Lung Ablation: Year in Review

Dr. Robert Suh, MD, a Clinical Professor in the Department of Radiological Sciences at the Ronald Reagan UCLA Medical Center, presented a comprehensive overview of the current state of lung ablation during CIO 2023. 

Dr. Robert Suh, MD, a Clinical Professor in the Department of Radiological Sciences at the Ronald Reagan UCLA Medical Center, presented a comprehensive overview of the current state of lung ablation during the 2023 Symposium on Clinical Interventional Oncology. His presentation aimed to provide a year in review, summarizing key findings from recent studies related to lung ablation. 

The talk began by acknowledging Dr. Suh's gratitude for the opportunity to discuss advancements in lung ablation. He conducted a PubMed search, yielding 443 results related to lung ablation in the last year. He filtered this extensive pool to focus on studies contributing valuable insights to the existing body of knowledge. 

One notable study from NYU investigated cryoablation in elderly patients (80 and over) with stage 1A, 1B, and 2B lung cancers. The results were remarkable, with a 100% overall survival at one year and 94% at two and three years. However, the study also highlighted a high incidence of pneumothoraces, emphasizing the need for careful consideration of complications. 

The discussion then shifted to microwave ablation, with a notable study from Shanghai comparing outcomes for tumors near and away from the bronchovascular bundle. Tumors ablated away from the bundle showed significantly better overall survival at one, two, and three years, as well as a better local-progression-free survival at every annual time point. This raised important considerations for the challenges posed by tumors in proximity to the bronchovascular bundle. 

Another Chinese study of microwave ablation investigated the incidence of cavitation. Factors such as tumor contact with larger blood vessels or bronchi, increased power, and larger ablation volumes were linked to cavitation. The study emphasized the importance of caution when treating tumors with microwave ablation near critical structures to avoid complications such as delayed hydro pneumothorax, bronchopleural fistula, and longer hospitalizations. “This in combination with the prior paper amplifies the need to use caution when treating with microwave ablation tumors in and around the bronchovascular bundle,” noted Dr. Suh.  

Dr. Suh discussed a study by Hahn that aimed to predict the pain associated with lung microwave ablation. Factors such as nodule depth, proximity to the pleura, puncture depth, and the use of multiple antennas were identified as predictors of severe pain. The presentation featured a nomogram to help guide decisions based on these factors. 

The session concluded with research that explored the incidence of persistent air leaks and factors influencing hospital stay duration in lung ablation. Microwave ablation was associated with a significantly higher rate of persistent air leaks compared to cryoablation, and the use of cryoablation reduced the odds of a persistent air leak by 67%. Factors such as chronic obstructive pulmonary disease and the use of general anesthesia when doing microwave ablation were independently associated with longer hospital stays. 

Dr. Suh's presentation highlighted the progress made in lung ablation, particularly in the elderly population, and underscored the importance of caution when dealing with tumors near critical structures. The findings emphasized the need for a nuanced approach to maximize efficacy while minimizing complications in lung ablation procedures.