Microwave ablation of lung tumors

Transcription

1 Microwave ablation of lung tumors Poster No.: C-2490 Congress: ECR 2012 Type: Scientific Exhibit Authors: G. Carrafiello 1, A. M. Ierardi 1, E. Macchi 1, N. Lucchina 1, V. Molinelli 1, E. Duka 1, C. Pellegrino 1, F. Piacentino 2, C. Fugazzola 1 ; 1 Varese/IT, 2 varese/it Keywords: DOI: Lung, Oncology, CT, Ablation procedures, Neoplasia /ecr2012/C-2490 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 7

2 Purpose Lung cancer is one of the tumors arousing great interest among the scientific community in relation to the continuous increase of its incidence and high mortality rate worldwide. This tumour has the highest rate of incidence and mortality (1.35 million new cases annually and 1.18 million deaths), with the highest frequency in the United States of America and Europe. The aim of this study is the evaluation of feasibility, effectiveness and safety of microwave ablation (MWA) in lung tumors. Methods and Materials In this observational retrospective study, from 16 January 2009 to September 2011, were included 24 patients (16 males, 8 females) with an average age of 73 years (range years). The twenty-four patients underwent percutaneous microwave ablation of 26 intraparenchymal pulmonary masses. All patients were judged to be inoperable on the basis of tumour stage, comorbidities, advanced age and/or refusal to undergo surgery. A MWA system (Evident Microwave Ablation System, Covidien Ltd) consists of a generator capable of producing 45 W of power at a frequency of 915 MHz and coaxial cables to connect each generator with a straight (14.5 Gauge) microwave antenna. Antennas used for percutaneous procedures have the possibility to produce a radiating section length of 2 or 3.7 cm. Two or more antennas were used depending on the diameter of the lesion. Lesions with a diameter #3 cm were treated with a single antenna, lesions with a diameter >3 cm were treated by placing two antennas simultaneously. In all sessions the antenna placement procedure was performed under XperCT guidance. Throughout the entire ablation session patients were monitored by an anesthesiologist. At the end of each procedure a Cone Beam CT-scan was performed to verify the possible occurrence of complications after the treatment. All patients underwent CT follow-up with and without contrast administration at 1, 3 and 6 months and yearly in combination with complete blood and metabolic tests. Technical success was defined as the correct deployment of antennas into the lesions. Page 2 of 7

3 Safety was defined as the frequency of complications. All complications were recorded and classified into major and minor according to the Society of Interventional Radiology classification (SIR). Efficacy of the technique was defined on the basis of local control evaluating the enhancement of the lesion in follow-up CT-scans. The absence of contrast enhancement(<15hu) in the ablation area and a thin peripheral rim of enhancement with a thickness <5 mm at CT-scan performed after 3 months indicates a complete response. Focal irregular enhancement of treated lesion (> 15HU) was considered as a sign of residual disease. Images for this section: Fig. 1: A MWA system (Evident Microwave Ablation System, Covidien Ltd) consists of a generator capable of producing 45 W of power at a frequency of 915 MHz and coaxial cables to connect each generator with a straight (14.5 Gauge) microwave antenna placed into the lesion. Page 3 of 7

4 Results Technical success was 100%. In all cases, the antennas were correctly placed within the lesion. No major complications were recorded. Asymptomatic grade 1 pneumothorax was recorded in 9 patients (37,5 %). One case of asymptomatic pleural effusion and one case of hemoptysis, that did not require transfusion, were observed. None of the treated patients presente with post-ablation syndrome after the procedure. Complete necrosis was observed in 16 out of 26 lesions (61,6%). Partial necrosis was obtained in 30,8 % (8/26 lesions); these patients underwent another session of MWA with a complete necrosis of the lesion at the following CT-scans. In one case (3,8 %) was observed a progression of the disease and in another case (3,8 %) stability of disease was registered. Images for this section: Page 4 of 7

5 Fig. 2: A)CT-scan performed before the treatment: primary lung cancer (arrow); B) CTscan shows the antenna (arrow head) placed across the tumour; C) CT-scan reveals cavitation (star) of the lesion after the treatment. Fig. 3: A,B) CT-scan shows a lung cancer (arrow) located closer to important vessels; C) CT-scan shows the antenna placed across the tumour; D) CT-scan perfomed after 1 month; E) CT-scan performed after 3 month revealed a disease recurrence; F) CT-scan performed after the 2 session of MWA reveals complete necrosis. Page 5 of 7

6 Conclusion Our preliminary experience may be considered in accordance with Literature data, in terms of efficacy and safety. More patients with a longer period of follow-up are necessary to affirm microwave ablation of lung cancer as a good technique for local control of lung masses. References 1. Alberg AJ, Ford JG, Samet JM; et al. Epidemiology of lung cancer: ACCP evidencebased clinical practice guidelines (2nd edition). Chest. 2007;132:29S-55S. 2. Simon CJ,DupuyDE, DiPetrillo TA, et al. Pulmonary radiofrequency ablation: long- term safety and efficacy in 153 patients. Radiology. 2007;243: Simon CJ, Dupuy DE, Mayo-Smith WW (2005) Microwave ablation: principles and applications. RadioGraphics 25:S69-S Carrafiello G, Laganà D, Mangini M et al (2008) Microwave tumors ablation: principles, clinical applications and review of preliminary experiences. Int J Surg 6: Wolf FJ, Grand DJ, Machan JT et al (2008) Microwave ablation of lung malignancies: effectiveness, CT findings, and safety in 50 patients. Radiology 247: Braak SJ, van Strijen MJL, van Leersum et al. (2010) Real-Time 3D Fluoroscopy Guidance During Needle Interventions: Technique, Accuracy, and Feasibility. AJR Am J Roentgenol. 194(5):W Brace CL,Hinshaw JL, Laeseke PF et al (2009) Pulmonary thermal ablation: comparison of radiofrequency and microwave devices by using gross pathologic and CT findings in a swine model. Radiology 251: Goldberg SN, Dupuy DE. (2001) Image-guided radiofrequency tumour ablation: challenges and opportunities-parti.j Vasc Interv Radiol 12(10): Vogl TJ, Naguib NN, Gruber-Rouh T et al. (2011) Microwave ablation therapy: clinical utility in treatment of pulmonary metastases. Radiology.261(2): Cheung JY, Kim Y, Shim SS et al. (2011) Combined Fluoroscopy- and CT-Guided Transthoracic Needle Biopsy Using ac-arm Cone-Beam CTSystem: Comparison with Fluoroscopy Guided Biopsy. Korean J Radiol 12(1): Page 6 of 7

7 11. Laganà D, Carrafiello G, Mangini M, et al. (2008) Hepatic Radiofrequency under CTfluoroscopy Guidance. Radiol Med 113: Hwang HS, Chung MJ, Lee JW, et al.(2010) C-Arm Cone-Beam CT-Guided Percutaneous Transthoracic Lung Biopsy: Usefulness in Evaluation of Small Pulmonary Nodules. AJR 195:W400-W Balter S, Schieler BA, Miller DL et al.(2004) Radiation doses in interventional radiology procedures: the RAD-IR Study. Part III: Dosimetric performance of the interventional fluoroscopy units. J Vasc Interv Radiol 15(9): Personal Information Page 7 of 7