Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Image-guided ablation of lung tumors

Damian E Dupuy, MD
Section Editors
Rogerio C Lilenbaum, MD, FACP
Steven E Schild, MD
Eric Vallières, MD, FRCSC
Deputy Editor
Sadhna R Vora, MD


Lung cancer is the leading cause of cancer deaths worldwide in men, and second most common in women [1]. In the United States, lung cancer will occur in approximately 225,000 patients and cause over 160,000 deaths annually [2]. Worldwide, lung cancer occurred in approximately 1.8 million patients in 2012 and caused an estimated 1.6 million deaths [3]. The lung is also a common site for metastatic disease. Common primary tumors metastasizing to the lungs include colorectal cancer, breast cancer, renal cancer, melanoma, sarcomas, and head and neck cancer.

Surgery is the standard treatment option for most patients with resectable lung cancer and for the unusual patient with oligometastatic lung metastases. However, surgery is not appropriate in many cases because of the presence of disseminated disease or because the patient’s age or comorbidity precludes a surgical approach. In these settings, palliation of pulmonary symptoms may be beneficial.

The options for patients in this situation include palliative surgical procedures, different types of radiation therapy, and image-guided techniques. Systemic chemotherapy may be too toxic for this group of patients and many may have already failed this treatment option. Over the past two decades many image-guided techniques have been applied to the treatment of lung neoplasms. All of these techniques rely on thermal or electrical methods to directly destroy tumor cells in-situ [4]. These image-guided procedures are almost exclusively performed under computed tomography (CT) guidance. There are many factors that affect the utilization and patient outcomes when these techniques are to be considered, including tumor biology, tumor location and extent, and the patient’s overall health.

Among image-guided techniques, radiofrequency ablation is used more commonly than microwave ablation, laser ablation, cryoablation, and irreversible electroporation. These techniques are discussed below, including clinical data where available. However, there are no trials comparing these image-guided techniques.

