Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, FND-202, Boston, MA 02114.
AJR Am J Roentgenol. 2022 Sep;219(3):471-485. doi: 10.2214/AJR.21.27099. Epub 2022 Mar 23.
Percutaneous image-guided thermal ablation (IGTA) has been endorsed by multiple societies as a safe and effective lung-preserving treatment of primary lung cancer and metastases involving the lung and chest wall. This article reviews the role of IGTA in the care continuum of patients with thoracic neoplasms and discusses strategies to identify the optimal local therapy considering patient and tumor characteristics. The advantages and disadvantages of percutaneous thermal ablation compared with surgical resection and stereotactic body radiotherapy are summarized. Principles of radiofrequency ablation, microwave ablation, and cryoablation, as well as the emerging use of transbronchial thermal ablation, are described. Specific considerations are presented regarding the role of thermal ablation for early-stage non-small cell lung cancer (NSCLC), multifocal primary NSCLC, pulmonary metastases, salvage of recurrent NSCLC after surgery or radiation, and pain palliation for tumors involving the chest wall. Recent changes to professional society guidelines regarding the role of thermal ablation in the lung, including for treatment of oligometastatic disease, are highlighted. Finally, recommendations are provided for imaging follow-up after thermal ablation of lung tumors, accompanied by examples of expected postoperative findings and patterns of disease recurrence.
经皮影像引导热消融（IGTA）已被多个学会认可为一种安全有效的治疗原发性肺癌和累及肺和胸壁的转移灶的保肺治疗方法。本文综述了 IGTA 在胸内肿瘤患者治疗连续性中的作用，并讨论了根据患者和肿瘤特征确定最佳局部治疗方法的策略。总结了与手术切除和立体定向体放射治疗相比，经皮热消融的优缺点。描述了射频消融、微波消融和冷冻消融的原则，以及经支气管热消融的新应用。特别提出了热消融在早期非小细胞肺癌（NSCLC）、多灶性原发性 NSCLC、肺转移、手术或放疗后复发性 NSCLC 的挽救治疗以及累及胸壁肿瘤的止痛等方面的作用。强调了专业学会指南中关于热消融在肺部作用的最新变化，包括寡转移疾病的治疗。最后，提供了肺肿瘤热消融后影像学随访的建议，并附有术后预期发现和疾病复发模式的示例。
