MS06.02 The Role of Interventional Pulmonology and Radiology

Abstract

The Role of Pulmonology and Interventional Radiology in the Management of Oligometastatic NSCLC Oligometastatic disease is a difficult management issue when encountered in NSCLC. Often defined as low metastatic burden and limited organ involvement disease, with clinical impact perceived as between truly localised potentially curable disease and an extensive incurable metastatic tumour, therefore with major implication for the patient in terms of treatment, with the potential to pivot the decision making from palliative to curative intent. In addition the site(s) of oligometastatic disease is heterogenous with potential to affect any site in the body, both intra and extra- thoracic, thus requiring a truly multidisciplinary approach to its management. It is essential to make an accurate diagnosis, to consider synchronous cancers and to rule out more extensive metastatic disease given the differing management strategies required. For the Pulmonologist and Interventional Radiologist, for intrathoracic oligometastatic disease, the issues are the diagnostic challenges and potential therapeutics. The use of image guided trans thoracic needle biopsy has long been used effectively by Interventional Radiology for the pathological diagnosis of suspected lesions. With modern endobronchial ultrasound, Pulmonologists are able to contribute more by accessing central and peripheral lung lesions by navigation and guided bronchoscopy e.g. ultrasound guided, electromagnetic navigation and transparenchymal approaches. With the increasing use of molecular techniques to distinguish cancers even of the same morphological appearance, such diagnostic approaches are of increasing clinical utility. For intrathoracic therapeutics, local Interventional Radiology ablative techniques such as radiofrequency ablation has long been used, with microwave ablation increasingly popular. In parallel with diagnostics, emerging Pulmonology techniques are also researching the potential application of these techniques applied endobronchially in addition to new modalities such as steam ablation. Interventional Radiologists also have a useful role to play in the management of extra-thoracic oligometastatic disease, as techniques such as radiofrequency and microwave ablation can be used such as for liver lesions. This session will review the emerging data for the key role of Pulmonology and Interventional Radiology in the Management of Oligometastatic NSCLC. Pulmonology, Interventional Radiology, Oligometastatic NSCLC