Thomas Vogl, Institute of Diagnostic and Interventional Radiology, Goethe University, Frankfurt, spoke at ECIO (19–22 June, Budapest Hungary) about novel lung ablative techniques and the evidence for combination ablative therapies.
Vogl told delegates that decision making when treating a patient with a large tumour is difficult as there are many factors which have to be considered such as localisation of the tumour, disease-free intervals, symptoms and side effects, amongst others factors. He said, in order to optimise tumour ablation the operator had to consider the biology of the patient and tumour, the technology available and the strategy for ablation, ie. crytoreduction or downstaging.
There are a number of ablative technologies and techniques currently available for the treatment of pulmonary tumours, such as radiofrequency ablation, microwave ablation, cryotherapy, irreversible electroporation and laser therapy.
Vogl commented that microwave ablation was quicker, achieved higher intratumoural temperatures, left a clearer delineated ablation zone, allowed simultaneous ablation and resulted in lower procedural pain than radiofrequency ablation. He added that, of the two techniques, the results published in the European Journal of Radiology in April 2010 showed that “tumour type per se did not affect control” when using radiofrequency ablation.
The results of another study, published in the Journal of Vascular and Interventional Radiology (September 2011), Vogl noted that, in a cohort of patients treated with radiofrequency ablation and microwave ablation algorithmic approach showed that patients who developed pneumothorax as a complication could be “managed by close observation without interruption of ablation therapy”, for both techniques.
In terms of optimising thermal ablation in the future, Vogl said that microwave ablation could be used in combination with transpulmonary chemoembolization, bland embolization and vein/artery occlusion for large lesions or high tumour burden.
He said, in the case of using chemoembolization and microwave ablation together, embolization can decrease the heat sink effect and microwave ablation can increase the circulating drug deposited, therefore increasing tumour response.
Vogl concluded that there are a number of different ablation systems currently available, and that ablation is a safe and effective treatment with low complications rates. He added that local tumour control depends on the size of the tumour and its location.
“The case for combining thermal ablation with other therapies (including chemotherapy, radiation, percutaneous ethanol injection and hyperthermia) cannot be overstated”, he added.