Vittorio Catena

Percutaneous thermal ablation of primary lung cancer

Percutaneous ablation of small-size non-small-cell lung cancer (NSCLC) has demonstrated feasibility and safety in nonsurgical candidates. Radiofrequency ablation (RFA), the most commonly used technique, has an 80-90% reported rate of complete ablation, with the best results obtained in tumors less than 2-3cm in diameter. The highest one-, three-, and five-year overall survival rates reported in NSCLC following RFA are 97.7%, 72.9%, and 55.7% respectively. Tumor size, tumor stage, and underlying comorbidities are the main predictors of survival. Other ablation techniques such as microwave or cryoablation may help overcome the limitations of RFA in the future, particularly for large tumors or those close to large vessels. Stereotactic ablative radiotherapy (SABR) has its own complications and carries the risk of fiducial placement requiring multiple lung punctures. SABR has also demonstrated significant efficacy in treating small-size lung tumors and should be compared to percutaneous ablation.

Percutaneous thermal ablation of lung tumors – Radiofrequency, microwave and cryotherapy: Where are we going?

Main indications of percutaneous pulmonary thermal ablation are early stage non-small cell lung carcinoma (NSCLC) for patients who are not amenable to surgery and slow-evolving localized metastatic disease, either spontaneous or following a general treatment. Radiofrequency ablation (RFA) is the most evaluated technique. This technique offers a local control rate ranging between 80 and 90% for tumors <3cm in diameter. Other more recently used ablation techniques such as microwaves and cryotherapy could overcome some limitations of RFA. One common characteristic of these techniques is an excellent tolerance with very few complications. This article reviews the differences between these techniques when applied to lung tumors, indications, results and complications. Future potential associations with immunotherapy will be discussed.

Combined Cementoplasty and Percutaneous Image-Guided Screw Fixation for Treatment of Sacral Osteoradionecrosis: A Case Report

Sacral osteoradionecrosis is a pelvic radiation-induced injury. The case illustrates this complication with interventional radiology support. Combination of imaging modalities aided in diagnosis and a biopsy confirmed it. An initial sacral cementoplasty procedure was not sufficient to obtain analgesia, because necrosis continued to evolve. In order to better stabilize the weakened pelvic girdle and reduce pain, percutaneous screw fixation was performed. The patient has a favorable outcome, with reduction of pain and early rehabilitation. No infectious, hemorrhagic complication nor migration of the screws were observed at 6 months’ follow-up. Percutaneous image-guided screwing is a minimally invasive technique allowing stabilization of weakened bone and may be proposed in combination with cementoplasty in patients with sacral osteoradionecrosis.