dacheng, BAI Xiangdou, CUI Baiqiang, GOU Yunjiu. Research advances in thermal ablation for lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(1): 166-172. doi: 10.7507/1007-4848.202203061 Copy

1.	Gao S, Li N, Wang S, et al. Lung cancer in People's Republic of China. J Thorac Oncol, 2020, 15(10): 1567-1576.
2.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
3.	Alexander ES, Dupuy DE. Lung cancer ablation: Technologies and techniques. Semin Intervent Radiol, 2013, 30(2): 141-150.
4.	Chan MV, Huo YR, Cao C, et al. Survival outcomes for surgical resection versus CT-guided percutaneous ablation for stage Ⅰ non-small cell lung cancer (NSCLC): A systematic review and meta-analysis. Eur Radiol, 2021, 31(7): 5421-5433.
5.	柯明耀, 陈智德, 曾俊莉, 等. 肺磨玻璃结节诊治策略与消融治疗. 中国胸心血管外科临床杂志, 2022, 29(1): 11-22.
6.	Zemlyak A, Moore WH, Bilfinger TV. Comparison of survival after sublobar resections and ablative therapies for stage Ⅰ non-small cell lung cancer. J Am Coll Surg, 2010, 211(1): 68-72.
7.	Uhlig J, Ludwig JM, Goldberg SB, et al. Survival rates after thermal ablation versus stereotactic radiation therapy for stage 1 non-small cell lung cancer: A national cancer database study. Radiology, 2018, 289(3): 862-870.
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.	Venturini M, Cariati M, Marra P, et al. CIRSE standards of practice on thermal ablation of primary and secondary lung tumours. Cardiovasc Intervent Radiol, 2020, 43(5): 667-683.
10.	Kodama H, Yamakado K, Hasegawa T, et al. Radiofrequency ablation using a multiple-electrode switching system for lung tumors with 2.0-5.0-cm maximum diameter: Phase Ⅱ clinical study. Radiology, 2015, 277(3): 895-902.
11.	Steinke K, Haghighi KS, Wulf S, et al. Effect of vessel diameter on the creation of ovine lung radiofrequency lesions in vivo: Preliminary results. J Surg Res, 2005, 124(1): 85-91.
12.	Quirk MT, Lee S, Murali N, et al. Alternatives to surgery for early-stage non-small cell lung cancer: Thermal ablation. Clin Chest Med, 2020, 41(2): 197-210.
13.	黄伟, 马幸生. 微波消融术在肺癌中的应用. 中国胸心血管外科临床杂志, 2015, 22(3): 265-268.
14.	Brace CL, Laeseke PF, Sampson LA, et al. Microwave ablation with a single small-gauge triaxial antenna: In vivo porcine liver model. Radiology, 2007, 242(2): 435-440.
15.	Sharma A, Abtin F, Shepard JA. Image-guided ablative therapies for lung cancer. Radiol Clin North Am, 2012, 50(5): 975-999.
16.	Lin M, Eiken P, Blackmon S. Image guided thermal ablation in lung cancer treatment. J Thorac Dis, 2020, 12(11): 7039-7047.
17.	Dupuy DE, Zagoria RJ, Akerley W, et al. Percutaneous radiofrequency ablation of malignancies in the lung. AJR Am J Roentgenol, 2000, 174(1): 57-59.
18.	Chi J, Ding M, Shi Y, et al. Comparison study of computed tomography-guided radiofrequency and microwave ablation for pulmonary tumors: A retrospective, case-controlled observational study. Thorac Cancer, 2018, 9(10): 1241-1248.
19.	Macchi M, Belfiore MP, Floridi C, et al. Radiofrequency versus microwave ablation for treatment of the lung tumours: LUMIRA (lung microwave radiofrequency) randomized trial. Med Oncol, 2017, 34(5): 96.
20.	Jiang B, Mcclure MA, Chen T, et al. Efficacy and safety of thermal ablation of lung malignancies: A network meta-analysis. Ann Thorac Med, 2018, 13(4): 243-250.
21.	Lee EW, Chen C, Prieto VE, et al. Advanced hepatic ablation technique for creating complete cell death: Irreversible electroporation. Radiology, 2010, 255(2): 426-433.
22.	Herth FJ, Valipour A, Shah PL, et al. Segmental volume reduction using thermal vapour ablation in patients with severe emphysema: 6-month results of the multicentre, parallel-group, open-label, randomised controlled STEP-UP trial. Lancet Respir Med, 2016, 4(3): 185-193.
23.	Ferguson JS, Henne E. Bronchoscopically delivered thermal vapor ablation of human lung lesions. J Bronchology Interv Pulmonol, 2019, 26(2): 108-113.
