Chapter 104 - Lung Ablation

Abstract

Lung cancer is both the most common primary cancer and the most common cause of cancer death. Although surgery remains the mainstay of treatment for lung cancer, many patients are deemed medically inoperable, and radiation therapy shows only fair long-term survival rates. Image-guided thermal ablation techniques, including radiofrequency, microwave, laser, and cryotherapy, have been increasingly used in both curative and palliative settings for both primary and metastatic disease. To date, successful use of these modalities has been documented in treatment of solid tumors in various other organs including the liver, kidney, and bones. Several recent retrospective and prospective cohort studies have also shown safety and efficacy of thermal ablation within the lung, although there are unique challenges due to organ-specific anatomy, physiology, and risk of complication. Of note, a recent prospective pilot trial assessing 2-year post-radiofrequency ablation survival and local control in patients with stage IA medically inoperable non–small cell lung cancer showed overall survival rates of 86% at 1 year and 70% at 2 years, with local tumor recurrence-free rates of 69% at 1 year and 60% at 2 years. This chapter aims to review the biophysics of thermal ablation modalities, the results of notable recent outcomes studies, complications associated with lung ablation, new innovations in ablation techniques, and the overall role of lung ablation in multidisciplinary treatment of lung cancer.