Primary lung cancer (2025)
Description
Authors: C. Floridi and A. Veltri
Reviewers: D. Filippiadis, A. Gjoreski, R. Hoffmann, R. Iezzi, J. Jennings, K. Ringe and R. Uberoi
This course corresponds to chapters 2.2.5.3 Non-vascular interventional oncology and 2.2.5.3.1 Malignant chest and abdominal disease in the European Curriculum and Syllabus for Interventional Radiology.
Abstract
Non-small cell lung cancer (NSCLC) is a major cause of cancer and death worldwide. Thus, offering better strategies to combat the disease is crucial. For early-stage disease (stage I and II), surgery continues to represent the gold standard for treatment; nevertheless, approximately 20% of patients remain ineligible for surgery due to existing comorbidities. Until recently, these “non-surgical” patients were treated with conventional radiotherapy, but current treatments such as stereotactic body radiotherapy (SBRT) and thermal ablation (TA) are showing promising results. The three most widely used ablative modalities in the lung are radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation. RFA and MWA use heat to cause tumour cell necrosis, whereas cryoablation relies on serial freezing and thawing. In different studies, tumour size and tumour stage are the main predictive factors of survival, but, besides that, the comorbidities that are often severe in these patients are also predictive of overall survival. Compared with RFA, MWA achieves a greater and more rapid temperature rise that is less reliant on thermal conduction. As a result, MWA creates more homogeneous ablation zones in less time than RFA. It is also less susceptible to heat sink effects, helping to overcome some limitations of RFA, namely for large tumours or those close to large vessels. In addition to a good tolerance and efficacy, one of the main advantages of thermal ablation techniques is that it is a stand-alone therapy, which can be repeated in case of local failure. The low invasiveness and repeatability are major advantages to minimize toxicities. Thermal ablation should be compared to stereotaxic body radiation therapy, which has also demonstrated high local control rate. Similar to surgery, indications are evolving in combining thermal ablation with systemic therapies, in a neoadjuvant or adjuvant setting, or in oligometastatic disease. In this way, combining thermal ablation and immunotherapy for a synergistic effect is also under investigation.
Learning objectives
- To learn about the different subtypes of NSCLC and the TNM staging
- To understand the different treatment strategies in NSCLC
- To understand typical indications and contraindications of percutaneous thermal ablation techniques in NSCLC
- To know which imaging criteria are required to plan a thermal ablation
- To choose the most appropriate ablation technique in different cases
- To learn about the environment for a good practice (anaesthesia and safety facilities)
- To learn about critical indications (tips and tricks)
- To learn about combined therapy in a more personalized treatment strategy
- To learn about complications and their management
- To know imaging analysis criteria to use for ablation assessment and follow-up (including frequency of imaging)
- To know how to interpret the different evolutions of a thermal ablation zone
- To know predictors for treatment success and failure
- To learn about the clinical outcome of ablation therapies according to the recent literature
Further information
This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for Interventional Radiology and corresponds to chapters 2.2.5.3 Non-vascular interventional oncology and 2.2.5.3.1 Malignant chest and abdominal disease.
The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around two hours and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award 2 European CME credits (ECMEC). Please note that this course will be taken offline on October 15, 2030.
The acquired CME Certificate will be available in the myCIRSE area under CIRSE Academy.
The enrolment period of this course is linked to the validity of the All-Access Pass.
Release date: October 2025