24.	Welch BT, Brinjikji W, Schmit GD, et al. A national analysis of the complications, cost, and mortality of percutaneous lung ablation. J Vasc Interv Radiol, 2015, 26(6): 787-791.
25.	Hiraki T, Gobara H, Mimura H, et al. Percutaneous radiofrequency ablation of clinical stage Ⅰ non-small cell lung cancer. J Thorac Cardiovasc Surg, 2011, 142(1): 24-30.
26.	Inoue M, Nakatsuka S, Yashiro H, et al. Percutaneous cryoablation of lung tumors: Feasibility and safety. J Vasc Interv Radiol, 2012, 23(3): 295-302.
27.	Palussière J, Chomy F, Savina M, et al. Radiofrequency ablation of stage ⅠA non-small cell lung cancer in patients ineligible for surgery: Results of a prospective multicenter phaseⅡtrial. J Cardiothorac Surg, 2018, 13(1): 91.
28.	Huang BY, Li XM, Song XY, et al. Long-term results of CT-guided percutaneous radiofrequency ablation of inoperable patients with stage Ⅰa non-small cell lung cancer: A retrospective cohort study. Int J Surg, 2018, 53: 143-150.
29.	Yang X, Ye X, Zheng A, et al. Percutaneous microwave ablation of stageⅠ medically inoperable non-small cell lung cancer: Clinical evaluation of 47 cases. J Surg Oncol, 2014, 110(6): 758-763.
30.	Moore W, Talati R, Bhattacharji P, et al. Five-year survival after cryoablation of stage Ⅰ non-small cell lung cancer in medically inoperable patients. J Vasc Interv Radiol, 2015, 26(3): 312-319.
31.	Palussiere J, Lagarde P, Aupérin A, et al. Percutaneous lung thermal ablation of non-surgical clinical N0 non-small cell lung cancer: Results of eight years' experience in 87 patients from two centers. Cardiovasc Intervent Radiol, 2015, 38(1): 160-166.
32.	Lanuti M, Sharma A, Digumarthy SR, et al. Radiofrequency ablation for treatment of medically inoperable stage Ⅰ non-small cell lung cancer. J Thorac Cardiovasc Surg, 2009, 137(1): 160-166.
33.	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.
34.	Fode MM, Høyer M. Survival and prognostic factors in 321 patients treated with stereotactic body radiotherapy for oligo-metastases. Radiother Oncol, 2015, 114(2): 155-160.
35.	Chan MD, Dupuy DE, Mayo-Smith WW, et al. Combined radiofrequency ablation and high-dose rate brachytherapy for early-stage non-small-cell lung cancer. Brachytherapy, 2011, 10(3): 253-259.
36.	Sandler KA, Abtin F, Suh R, et al. A prospective phase 2 study evaluating safety and efficacy of combining stereotactic body radiation therapy with heat-based ablation for centrally located lung tumors. Int J Radiat Oncol Biol Phys, 2018, 101(3): 564-573.
37.	Rangamuwa K, Leong T, Weeden C, et al. Thermal ablation in non-small cell lung cancer: A review of treatment modalities and the evidence for combination with immune checkpoint inhibitors. Transl Lung Cancer Res, 2021, 10(6): 2842-2857.
38.	Zhu J, Yu M, Chen L, et al. Enhanced antitumor efficacy through microwave ablation in combination with immune checkpoints blockade in breast cancer: A pre-clinical study in a murine model. Diagn Interv Imaging, 2018, 99(3): 135-142.
39.	Lin M, Liang SZ, Wang XH, et al. Clinical efficacy of percutaneous cryoablation combined with allogenic NK cell immunotherapy for advanced non-small cell lung cancer. Immunol Res, 2017, 65(4): 880-887.
40.	Evaluating the safety and efficacy of pembrolizumab combined with MWA for advanced NSCLC. URL: https://ClinicalTrials.gov/show/NCT03769129. Accessed on 2020-08-04.
41.	Cryoablation combined with camrelizumab and apatinib for multiprimary lung cancer. URL: https://ClinicalTrials.gov/show/ NCT04201990. Accessed on 2019-12-17.
42.	Study of core needle biopsy and cryoablation of an enlarging T umor in patients with metastatic lung cancer and metastatic melanoma receiving post-progression immune checkpoint inhibitor therapy. URL: https://ClinicalTrials.gov/show/NCT03290677. Accessed on 2021-2-23.
43.	Cryoablation in combination (or not) with pembrolizumab and pemetrexed-carboplatin in 1st-line T reatment for patients with metastatic lung adenocarcinoma. URL: https://ClinicalTrials.gov/show/NCT04339218. Accessed on 2021-11-05.
