Image-guided ablation of lung tumors
- Damian E Dupuy, MD
Damian E Dupuy, MD
- Director of Tumor Ablation
- Rhode Island Hospital
- Professor of Diagnostic Imaging
- Brown Medical School
- Section Editors
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
- Steven E Schild, MD
Steven E Schild, MD
- Section Editor — Radiation Therapy
- Professor of Radiation Oncology
- Mayo Clinic College of Medicine
- Eric Vallières, MD, FRCSC
Eric Vallières, MD, FRCSC
- Surgical Director of the Lung Cancer Program
- Swedish Cancer Institute
Lung cancer is the leading cause of cancer deaths worldwide in men, and second most common in women . In the United States, lung cancer will occur in approximately 225,000 patients and cause over 160,000 deaths annually . Worldwide, lung cancer occurred in approximately 1.8 million patients in 2012 and caused an estimated 1.6 million deaths . 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 . 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".)
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