Bronchoscopic peripheral tumor ablation

Given the improvements in access to various parts of the lung with different scope or catheter-based systems, one of the seemingly inevitable outcomes is the development of ablative modalities to apply energy to local areas of the lung as a treatment for malignancies in general and lung cancer specifically. Again, this is an emerging area of significant interest albeit with limited data to date.
The initial work in this area came from a Japanese group and built off of a treat and resect approach published in 2010 wherein different amounts of radiofrequency energy were applied to various lesions that subsequently underwent resection (20). Ultimately, they reported on two patients treated with a flexible radiofrequency ablation catheter-based system deployed via a CT-guided bronchoscopic approach to treat patients with medically inoperable, small peripheral lung cancers (21). One of the two patients recurred at the treated site after a 4-year interval and was retreated with the same system and has remained stable at a 12-month follow-up. The second patients remained stable at 40 months of follow-up.
This was followed by another paper published by this group in 2015 which evaluated 23 peripheral lung lesions in 20 patients with early-stage non-small cell lung cancer again using a CT-guided bronchoscopic approach in conjunction with a cooled radiofrequency ablation (RFA) catheter (22). Local disease control was achieved in most patients, 82.6%, with median progression free survival of 35 months. In addition, there were no reported serious adverse events.
Indeed, work has continued in this area and a recent case series from Xie et al. was published, wherein three patients were treated with a flexible RFA catheter, delivered with the aid of navigational bronchoscopy (23). In that setting, a total of three patients, two patients with nonsurgical stage IA lung cancer and one patient with a lung metastasis, underwent treatment with the RFA system utilizing navigational bronchoscopy. Partial responses were seen in two of the three patients with one of the patients having a complete response. One of the patients with a partial response developed progressive disease at 6-month follow-up. The other two patients had 1-year progression-free survival. There were no serious adverse events reported and they concluded that navigational bronchoscopic-guided RFA is a safe and feasible procedure for poor surgical candidates with stage IA lung cancer or oligometastatic disease to the lung.
Most recently, the first case was completed that employed a navigational platform utilizing a TBAT, a CBCT system for real-time visualization and further refinement of catheter position and ablation zone overlay, and a flexible microwave catheter, the Medtronic Emprint™ ablation catheter with thermosphere™ technology, to treat a patient at St. Bartholomew’s Hospital in London in the setting of a presumed single metastatic focus of endometrial cancer. The procedure was well tolerated with the successful delivery of ablation energy and the work in ongoing.

来源：

Krimsky WS, Pritchett MA, Lau KK. Towards an optimization of bronchoscopic approaches to the diagnosis and treatment of the pulmonary nodules: a review. J Thorac Dis 2018;10(Suppl 14):S1637-S1644. doi: 10.21037/jtd.2018.04.38