Role of Thermal Ablation in Pulmonary Metastases of Hepatobiliary and Gastrointestinal Malignancies

Document Type : Original Article

Authors

1 Department Interventional and Diagnostic Radiology Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt.

2 Department of Clinical Oncology and Nuclear Medicine, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt.

Abstract

Background: Pulmonary oligometastases from hepatobiliary and gastrointestinal primary cancers are associated with poor prognosis and limited treatment options. While local surgical resection and systemic therapies remain the mainstay, thermal ablation techniques, have emerged as effective local therapies for managing oligometastatic disease. These techniques offer a minimally invasive approach to manage pulmonary oligometastases in patients who are ineligible for resection.
Aim of the work: It was to evaluate the role of local thermal ablative therapy specifically microwave ablation in management of metastatic lung tumors from hepatobiliary and gastrointestinal origin.
Patients and methods: It was a prospective study performed on 60 patients [40 females and 20 males, Mean age 53.53] underwent computed tomography-guided percutaneous Microwave ablation for pulmonary oligometastases from hepatobiliary and gastrointestinal primaries. Outcomes included technical effectiveness, local tumor control, disease-free interval, overall survival, progression-free survival and complications.
Results: The mean hospital stay was 1.68 day per session. Pneumothorax incidence was 50% with only 3.9% requiring chest tube placement. There was a significant association between number of needle punctures [p value 0.02] and lateral position [p value <0.001] and pneumothorax incidence. The technique effectiveness rate was 97.5%. Complete response was 92.5%, 87.5% and 75% at 1, 3 and 6 months respectively. The mean follow-up period was nearly 1 year. The mean disease free interval was 9.1months. Six- month and one-year overall survival rates were 87.6% and 69.3%, while six-month and one-year progression free survival probability was 58.8%. Ground-glass opacity greater than 5 mm around the nodule was substantially associated with progression-free survival [P value 0.011].
Conclusion: Thermal ablation is a viable alternative option for patients with pulmonary oligometastasis who are not eligible for surgery. It boasts a strong safety profile and provides effective local tumor control. 

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