Percutaneous laser-induced thermoablation (LIT) of non-resectable lung metastases and primary lung tumors: A preliminary evaluation of technical aspects and local efficiency

Abstract

17106 Background: Surgical resection remains the standard of care for solitary lung metastasis from colorectal cancer or primitive lung tumors. Nevertheless only a small part of patients can be radically resected. Thermal ablation is a mini-invasive local treatment that can be considered an alternative approach in non-resectable lesions or inoperable patients. Methods: We present a consecutive series of thirteen patients treated with LIT from March 2004 to March 2005. Nine patients had a small (maximum diameter smaller than 5 cm) non-resectable lung carcinoma while four patients had a solitary metastasis from colorectal cancer. Median age was 70-yrs (range 55–87), male-female ratio was 2:1. After mild sedation and local anaesthesia, optical fibers were inserted directly into the tumor with CT-guided percutaneous needle placement. Each optical fiber was connected to a neodymium:yttrium-aluminium-garnet (ND:YAG) laser, which delivers concentrated light at a wave-length of 1064 nm, with a 5-Watt power and a 1800-Joule energy per single fiber. A minimum of two and a maximum of four needles were used, with a 5 to 8 mm distance from one needle to another. Results: All the patients tolerated LIT procedure well, developing a minimal pneumothorax, which did not require any treatment. Easy manageable local side-effects occurred in two cases (a mild self-limiting haemoptysis and a pleural empyema). Post-treatment CT-scan demonstrated complete thermonecrosis in all the lesions smaller than 3 cm and almost complete in the bigger ones (3 to 5 cm). All the patients are still alive, with a local tumor control rate of 100% at radiological follow-up: no local progression was observed in 10 pts with a follow-up of at least 12 months and in 3 pts with a follow-up of at least 6 months. Conclusions: Percutaneous LIT permitted a complete ablation of lung metastases and lung carcinomas with an optimal local tumor control rate at 1-year and a low complication rate. Complete necrosis was achieved only in lesions with maximum diameter smaller than 3 cm. No significant financial relationships to disclose.