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Purpose: Invasive pulmonary aspergillosis (IPA) is a life-threatening complication of microwave ablation (MWA) during the treatment of primary or metastatic lung tumors. The purpose of this study was to investigate the clinical, radiological and demographic characteristics and treatment responses of patients with IPA after MWA. Materials and methods: From January 2011 to January 2016, all patients who were treated by MWA of their lung tumors from six health institutions were enrolled in this study. Patients with IPA secondary to MWA were identified and retrospectively evaluated for predisposing factors, clinical treatment, and outcome. Results: The incidence of IPA secondary to lung MWA was 1.44% (23/1596). Of the 23 patients who developed IPA, six died as a consequence, resulting in a high mortality rate of 26.1%. Using computed tomography (CT), pulmonary cavitation was the most common finding and occurred in 87.0% (20/23) of the patients. Sudden massive hemoptysis was responsible for one-third of the deaths (2/6). Most patients (22/23) received voriconazole as an initial treatment, and six patients with huge cavities underwent intracavitary lavage. Finally, 17 patients (73.9%) achieved treatment success. Conclusions: Lung MWA may be an additional host risk factor for IPA, particularly in elderly patients with underlying diseases and in patients who have recently undergone chemotherapy. Early and accurate diagnosis of IPA after MWA is critical for patient prognosis. Voriconazole should be given as the first-line treatment as early as possible. Bronchial artery embolization or intracavitary lavage may be required in some patients. [ABSTRACT FROM AUTHOR]

Although surgical resection with curative intent is the main therapy for both primary and metastatic lung tumors, about 80% of lung cancers cannot be removed by surgery. Because most patients with unresectable lung cancer only receive limited benefits from traditional radiotherapy and chemotherapy, many novel local treatment modalities have emerged including local ablation therapy. The Minimally Invasive Treatment of Lung Cancer Branch, Professional Committee of Minimally Invasive Treatment of Cancer of the Chinese Anti-Cancer Association and Committee on Tumor Ablations, Chinese College of Interventionalists have organized multidisciplinary experts to develop guidelines for this treatment modality. These guidelines aim at standardizing thermal ablation procedures, describing the indications for candidates, assessing outcomes, and preventing postablation complications. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study is to retrospectively evaluate the safety and efficacy of microwave ablation (MWA) for the treatment of ground-glass opacity (GGO)-lung adenocarcinoma.Materials and Methods: From December 2013 to June 2017, a total of 51 patients (22 males and 29 females, mean age of 69.4 ± 10.1 years) were included in this study, with 51 lung adenocarcinoma lesions showing GGO (mean long-axis diameter of 18.7 ± 6.05 mm). They received a total of 52 sessions of percutaneous computed tomography-guided (CT-guided) MWA. First, lung adenocarcinoma with GGO was histologically defined by needle biopsy under the guidance of CT. Second, the efficacy of CT-guided MWA was analyzed, including the feasibility, safety, 3 years local progression-free survival (LPFS), 3 years disease-specific survival, and 3 years overall survival (OS). Final, complications after MWA were also summarized.Results: The technical success rate was 100%, without MWA procedure-related death. At the median follow-up period (27.02, range: 7-45 months), the rates of 3 years LPFS, cancer-specific survival, and OS were 98%, 100%, and 96%, respectively. The complications after MWA included pneumothorax (48.1%, 25/52), hemoptysis (28.8%, 14/52), pleural effusion (23.1%, 12/52), and pulmonary infection (7.7%, 4/52).Conclusions: CT-guided percutaneous MWA was a feasible, safe, and effective therapeutic approach for treating GGO-lung adenocarcinoma. [ABSTRACT FROM AUTHOR]

