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Microwave Ablation of Lung Malignancies: Effectiveness, CT Findings, and Safety in 50 Patients¹

¹ From the Departments of Diagnostic Imaging and Radiation Oncology, Office of Research Administration, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903. From the 2007 RSNA Annual Meeting. Received June 9, 2007; revision requested August 13; revision received October 5; accepted December 17; final version accepted December 18. D.E.D. supported by Endocare and Veran Medical. Address correspondence to D.E.D. (e-mail: ddupuy{at}lifespan.org).

Purpose: To retrospectively evaluate effectiveness, follow-up imaging features, and safety of microwave ablation in 50 patients with intraparenchymal pulmonary malignancies.

Materials and Methods: This HIPAA-compliant study was approved by the institutional review board; informed consent was waived. From November 10, 2003, to August 28, 2006, 82 masses (mean, 1.42 per patient) in 50 patients (28 men, 22 women; mean age, 70 years) were percutaneously treated in 66 microwave ablation sessions. Each tumor was ablated with computed tomographic (CT) guidance. Follow-up contrast material–enhanced CT and positron emission tomographic (PET) scans were reviewed. Mixed linear modeling and logistic regression were performed. Time-event data were analyzed (Kaplan-Meier survival estimates and log-rank statistic). All event times were the time to a patient's first event ( level = .05, all analyses).

Results: At follow-up (mean, 10 months), 26% (13 of 50) of patients had residual disease at the ablation site, predicted by using index size of larger than 3 cm (P = .01). Another 22% (11 of 50) of patients had recurrent disease resulting in a 1-year local control rate of 67%, with mean time to first recurrence of 16.2 months. Kaplan-Meier analysis yielded an actuarial survival of 65% at 1 year, 55% at 2 years, and 45% at 3 years from ablation. Cancer-specific mortality yielded a 1-year survival of 83%, a 2-year survival of 73%, and a 3-year survival of 61%; these values were not significantly affected by index size of larger than 3 cm or 3 cm or smaller or presence of residual disease. Cavitation (43% [35 of 82] of treated tumors) was associated with reduced cancer-specific mortality (P = .02). Immediate complications included pneumothorax (Common Terminology Criteria for Adverse Events [CTCAE] grades 1 [18 of 66 patients] and 2 [eight of 66 patients]), hemoptysis (four of 66 patients), and skin burns (CTCAE grades 2 [one of 66 patients] and 3 [one of 66 patients]).

Conclusion: Microwave ablation is effective and may be safely applied to lung tumors.

© RSNA, 2008