44.	Microwave ablation in combination with camrelizumab versus camrelizumab in metastatic non-small-cell lung cancer. URL: https://ClinicalTrials.gov/show/NCT04102982. Accessed on 2020-11-02.

1. Gao S, Li N, Wang S, et al. Lung cancer in People's Republic of China. J Thorac Oncol, 2020, 15(10): 1567-1576.
2. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
3. Alexander ES, Dupuy DE. Lung cancer ablation: Technologies and techniques. Semin Intervent Radiol, 2013, 30(2): 141-150.
4. Chan MV, Huo YR, Cao C, et al. Survival outcomes for surgical resection versus CT-guided percutaneous ablation for stage Ⅰ non-small cell lung cancer (NSCLC): A systematic review and meta-analysis. Eur Radiol, 2021, 31(7): 5421-5433.
5. 柯明耀, 陈智德, 曾俊莉, 等. 肺磨玻璃结节诊治策略与消融治疗. 中国胸心血管外科临床杂志, 2022, 29(1): 11-22.
6. Zemlyak A, Moore WH, Bilfinger TV. Comparison of survival after sublobar resections and ablative therapies for stage Ⅰ non-small cell lung cancer. J Am Coll Surg, 2010, 211(1): 68-72.
7. Uhlig J, Ludwig JM, Goldberg SB, et al. Survival rates after thermal ablation versus stereotactic radiation therapy for stage 1 non-small cell lung cancer: A national cancer database study. Radiology, 2018, 289(3): 862-870.
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. Venturini M, Cariati M, Marra P, et al. CIRSE standards of practice on thermal ablation of primary and secondary lung tumours. Cardiovasc Intervent Radiol, 2020, 43(5): 667-683.
10. Kodama H, Yamakado K, Hasegawa T, et al. Radiofrequency ablation using a multiple-electrode switching system for lung tumors with 2.0-5.0-cm maximum diameter: Phase Ⅱ clinical study. Radiology, 2015, 277(3): 895-902.
11. Steinke K, Haghighi KS, Wulf S, et al. Effect of vessel diameter on the creation of ovine lung radiofrequency lesions in vivo: Preliminary results. J Surg Res, 2005, 124(1): 85-91.
12. Quirk MT, Lee S, Murali N, et al. Alternatives to surgery for early-stage non-small cell lung cancer: Thermal ablation. Clin Chest Med, 2020, 41(2): 197-210.
13. 黄伟, 马幸生. 微波消融术在肺癌中的应用. 中国胸心血管外科临床杂志, 2015, 22(3): 265-268.
14. Brace CL, Laeseke PF, Sampson LA, et al. Microwave ablation with a single small-gauge triaxial antenna: In vivo porcine liver model. Radiology, 2007, 242(2): 435-440.
15. Sharma A, Abtin F, Shepard JA. Image-guided ablative therapies for lung cancer. Radiol Clin North Am, 2012, 50(5): 975-999.
16. Lin M, Eiken P, Blackmon S. Image guided thermal ablation in lung cancer treatment. J Thorac Dis, 2020, 12(11): 7039-7047.
17. Dupuy DE, Zagoria RJ, Akerley W, et al. Percutaneous radiofrequency ablation of malignancies in the lung. AJR Am J Roentgenol, 2000, 174(1): 57-59.
18. Chi J, Ding M, Shi Y, et al. Comparison study of computed tomography-guided radiofrequency and microwave ablation for pulmonary tumors: A retrospective, case-controlled observational study. Thorac Cancer, 2018, 9(10): 1241-1248.
19. Macchi M, Belfiore MP, Floridi C, et al. Radiofrequency versus microwave ablation for treatment of the lung tumours: LUMIRA (lung microwave radiofrequency) randomized trial. Med Oncol, 2017, 34(5): 96.
20. Jiang B, Mcclure MA, Chen T, et al. Efficacy and safety of thermal ablation of lung malignancies: A network meta-analysis. Ann Thorac Med, 2018, 13(4): 243-250.
21. Lee EW, Chen C, Prieto VE, et al. Advanced hepatic ablation technique for creating complete cell death: Irreversible electroporation. Radiology, 2010, 255(2): 426-433.
22. Herth FJ, Valipour A, Shah PL, et al. Segmental volume reduction using thermal vapour ablation in patients with severe emphysema: 6-month results of the multicentre, parallel-group, open-label, randomised controlled STEP-UP trial. Lancet Respir Med, 2016, 4(3): 185-193.
23. Ferguson JS, Henne E. Bronchoscopically delivered thermal vapor ablation of human lung lesions. J Bronchology Interv Pulmonol, 2019, 26(2): 108-113.
24. Welch BT, Brinjikji W, Schmit GD, et al. A national analysis of the complications, cost, and mortality of percutaneous lung ablation. J Vasc Interv Radiol, 2015, 26(6): 787-791.