Background: The study was conducted to retrospectively evaluate the safety and effectiveness of computed tomography (CT)‐guided percutaneous microwave ablation (MWA) for peripheral non‐small cell lung cancer (NSCLC) in 11 patients with a single lung after pneumonectomy. Methods: From May 2011 to March 2015, 11 single‐lung patients (8 men and 3 women; mean age 60.3 years, range 46–71) with peripheral NSCLC underwent 12 sessions of MWA. Eleven tumors measuring 13–52 mm (mean 30.2 mm) were treated. Follow‐up was performed via CT scan at 1, 3, 6, 12, 18, and 24 months after the procedure and annually thereafter. Clinical outcomes were evaluated and complications after MWA were summarized. Results: At a median follow‐up period of 20 months (range 6–38), four patients showed evidence of local recurrence at a rate of 36.4% (4/11). Median overall survival was 20 months. The overall survival rates at one, two, and three years after MWA were 88.7%, 63.6%, and 42.3%, respectively. Complications after MWA included pneumothorax (33.3%), hemoptysis (33.3%), intrapulmonary bleeding (25%), pleural effusion (16.7%), and pulmonary infection (8.3%). None of the patients died during the procedure or in the 30 days after MWA. Conclusion: CT‐guided percutaneous MWA is safe and effective for the treatment of peripheral NSCLC in patients with a single lung after prior pneumonectomy. [ABSTRACT FROM AUTHOR]

Objectives: To verify the association between EGFR status and clinical response to microwave ablation (MWA) and survival.Methods: NSCLC patients with known EGFR status and treated with MWA in combination with chemotherapy were retrospectively enrolled in the study.Results: A total of 61 patients were recruited. EGFR mutations were found in 28 patients (39.4 %), and were more common in women (67.7 %) and nonsmokers (74.1 %). Complete ablation was achieved in 69.7 % of patients with EGFR mutant tumours and in 82.1 % of patients with EGFR wild-type tumours (p = 0.216). The median progression-free survival (PFS) and overall survival (OS) were 8.3 months and 27.2 months in patients with an EGFR mutant tumour. The corresponding values were 5.4 months (p = 0.162) and 17.8 months (p = 0.209) in patients with an EGFR wild-type tumour. Patients with complete ablation had longer PFS (7.8 months vs. 4.2 months, p = 0.024) and OS (28.1 months vs. 12.6 months, p = 0.001) than those with incomplete ablation. Multivariate analyses also showed that response to MWA was an independent prognostic factor for OS, but EGFR status was not, and that neither response to MWA nor EGFR status was a prognostic factor for PFS.Conclusions: The EGFR status was not related to response to MWA, and response to MWA was a predictor of survival.Key Points: • EGFR mutations were commonly seen in women and in nonsmokers • EGFR status had no correlation with the response to MWA, PFS and OS. • The response to MWA could predict PFS and OS. [ABSTRACT FROM AUTHOR]

Objectives: This prospective trial was performed to verify whether microwave ablation (MWA) in combination with chemotherapy could provide superior survival benefit compared with chemotherapy alone.Materials and Methods: From March 1, 2015, to June 20, 2017, treatment-naïve patients with pathologically verified advanced or recurrent non-small cell lung cancer (NSCLC) were randomly assigned to MWA plus chemotherapy group or chemotherapy group. The primary endpoint was progression-free survival (PFS), while the secondary endpoints included overall survival (OS), time to local progression (TTLP), and objective response rate (ORR). The complications and adverse events were also reported.Results: A total of 293 patients were randomly assigned into the two groups. One hundred forty-eight patients with 117 stage IV tumors were included in the MWA plus chemotherapy group. One hundred forty-five patients with 113 stage IV tumors were included in the chemotherapy group. The median follow-up period was 13.1 months and 12.4 months, respectively. Median PFS was 10.3 months (95% CI 8.0-13.0) in the MWA plus chemotherapy group and 4.9 months (95% CI 4.2-5.7) in the chemotherapy group (HR = 0.44, 95% CI 0.28-0.53; p < 0.0001). Median OS was not reached in the MWA plus chemotherapy group and 12.6 months (95% CI 10.6-14.6) in the chemotherapy group (HR = 0.38, 95% CI 0.27-0.53; p < 0.0001) using Kaplan-Meier analyses with log-rank test. The median TTLP was 24.5 months, and the ORR was 32% in both groups. The adverse event rate was not significantly different in the two groups.Conclusions: In patients with advanced NSCLC, longer PFS and OS can be achieved with the treatment of combined MWA and chemotherapy than chemotherapy alone.Key Points: • Patients treated with MWA plus chemotherapy had superior PFS and OS over those treated with chemotherapy alone. • The ORR of patients treated with MWA plus chemotherapy was similar to that of those treated with chemotherapy alone. • Complications associated with MWA were common but tolerable and manageable. [ABSTRACT FROM AUTHOR]