The roles of limited surgical techniques and stereotactic body radiation therapy are discussed separately. (See "Management of stage I and stage II non-small cell lung cancer", section on 'Limited (sublobar) resection' and "Surgical resection of pulmonary metastases: Benefits, indications, preoperative evaluation, and techniques" and "Stereotactic body radiation therapy for primary and metastatic lung tumors".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: Aug 30, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65:87.
  2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015; 65:5.
  3. Brambilla E, Travis WD. Lung cancer. In: World Cancer Report, Stewart BW, Wild CP (Eds), World Health Organization, Lyon 2014.
  4. Ahmed M, Brace CL, Lee FT Jr, Goldberg SN. Principles of and advances in percutaneous ablation. Radiology 2011; 258:351.
  5. Organ LW. Electrophysiologic principles of radiofrequency lesion making. Appl Neurophysiol 1976-1977; 39:69.
  6. Nahum Goldberg S, Dupuy DE. Image-guided radiofrequency tumor ablation: challenges and opportunities--part I. J Vasc Interv Radiol 2001; 12:1021.
  7. Boston Scientific RF 3000 radiofrquency ablation system http://www.bostonscientific.com/templatedata/imports/collateral/Radiology/broc_rf3000_03_us.pdf.
  8. StarBurst (RITA) radiofrequency ablation system http://www.angiodynamics.com/products/what-is-rfa.
  9. Cool-Tip Covidien radiofrequency ablation system http://surgical.covidien.com/products/ablation-systems/cool-tip-rf-ablation-system-e-series.
  10. Simon CJ, Dupuy DE, DiPetrillo TA, et al. Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients. Radiology 2007; 243:268.
  11. Lee JM, Jin GY, Goldberg SN, et al. Percutaneous radiofrequency ablation for inoperable non-small cell lung cancer and metastases: preliminary report. Radiology 2004; 230:125.
  12. Lencioni R, Crocetti L, Cioni R, et al. Response to radiofrequency ablation of pulmonary tumours: a prospective, intention-to-treat, multicentre clinical trial (the RAPTURE study). Lancet Oncol 2008; 9:621.
  13. de Baère T, Palussière J, Aupérin A, et al. Midterm local efficacy and survival after radiofrequency ablation of lung tumors with minimum follow-up of 1 year: prospective evaluation. Radiology 2006; 240:587.
  14. Ambrogi MC, Fanucchi O, Cioni R, et al. Long-term results of radiofrequency ablation treatment of stage I non-small cell lung cancer: a prospective intention-to-treat study. J Thorac Oncol 2011; 6:2044.
  15. Kashima M, Yamakado K, Takaki H, et al. Complications after 1000 lung radiofrequency ablation sessions in 420 patients: a single center's experiences. AJR Am J Roentgenol 2011; 197:W576.
  16. Dupuy DE. Treatment of medically inoperable non-small-cell lung cancer with stereotactic body radiation therapy versus image-guided tumor ablation: can interventional radiology compete? J Vasc Interv Radiol 2013; 24:1139.
  17. Chua TC, Sarkar A, Saxena A, et al. Long-term outcome of image-guided percutaneous radiofrequency ablation of lung metastases: an open-labeled prospective trial of 148 patients. Ann Oncol 2010; 21:2017.
  18. Palussière J, Marcet B, Descat E, et al. Lung tumors treated with percutaneous radiofrequency ablation: computed tomography imaging follow-up. Cardiovasc Intervent Radiol 2011; 34:989.
  19. de Baère T, Aupérin A, Deschamps F, et al. Radiofrequency ablation is a valid treatment option for lung metastases: experience in 566 patients with 1037 metastases. Ann Oncol 2015; 26:987.
  20. Dupuy DE, Fernando HC, Hillman S, et al. Radiofrequency ablation of stage IA non-small cell lung cancer in medically inoperable patients: Results from the American College of Surgeons Oncology Group Z4033 (Alliance) trial. Cancer 2015; 121:3491.
  21. Borghol S, Alberti N, Frulio N, et al. Pulmonary artery pseudoaneurysm after radiofrequency ablation: report of two cases. Int J Hyperthermia 2015; 31:1.
  22. Vaughn C, Mychaskiw G 2nd, Sewell P. Massive hemorrhage during radiofrequency ablation of a pulmonary neoplasm. Anesth Analg 2002; 94:1149.
  23. Bi N, Shedden K, Zheng X, Kong F. Comparison of the Effectiveness of Radiofrequency Ablation With Stereotactic Body Radiation Therapy in Inoperable Stage I Non-Small Cell Lung Cancer: A Systemic Review and Meta-analysis. Pract Radiat Oncol 2013; 3:S19.
  24. Simon CJ, Dupuy DE, Mayo-Smith WW. Microwave ablation: principles and applications. Radiographics 2005; 25 Suppl 1:S69.