25. Hiraki T, Gobara H, Mimura H, et al. Percutaneous radiofrequency ablation of clinical stage Ⅰ non-small cell lung cancer. J Thorac Cardiovasc Surg, 2011, 142(1): 24-30.
26. Inoue M, Nakatsuka S, Yashiro H, et al. Percutaneous cryoablation of lung tumors: Feasibility and safety. J Vasc Interv Radiol, 2012, 23(3): 295-302.
27. Palussière J, Chomy F, Savina M, et al. Radiofrequency ablation of stage ⅠA non-small cell lung cancer in patients ineligible for surgery: Results of a prospective multicenter phaseⅡtrial. J Cardiothorac Surg, 2018, 13(1): 91.
28. Huang BY, Li XM, Song XY, et al. Long-term results of CT-guided percutaneous radiofrequency ablation of inoperable patients with stage Ⅰa non-small cell lung cancer: A retrospective cohort study. Int J Surg, 2018, 53: 143-150.
29. Yang X, Ye X, Zheng A, et al. Percutaneous microwave ablation of stageⅠ medically inoperable non-small cell lung cancer: Clinical evaluation of 47 cases. J Surg Oncol, 2014, 110(6): 758-763.
30. Moore W, Talati R, Bhattacharji P, et al. Five-year survival after cryoablation of stage Ⅰ non-small cell lung cancer in medically inoperable patients. J Vasc Interv Radiol, 2015, 26(3): 312-319.
31. Palussiere J, Lagarde P, Aupérin A, et al. Percutaneous lung thermal ablation of non-surgical clinical N0 non-small cell lung cancer: Results of eight years' experience in 87 patients from two centers. Cardiovasc Intervent Radiol, 2015, 38(1): 160-166.
32. Lanuti M, Sharma A, Digumarthy SR, et al. Radiofrequency ablation for treatment of medically inoperable stage Ⅰ non-small cell lung cancer. J Thorac Cardiovasc Surg, 2009, 137(1): 160-166.
33. 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.
34. Fode MM, Høyer M. Survival and prognostic factors in 321 patients treated with stereotactic body radiotherapy for oligo-metastases. Radiother Oncol, 2015, 114(2): 155-160.
35. Chan MD, Dupuy DE, Mayo-Smith WW, et al. Combined radiofrequency ablation and high-dose rate brachytherapy for early-stage non-small-cell lung cancer. Brachytherapy, 2011, 10(3): 253-259.
36. Sandler KA, Abtin F, Suh R, et al. A prospective phase 2 study evaluating safety and efficacy of combining stereotactic body radiation therapy with heat-based ablation for centrally located lung tumors. Int J Radiat Oncol Biol Phys, 2018, 101(3): 564-573.
37. Rangamuwa K, Leong T, Weeden C, et al. Thermal ablation in non-small cell lung cancer: A review of treatment modalities and the evidence for combination with immune checkpoint inhibitors. Transl Lung Cancer Res, 2021, 10(6): 2842-2857.
38. Zhu J, Yu M, Chen L, et al. Enhanced antitumor efficacy through microwave ablation in combination with immune checkpoints blockade in breast cancer: A pre-clinical study in a murine model. Diagn Interv Imaging, 2018, 99(3): 135-142.
39. Lin M, Liang SZ, Wang XH, et al. Clinical efficacy of percutaneous cryoablation combined with allogenic NK cell immunotherapy for advanced non-small cell lung cancer. Immunol Res, 2017, 65(4): 880-887.
40. Evaluating the safety and efficacy of pembrolizumab combined with MWA for advanced NSCLC. URL: https://ClinicalTrials.gov/show/NCT03769129. Accessed on 2020-08-04.
41. Cryoablation combined with camrelizumab and apatinib for multiprimary lung cancer. URL: https://ClinicalTrials.gov/show/ NCT04201990. Accessed on 2019-12-17.
42. Study of core needle biopsy and cryoablation of an enlarging T umor in patients with metastatic lung cancer and metastatic melanoma receiving post-progression immune checkpoint inhibitor therapy. URL: https://ClinicalTrials.gov/show/NCT03290677. Accessed on 2021-2-23.
43. Cryoablation in combination (or not) with pembrolizumab and pemetrexed-carboplatin in 1st-line T reatment for patients with metastatic lung adenocarcinoma. URL: https://ClinicalTrials.gov/show/NCT04339218. Accessed on 2021-11-05.
44. Microwave ablation in combination with camrelizumab versus camrelizumab in metastatic non-small-cell lung cancer. URL: https://ClinicalTrials.gov/show/NCT04102982. Accessed on 2020-11-02.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Research advances in thermal ablation for lung cancer

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