Aim: The present study evaluated the safety and efficacy of camrelizumab (a programmed death-1 antibody) in combination with microwave ablation (MWA) in advanced non-small cell lung cancer (NSCLC).Materials and Methods: A total of 21 patients were prospectively enrolled. MWA was performed in 25 pulmonary lesions during 21 sessions. Camrelizumab was administered 5-7 days after MWA as a dose of 200 mg, which was repeated every 2 weeks until disease progression or intolerable toxicities. The primary endpoints were safety and the objective response rate (ORR). Other endpoints included progression-free survival (PFS) and overall survival (OS).Results: The technical success rate was 100%. No treatment-associated deaths were identified. Major complications, minor complications, and side effects of MWA were observed in 9, 8, and 14 patients, respectively. The main major complications included pneumothorax, pneumonia, hemorrhage, and pleural effusion. The adverse events of camrelizumab included reactive skin capillary hyperplasia (n = 9), hypothyroidism (n = 5), pneumonia (n = 4), fatigue (n = 2), leukopenia (n = 1), and neutropenia (n = 1). Grade 2 and 3 camrelizumab adverse events were identified in eight and three patients, respectively. The ORR was 33.3%, with two patients achieving complete response and five patients achieving partial response. The median PFS was 5.1 months and OS was not reached.Conclusions: Camrelizumab administration combined with MWA was safe in the treatment of advanced NSCLC, and the combination improved the ORR of camrelizumab alone compared to previous reports. [ABSTRACT FROM AUTHOR]

This retrospective study assessed the incidence rate, risk factors, and clinical course of early enlarging cavitation after percutaneous microwave ablation (MWA) of primary lung cancer (PLC). This study included 557 lesions of 514 patients with PLC who underwent CT-guided percutaneous MWA between 1 January 2018 and 31 December 2021. Of these patients, 29 developed early enlarging cavitation and were enrolled in the cavity group, and 173 were randomly enrolled in the control group. Early enlarging cavitation of the lung was defined as the development of a cavity ≥30 mm within 7 days after MWA. Overall, 31 (5.57%, 31/557 tumors) early enlarging cavitations occurred at an average of 5.83 ± 1.55 d after MWA. The risk factors were lesion contact with a large vessel (diameter ≥3 mm), lesion contact with the bronchus (diameter ≥2 mm), and a large ablated parenchymal volume. The cavity group had a higher incidence rate of delayed hydropneumothorax (12.9%) and bronchopleural fistula (9.68%) than the control group, resulting in a longer hospitalization (9.09 ± 5.26 days). Until Dec 31, 2022, 27 cavities disappeared after a mean of 217.88 ± 78.57 d (range, 111–510 d), two persisted, and two were lost to follow-up. Early enlarging cavitation occurred in 5.57% PLC cases that underwent MWA, causing serve complications and longer hospitalization. The risk factors were ablated lesion contact with large vessels and bronchi, as well as a larger ablated parenchymal volume. [ABSTRACT FROM AUTHOR]