  25. Ward RC, Healey TT, Dupuy DE. Microwave ablation devices for interventional oncology. Expert Rev Med Devices 2013; 10:225.
  26. Evident (Covidien) microwave ablation system http://surgical.covidien.com/products/ablation-systems.
  27. MicrothermX BSD microwave ablation system http://www.bsdmedical.com/usa/brochures/Microthermx_Brochure.pdf.
  28. Avecure Medwaves microwave ablation system http://www.medwaves.com/.
  29. Certus 140 Neuwave Medical microwave ablation system http://www.neuwavemedical.com/NeuWaveMedicalFilePile/NeuWaveFDAClearancePress20101028Final9.pdf.
  30. AMICA microwave ablation system http://www.mermaidmedical.dk/PDF/Norway/9_Thermoablation/AMICA%20Aparatus%20for%20Microwawe%20Ablation.pdf.
  31. Acculis MTA microwave ablation system http://www.angiodynamics.com/products/Acculis.
  32. Wolf FJ, Grand DJ, Machan JT, et al. Microwave ablation of lung malignancies: effectiveness, CT findings, and safety in 50 patients. Radiology 2008; 247:871.
  33. Vogl TJ, Worst TS, Naguib NN, et al. Factors influencing local tumor control in patients with neoplastic pulmonary nodules treated with microwave ablation: a risk-factor analysis. AJR Am J Roentgenol 2013; 200:665.
  34. 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; 82:177.
  35. Hall RR, Beach AD, Baker E, Morison PC. Incision of tissue by carbon dioxide laser. Nature 1971; 232:131.
  36. Vogl TJ, Straub R, Lehnert T, et al. [Percutaneous thermoablation of pulmonary metastases. Experience with the application of laser-induced thermotherapy (LITT) and radiofrequency ablation (RFA), and a literature review]. Rofo 2004; 176:1658.
  37. Rosenberg C, Puls R, Hegenscheid K, et al. Laser ablation of metastatic lesions of the lung: long-term outcome. AJR Am J Roentgenol 2009; 192:785.
  38. BioTex Visuase laser technology http://www.biotexmedical.com/.
  39. Gage AA. History of cryosurgery. Semin Surg Oncol 1998; 14:99.
  40. Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology 1998; 37:171.
  41. Cryohit cryotherapy system http://www.galilmedical.com/.
  42. Endocare cryotherapy system https://www.healthtronics.com/physicians/cryotherapy/cryotherapy-services-and-solutions.
  43. Hinshaw JL, Littrup PJ, Durick N, et al. Optimizing the protocol for pulmonary cryoablation: a comparison of a dual- and triple-freeze protocol. Cardiovasc Intervent Radiol 2010; 33:1180.
  44. Maiwand MO. The role of cryosurgery in palliation of tracheo-bronchial carcinoma. Eur J Cardiothorac Surg 1999; 15:764.
  45. Wang H, Littrup PJ, Duan Y, et al. Thoracic masses treated with percutaneous cryotherapy: initial experience with more than 200 procedures. Radiology 2005; 235:289.
  46. Kawamura M, Izumi Y, Tsukada N, et al. Percutaneous cryoablation of small pulmonary malignant tumors under computed tomographic guidance with local anesthesia for nonsurgical candidates. J Thorac Cardiovasc Surg 2006; 131:1007.
  47. Yashiro H, Nakatsuka S, Inoue M, et al. Factors affecting local progression after percutaneous cryoablation of lung tumors. J Vasc Interv Radiol 2013; 24:813.
  48. Moore W, Talati R, Bhattacharji P, Bilfinger T. Five-year survival after cryoablation of stage I non-small cell lung cancer in medically inoperable patients. J Vasc Interv Radiol 2015; 26:312.
  49. Rubinsky B, Onik G, Mikus P. Irreversible electroporation: a new ablation modality--clinical implications. Technol Cancer Res Treat 2007; 6:37.
  50. Davalos RV, Mir IL, Rubinsky B. Tissue ablation with irreversible electroporation. Ann Biomed Eng 2005; 33:223.
  51. Nanoknife system http://www.angiodynamics.com/products/nanoknife.
  52. Maor E, Ivorra A, Leor J, Rubinsky B. The effect of irreversible electroporation on blood vessels. Technol Cancer Res Treat 2007; 6:307.
  53. Thomson KR, Cheung W, Ellis SJ, et al. Investigation of the safety of irreversible electroporation in humans. J Vasc Interv Radiol 2011; 22:611.
  54. Usman M, Moore W, Talati R, et al. Irreversible electroporation of lung neoplasm: a case series. Med Sci Monit 2012; 18:CS43.
  55. Crabtree T, Puri V, Timmerman R, et al. Treatment of stage I lung cancer in high-risk and inoperable patients: comparison of prospective clinical trials using stereotactic body radiotherapy (RTOG 0236), sublobar resection (ACOSOG Z4032), and radiofrequency ablation (ACOSOG Z4033). J Thorac Cardiovasc Surg 2013; 145:692.
  56. 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; 26:787.