Percutaneous Ablation of Lung Cancer (NSCLC)
- Lung cancer is the most frequent cause of cancer death: Incidence of 2.1 million patients and mortality of 1.7 million patients per year1
- Resection is standard of care for early tumours but only 15-30% of patients are eligible2
- Increased detection rates for early lung cancer due to screening programs
- Lung is a frequent site of metastatic disease: 1/3 of cancer patients develop lung metastasis3
Indications for Ablation
- Primary lung cancer: Small-size (<3 cm), non-small cell lung carcinoma (NSCLC) in non-surgical patients4
- Lung metastasis: Small-size (<3 cm) slow-evolving metastatic lung tumours, oligometastatic disease, recurrences after surgery or radiation tumours.5
- Patients with limited functional reserve of the lung
- RFA, MWA, Cryo5
- Multiplanar, CT-based confirmation of needle position required6
- Margins of 5 mm are predictive of effective ablation7
- Avoid ablation zones at organ borders (risk of pleural fistula and skin burns) through longer trajectories8
- European Society for Medical Oncology (ESMO): Ablation for lung-only or oligometastases of the lung9
- National Comprehensive Cancer Network (NCCN): Ablation as definitive local therapy for inoperable patients10
- American College of Chest Physicians (ACCP): Percutaneous ablation as a therapeutic option in inoperable patients11
|Treatment comparison||IR Ablation||SBRT||Resection|
|Tissue and function preservation||++||+||--|
|Short recovery time||++||++||--|
|Number of sessions||1||1-5||1|
|Applicability for future tumours||++||-||--|
Stereotactic Lung Cancer Ablation with CAS-One
- Multiplanar planning and validation avoid inaccurate needle placement
- Off-plane needle guidance enables access to all locations in the lung
- Accurate needle placement in one attempt reduces the risk of pneumothorax
- Fusion-based margin validation supports reliable and complete ablation
Primary lung cancer
- One-, three-, and five-year overall survival up to 97%, 72%, 55% reported for ablation12
- No difference in overall survival between surgery, RFA, and Cryoablation for stage I lesions13
- Ablation can treat several tumours and bilobar disease and induce complete necrosis14
- Number of tumours and bilobal disease do not affect survival15
- Lower morbidity and mortality compared to surgery4, 5
- Shorter treatment and faster recovery in comparison to surgery4, 16
- Only one treatment session for ablation whereas SBRT requires several sessions4
- Ablation is the most tissue-saving treatment
- Surgery requires wedge resections (=large volume loss and reduced lung function)
- SBRT leads to radiation-induced toxicity which prevents further treatments after 2 tumours and also increases risk for pathological rib fractures with severe pain consequences
- Bray, F. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA. Cancer J. Clin. 68, 394–424 (2018).
- Walters S. et al. Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study, 2004-2007
- Stella GM, Kolling S, Benvenuti S, Bortolotto C. Lung-Seeking Metastases. Cancers (Basel). 2019 Jul 19;11(7)
- de Baere, T. et al. Percutaneous thermal ablation of primary lung cancer. Diagn. Interv. Imaging 97, 1019–1024 (2016).
- Palussière, J., Catena, V. & Buy, X. Percutaneous thermal ablation of lung tumors – Radiofrequency, microwave and cryotherapy: Where are we going? Diagn. Interv. Imaging 98, 619–625 (2017).
- Antoch, G., Kuehl, H., Vogt, F. M., Debatin, J. F. & Stattaus, J. Value of CT Volume Imaging for Optimal Placement of Radiofrequency Ablation Probes in Liver Lesions. J. Vasc. Interv. Radiol. 13, 1155–1161 (2002).
- Anderson, E. M., Lees, W. R. & Gillams, A. R. Early Indicators of Treatment Success After Percutaneous Radiofrequency of Pulmonary Tumors. Cardiovasc. Intervent. Radiol. 32, 478–483 (2009).
- Hinshaw, J. L., Lubner, M. G., Ziemlewicz, T. J., Lee, F. T. & Brace, C. L. Percutaneous Tumor Ablation Tools: Microwave, Radiofrequency, or Cryoablation—What Should You Use and Why? RadioGraphics 34, 1344–1362 (2014).
- Postmus, P. E. et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. Off. J. Eur. Soc. Med. Oncol. 28, iv1–iv21 (2017).
- Ettinger, D. S. et al. , version 5.2018 featured updates to the NCCN guidelines. JNCCN Journal of the National Comprehensive Cancer Network vol. 16 807–821 (2018).
- Detterbeck, F. C., Lewis, S. Z., Diekemper, R., Addrizzo-Harris, D. & Alberts, W. M. Executive Summary: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143, 7S-37S (2013).
- Kodama, H. et al. Lung radiofrequency ablation for the treatment of unresectable recurrent non-small-cell lung cancer after surgical intervention. Cardiovasc. Intervent. Radiol. 35, 563–569 (2012).
- Zemlyak, A., Moore, W. H. & Bilfinger, T. V. Comparison of Survival after Sublobar Resections and Ablative Therapies for Stage I Non-Small Cell Lung Cancer. J. Am. Coll. Surg. 211, 68–72 (2010).
- Jaskolka, J. D. et al. Pathologic assessment of radiofrequency ablation of pulmonary metastases. J. Vasc. Interv. Radiol. 21, 1689–1696 (2010).
- Gillams, A., Khan, Z., Osborn, P. & Lees, W. Survival after Radiofrequency Ablation in 122 Patients with Inoperable Colorectal Lung Metastases. Cardiovasc. Intervent. Radiol. 36, 724–730 (2013).
- Kim, S. R. et al. Comparison between surgery and radiofrequency ablation for stage i non-small cell lung cancer. Eur. J. Radiol. 81, 395–399 (2012).