This retrospective study aimed to assess the safety and efficacy of synchronous biopsy and microwave ablation (MWA) for highly suspected malignant lung ground-glass opacities (GGOs) adjacent to the mediastinum (distance ≤10 mm). Ninety patients with 98 GGOs (diameter range, 6–30 mm), located within 10 mm of the mediastinum, underwent synchronous biopsy and MWA at a single institution from 1 May 2020, to 31 October 2021 and were enrolled in this study. Synchronous biopsy and MWA involving the completion of the biopsy and MWA in a single procedure was performed. Safety, technical success rate, and local progression-free survival (LPFS) were evaluated. The risk factors for local progression were calculated using the Mann–Whitney U test. The technical success rate was 97.96% (96/98 patients). The LPFS rates at 3, 6, and 12 months were 95.0%, 90.0%, and 82.0%, respectively. The diagnostic rate of biopsy-proven malignancy was 72.45% (n = 71/98). Invasion of lesions into the mediastinum was a risk factor for local progression (p = 0.0077). The 30-day mortality rate was 0. The major complications were pneumothorax (13.27%), ventricular arrhythmias (3.06%), pleural effusion (1.02%), hemoptysis (1.02%), and infection (1.02%). Minor complications included pneumothorax (30.61%), pleural effusion (24.49%), hemoptysis (18.37%), ventricular arrhythmias (11.22%), structural changes in adjacent organs (3.06%), and infection (3.06%). Synchronous biopsy and MWA was effective for treating GGOs adjacent to the mediastinum without severe complications (Society of Interventional Radiology classification E or F). Invasion of lesions into the mediastinum was identified as a risk factor for local progression. [ABSTRACT FROM AUTHOR]

Introduction: To investigate the pulmonary nodules detected by low-dose computed tomography (LDCT), identified factors affecting the size and number of pulmonary nodules (single or multiple), and the pulmonary nodules diagnosed and management as lung cancer in healthy individuals. Methods: A retrospective analysis was conducted on 54,326 healthy individuals who received chest LDCT screening. According to the results of screening, the detection rates of pulmonary nodules, grouped according to the size and number of pulmonary nodules (single or multiple), and the patients' gender, age, history of smoking, hypertension, and diabetes were statistically analyzed to determine the correlation between each factor and the characteristics of the nodules. The pulmonary nodules in healthy individuals diagnosed with lung cancer were managed with differently protocols. Results: The detection rate of pulmonary nodules was 38.8% (21,055/54,326). The baseline demographic characteristics of patients with pulmonary nodules were: 58% male and 42% female patients, 25.7% smoking and 74.3% nonsmoking individuals, 40–60 years old accounted for 49%, 54.8% multiple nodules, and 45.2% single nodules, and ≤5-mm size accounted for 80.4%, 6–10 mm for 18.2%, and 11–30 mm for 1.4%. Multiple pulmonary nodules were more common in hypertensive patients. Diabetes is not an independent risk factor for several pulmonary nodules. Of all patients with lung nodules, 26 were diagnosed with lung cancer, accounting for 0.1% of all patients with pulmonary nodules, 0.6% with nodules ≥5 mm, and 2.2% with nodules ≥8 mm, respectively. Twenty-six patients with lung cancer were treated with surgical resection (57.7%), microwave ablation (MWA, 38.5%), and follow-up (3.8%). Conclusions: LDCT was suitable for large-scale pulmonary nodules screening in healthy individuals, which was helpful for the early detection of suspicious lesions in the lung. In addition to surgical resection, MWA is an option for early lung cancer treatment. [ABSTRACT FROM AUTHOR]

Background: This retrospective study aimed to assess the safety and efficacy of microwave ablation for lung tumors adjacent to the interlobar fissures. Methods: From May 2020 to April 2021, 59 patients with 66 lung tumors (mean diameter, 16.9 ± 7.7 mm; range, 6–30 mm) adjacent to the interlobar fissures who underwent microwave ablation at our institution were identified and included in this study. Based on the relationship between the tumor and the interlobar fissure, tumors can be categorized into close to the fissure, causing the fissure, and involving the fissure. The complete ablation rate, local progression‐free survival, complications, and associated factors were analyzed. Results: All 66 histologically proven tumors were treated using computed tomography‐guided microwave ablation. The complete ablation rate was 95.5%. Local progression‐free survival at 3, 6, 9, and 12 months were 89.4%, 83.3%, 74.2%, and 63.6%, respectively. The complications included pneumothorax (34.8%), pleural effusion (24.2%), cavity (18.2%), and pulmonary infection (7.6%). There were statistical differences in the incidence of pneumothorax, cavity, and delayed complications between the groups with and without antenna punctures through the fissure. Conclusions: Microwave ablation is a safe and effective treatment for lung tumor adjacent to the interlobar fissure. Antenna puncturing though the interlobar fissure may be a potential risk factor for pneumothorax, cavity, and delayed complications. [ABSTRACT FROM AUTHOR]

