CIO and Lung Ablation: A Collective Exhale of Information

Morning sessions review lung ablation therapies and potential for emerging technologies.

By Brenda Silva

As CIO 2018 continues, early sessions on day two looked to report on existing and emerging technologies for ablation with focused attention on lung, thyroid, and lymph nodes, as well as discussions on interventions for prostate and pancreatic cancers. Course Director Shaun Samuels, MD, moderated the session on lung ablation, which included the status of the treatment and alternative procedures for oncologists to consider.

Opening the topic, Alice Gillams, MB, CHB, MRCP, FRCR, made the case for performing lung ablation and detailed the requirements for optimal ablation. “When it comes to preserving the parenchyma, radiofrequency ablation (RFA) is much better than surgery at this time. I think that ablation has a major role and should be kept and used in the primary setting as a viable treatment option.”

Following next, Stephen Solomon, MD, gave a year-in-review report of lung ablation, noting the importance of tumor size when selecting patients. He pointed out that histology subtype predicts local recurrence of surgery after stereotactic body radiotherapy (SBRT), and that margins do matter and may need to be increased. He added, “Lung cancer histology and mutational status can predict the best responders to lung ablation therapy and can have a big impact on ablation outcomes.”

Dr. Solomon also addressed adjuvant therapy and cited a study from 2017 that compared the use of RFA alone and the use of RFA and chemotherapy together, with the combination therapy proving more successful.

Looking to explore lung cryoablation, Peter Littrup, MD, commented on its appeal at the present time. “Cryo opens consideration to more central tumors, and it offers excellent visualization. We hear so much about margins, and one of the great things about cryo is that you can actually see the margins.”

Dr. Littrup listed additional benefits of cryoablation such as that it allows users to expand their selection of central lesions and offers excellent CT guidance and visualization, as well as tighter probe spacing. “Cryo is a technically feasible and effective treatment option for primary lung and metastatic tumors. In fact, I think it’s a whole new area that’s about to explode.”

The next speaker to the podium, Minesh Mehta, MD, urged interventional oncologists not to forget about the role of SBRT in non-small cell lung cancer (NSCLC).

Dr. Mehta focused on early-stage NSCLC in a comparison of SBRT versus surgery. “The majority of patients continue to be treated with surgery, but SBRT is on a path of technological improvement, and we are seeing radiology procedures continuing to improve.”

He summed up, “What we know today for SBRT is that it’s a robust and mature technology, and its use is increasing, especially in surgically high-risk patients.”

Wrapping up the topic with a panel discussion, Dr. Samuels resumed his role as moderator for an operator’s session on lung ablation. Each panelist presented ablation cases with each case evaluated for its potential to use SBRT as an alternative treatment option.

Initiating a new discussion on thyroid ablation, moderator Ziv Haskal, MD, posited, “There is a need for ablating thyroid nodules. There is data that exists, as well as guidelines, documents, and recommendations from societies that are about to be updated. It’s a well-established image-guided therapy, and we have to be prepared to advance this because it’s in our sweet spots.”

Sean Tutton, MD, took over next with a presentation of lymph node ablation and other interventions. He noted, “Along with increased survival, another reason for using lymph node ablation is that it allows patients to maintain their chemotherapy because of its minimally invasive nature.”

Speaking next on interventions for adrenal malignancy, Debra Gervais, MD, pointed out that adrenal ablation began with endocrinologists and that the concept is not a new idea. However, the literature is sparse, and there needs to be more attention paid to this area of ablation.

Continuing the theme, Bradford Wood, MD, offered data on interventions for prostate cancer. “There are a lot of changes in the field lately, such as active surveillance, over diagnosis, and PSA downgrade. It’s an important field that we need to be at the table to learn more about.”

Reporting on interventions for pancreatic cancer, Govindarajan Narayanan, MD, explained, “The ideal patient is in stage 3 with selected patients in stage 4. It’s all done with CT guidance, general anesthesia, and an NG tube in place for oral contrast. The biggest concern is safe access to the tumor because of the potential for complications like bleeding, pancreatitis, and infection.”

Next, Dr. Samuels introduced the CIO’s Best Abstract and Runner-Up, Joseph Kaminski, MD, and Ehsan Fayazzadeh, MD, respectively, who each detailed their abstracts and research.

Finishing the second session, Course Director Constantino Peña, MD, acted as moderator for a panel discussion on dashcam video from Miami Cardiac & Vascular Institute (MCVI). The edited video included pre-recorded interventional oncology (IO) cases, which were reviewed and discussed, and allowed attendees to see referenced techniques applied and explained.