Technique Combines ‘Best of Both Worlds’ to Target Lung Nodules

A novel technique for pulmonary nodule ablation is feasible and safe for the treatment of early-stage lung cancers, lung metastases, and highly suspicious lung nodules, according to investigators.

The technique — bronchoscopic transbronchial microwave ablation — had a 100% technical success rate and produced low rates of complications in a single-center study.

“We combined the best of both worlds [for this] technique,” said investigator Joyce Chan, MBBS, of Prince of Wales Hospital in Hong Kong, when describing the method at the European Lung Cancer Virtual Congress 2021. The findings were published online April 1 in the Journal of Thoracic Oncology.

Chan explained that microwave ablation of lung nodules is faster and produces larger ablation zones, compared with radiofrequency ablation, and bronchoscopic ablation is thought to produce fewer pleural-based complications than percutaneous ablation.

Bronchoscopic transbronchial microwave ablation is performed in a hybrid operating room. First, the patient is intubated and anesthetized. Then, electromagnetic navigation bronchoscopy is used to zero in on the lung nodule, which is punctured by a microwave catheter. Cone-beam CT is used to confirm the location of the catheter.

“Next, we connect the system externally to a console, and then we just press the button to microwave it, just like what you do to food,” Chan explained.

Ablation takes about 10 minutes, and another CT is done to assess success. Ground-glass opacities are seen in the ablated area.

Study Results

Chan and colleagues performed a retrospective analysis of 36 patients who underwent bronchoscopic transbronchial microwave ablation between March 2019 and December 2020.

The patients were unfit for or unwilling to undergo surgical resection. They had to have stage 1a lung cancers, isolated lung oligometastases, or radiologically suspicious lesions. The nodules had to be less than 3 cm in size, preferably with a bronchus leading directly to the lesion.

The patients had a mean age of 68 years. Their lesions had a mean maximal diameter of 15.2 mm, and 68% were in the peripheral one third of the lung.

In all, 44 nodules were treated with bronchoscopic transbronchial microwave ablation. The technical success rate was 100%, although eight nodules required double ablation.

The majority of patients (95%) were discharged within 3 days, with 77% discharged on day 1. Complications included mild pain (15.9%), pneumothorax (9.1%), fever/ablation reaction (4.5%), self-limiting hemoptysis (2.3%), and bronchopleural fistula (2.3%).

The ablation zone volume decreased “rapidly” in the first 6 to 9 months, then leveled off, Chan noted.

In the 16 nodules with 1 year of follow-up, there were two complete responses, 13 partial responses, and no progressions.

It’s too soon to know if the recurrence rate will be lower than the up to 30% recurrence rate with percutaneous microwave ablation, and it’s too soon to know if, without transpleural puncture, the risk of tumor seeding is lower, Chan said.

“This presentation … is extremely important,” said invited discussant John Edwards, MBChB, PhD, of Sheffield (England) Teaching Hospitals National Health Service Foundation Trust. “There is a great novelty value in the combination. The complications and the radiologic response rates were quite acceptable.”

The research was funded by the University Grants Committee in Hong Kong. Chan reported having no disclosures. Her colleagues disclosed relationships with Medtronic, Siemens Healthineers, and Johnson & Johnson. Edwards disclosed relationships with AstraZeneca, Zimmer Biomet, Stryker Leibinger, Pacific Biosciences, BioNano Genomics, Argenx, and Moderna.

European Lung Cancer Virtual Congress 2021: Abstract 64MO. Presented March 27, 2021.

J Thorac Oncol. 2021;16:S729-36. Abstract

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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