Objective: To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. Materials and methods: From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. Results: Mean VAS score and morphine dose pre-procedure were 7.4 ± 1.6 (range, 5-10) and 47.7 ± 30.1 mg (range, 20-120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7 ± 1.2 ( p < 0.001) and 29.6 ± 16.1 mg ( p = 0.003); 7 days, 1.9 ± 1.7 ( p < 0.001) and 16.1 ± 12.0 mg ( p < 0.001); 1 month, 1.5 ± 0.9 ( p < 0.001) and 10.8 ± 10.9 ( p < 0.001); 3 months, 0.9 ± 0.7 ( p < 0.001) and 8.4 ± 9.2 mg ( p < 0.001); and 6 months, 1.2 ± 0.8 ( p < 0.001) and 9.2 ± 12.3 mg ( p < 0.001). Complications were observed in eight patients (28 %); among these, major complications were reported in two (7.7 %) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1 % (6/26). Conclusion: MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases. [ABSTRACT FROM AUTHOR]

Background: Combined therapy with immune checkpoint inhibitors (ICIs) and microwave ablation (MWA) is known to improve outcome in non-small cell lung cancer (NSCLC). However, the mechanism underlying the synergistic effect of these two treatments is unknown. Tumor immune microenvironment is known to affect the efficacy of ICI. Therefore, in the present study, we evaluated changes in the levels of peripheral cytokines at 48 h and 1-month post-ablation in patients with NSCLC.Materials and Methods: A total of 44 patients with primary NSCLC were retrospectively enrolled. All patients underwent MWA of the primary tumors. Plasma samples were collected pre- and post-ablation to examine the levels of various cytokines, including interleukin (IL)-2, IL-4, IL-6, IL-10, IL-12, IL-17, tumor necrosis factor (TNF)-α, and interferon-gamma (IFN-γ).Results: Although the levels of the majority of cytokines remained within normal range, levels of IL-2 and IFN-γ were significantly decreased at 48 h post-ablation and increased at 1-month post-ablation. In the subgroup analyses, changes in IL-2 and IFN-γ levels were commonly identified. Moreover, the Eastern Cooperative Oncology Group status, sex, pathology type, tumor site, and tumor size were associated with cytokines' levels pre-ablation or post-ablation.Conclusion: MWA of NSCLC tumors influenced the plasma levels of cytokines IL-2 and IFN-γ. [ABSTRACT FROM AUTHOR]

Purpose: The present study was designed to evaluate the safety and efficacy of computed tomography-guided percutaneous microwave ablation (MWA) to treat pulmonary nodules under conscious analgosedation with sufentanil.Materials and Methods: February to May 2021, 124 patients with 151 pulmonary nodules were enrolled in this study. The patients underwent 124 sessions of MWA. Sufentanil (0.25 μg/kg) was injected intravenously before MWA.Results: The technical success was 100% and no procedure-related deaths. The dosage of sufentanil was 16.6 ± 3.0 μg. The mean tumor diameter in the enrolled patients was 1.3 ± 0.8 cm. The intraoperative mean numerical rating scale (NRS) was 2.2 ± 1.7. Among the patients with NRS >3, seven patients had nodules adjacent to the pleura, while in ten patients, they were not adjacent. The mean systolic, diastolic blood pressure, and heart rate of patients were 139.1 ± 23.5 mmHg, 77.8 ± 12.3, and 76.1 ± 13.4 times/min, respectively, before sufentanil injection. The mean lowest systolic, lowest diastolic blood pressure, and lowest heart rate intraoperative were 132.9 ± 22.0 mmHg, 76.1 ± 12.1, and 74.0 ± 13.5 times/min. Twenty-six patients had mild adverse events including nausea (6.45%, 8/124), dizziness (2.42%, 3/124), vomiting(4.03%, 5/124), nausea and dizziness (2.42%, 3/124), nausea with vomiting and dizziness (2.42%, 3/124), urinary retention (1.61%, 2/124) and respiratory depression (0.81%, 1/124).Conclusion: Sufentanil is a feasible, safe, and effective analgesic for MWA in patients with pulmonary nodules. It can be used for clinical promotion. [ABSTRACT FROM AUTHOR]

