Bronchoscopic microwave ablation safe for inoperable lung malignancies

UK: A new study conducted by K. Lau and the team suggests that bronchoscopic microwave ablation (BMA) is an alternate therapy for people with medically inoperable lung cancer with oligo lung metastases. The findings of this study were presented at the European Respiratory Society International Congress 2022. 

With decreased pneumothorax rates, guided bronchoscopy is a safer option than percutaneous approaches. Researchers describe a four-year experience using bronchoscopic microwave ablation of peripheral lesions in this study.

This research was an institutional retrospective analysis of BMA from February 2018 to February 22. Using cone-beam CT, a flexible microwave ablation catheter, and navigation bronchoscopy, nodules were removed. Data evaluation was carried out after taking into account all relevant factors.

The key findings of this presentation were:

1. In 61 surgeries, 67 nodules (22 primary lung cancer and 45 oligometastases) were removed from 52 patients.

2. In the same procedure, 5 patients had multiple nodules (2–3) ablated (3 bilateral), along with concurrent wedge resection.

3. It took 2-3 bracketed ablations on 9 nodules.

4. The average length of a single ablation operation was 90 minutes (range 27-187).

5. There was only one pneumothorax due to a subpleural nodule and no deaths.

6. 13 patients (21%) exhibited moderate hemoptysis, 10 (16%) post-ablation syndrome and 16 (29%) minor chest discomfort. 

7. One patient experienced an empyema that needed to be drained.

8. Microbiology-confirmed infected cavitating lesions were seen in 2 patients.

9. Segmental collapse and bronchial stenosis occurred in 2 individuals.

10. The median time between occurrences was 326 days. Seven cases—2 re-ablated, 1 resected—presented as the illness progressed throughout the body.

11. During follow-up, 10 (19%) patients passed away; neither the index nodule nor the ablation were to blame.

In conclusion, the bronchial, parenchymal, and pleural compartments are all prone to complications. The author further said that the "rate of local recurrence is comparable to that seen in percutaneous lung ablation."

Reference: 

Lau, K., & London, (. (n.d.). Four year outcomes of bronchoscopic microwave ablation of peripheral lung nodules. European Respiratory Society International Congress, September 4 - 6, 2022.