A squamous cell lung cancer patient was treated with pneumonectomy. A recurrent lung cancer (adenocarcinoma) was found 45 months later and successfully biopsied and treated with microwave ablation. After 18 months of follow up, no evidence of tumor recurrence was observed. [ABSTRACT FROM AUTHOR]

The present study retrospectively evaluated the feasibility, safety, and short-term efficacy of computed tomography (CT)-guided percutaneous microwave ablation (MWA) to treat multiple synchronous ground-glass opacities (GGOs) of the lung. From October 2016 to May 2019, 33 patients (9 males and 24 females, mean age: 59.6 ± 10.0 years) with multiple GGOs (103 GGOs with mean size 12.3 ± 6.3 mm) were enrolled in this study. Patients underwent 66 procedures of CT-guided percutaneous MWA. The feasibility, safety, local progression-free survival, and overall survival were evaluated. The technical success and technique efficacy rate were 100% and no MWA procedure-related deaths were reported. The median follow-up period was 18.1 (range: 6.8–37.7) months. Major complications included pneumothorax (11/66, 16.7%), pleural effusion (2/66, 3.0%), pneumonia (3/66, 4.5%), and nerve injury (1/66, 1.5%), which were well controlled by appropriate treatment. Minor complications included pneumothorax (38/66, 57.6%), pleural effusion (43/66, 65.2%), hemoptysis (13/66, 19.7%), subcutaneous emphysema (4/66, 6.1%), and hemothorax (2/66, 3.0%). Currently, all patients are alive without local progression or tumor recurrence, despite the relatively insufficient follow-up time. CT-guided percutaneous MWA for the treatment of multiple synchronous lung GGOs is feasible, safe, and efficacious over short-term follow-up. It may also be employed as an alternative approach for nonsurgical candidates. A longer follow-up is warranted to evaluate the oncologic outcomes. [ABSTRACT FROM AUTHOR]

Background: Previous studies have documented the therapeutic value of computed tomography (CT)‐guided percutaneous microwave ablation (MWA) for early‐stage non‐small cell lung cancer (NSCLC). However, few studies have focused on patients aged 80 years and older. This retrospective study aimed to evaluate the safety and clinical outcomes of CT‐guided percutaneous MWA in patients aged 80 years and older with early‐stage peripheral NSCLC. Methods: A retrospective analysis of 63 patients aged 80 years and older with cT1a‐2bN0M0 peripheral NSCLC who underwent CT‐guided percutaneous MWA was performed between January 2008 and January 2018 at 11 hospitals in Shandong Province, China. Results: The median follow‐up time was 21.0 months. The overall median survival time was 50 months. The cancer‐specific median survival time was not reached in five years. The one‐, two‐, three‐, four‐, and five‐year overall survival rates were 97.1%, 92.6%, 63.4%, 54.4%, and 32.6%, respectively. The one‐, two‐, and three‐year cancer‐specific survival (CSS) rates were 97.9%, 97.9%, and 69.4%, respectively. The four‐ and five‐year CSS rates were not achieved. A total of 14 patients (22.2%) had local progression. The one‐, two‐, three‐, four‐, and five‐year local control rates were 88.8%, 78.8%, 70.3%, 63.9%, and 63.9%, respectively. The mortality rate was 0% within 30 days after the procedure. Major complications included pneumothorax requiring drainage (21.1%), pulmonary infection (4.2%), and pleural effusions requiring drainage (2.8%). Conclusions: CT‐guided percutaneous MWA is a safe and effective modality for treating patients aged 80 years and older with early‐stage peripheral NSCLC. [ABSTRACT FROM AUTHOR]