Cardiovascular and Interventional Radiological Society of Europe

Primary lung cancer – online course

55 | 25(for CIRSE members)

Description

Authors: C. Floridi and J. Palussière

Reviewers: F. Deschamps, F. Fanelli, D. Filippiadis, A. Krajina and C. Nice

 

Abstract

Non-small cell lung cancer remains a major cause of cancer and death worldwide. With this in mind, offering better strategies to combat the disease is crucial. For early-stage disease (stage I), surgery continues to represent the gold standard for treatment, nevertheless, approximately 20% of patients remain ineligible to 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 are showing promising results. Thermal ablation has demonstrated feasibility and good tolerance, with radiofrequency ablation (RFA) being the most commonly used and evaluated image-guided thermal ablation technique. 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. Other ablation techniques, such as microwaves and cryoablation, are developing and hopefully will help to overcome some limitations of RFA, namely for large tumours or tumours 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 minimise toxicities. Thermoablation should be compared to stereotaxic body radiation therapy, which has also demonstrated high local control rate. In the future, challenging strategies should extend the indications in combining thermoablation with systemic therapies. In this way, combining thermoablation and immunotherapy for a synergistic effect should be promising and deserves further investigations.

 

Learning Objectives

  • To learn about the TNM staging and the different subtypes of NSCLC
  • To understand the different treatment strategies in NSCLC
  • To understand typical indications and limitations of percutaneous thermal ablation techniques in NSCLC
  • To know which imaging criteria are requested to plan a thermal ablation
  • To learn about combined therapy in a more personalised treatment strategy
  • To choose the best method of ablation according to their own limitations
  • To learn about critical indications
  • To learn about the environment for a good practice (anaesthesia and image guidance)
  • To know which imaging to use for follow-up including frequency of imaging and criteria used for image analysis
  • To know how to interpret the different evolutions of a thermal ablation zone
  • To learn about the outcome of percutaneous ablation according to the recent literature
  • To learn about the complications and their management
  • To know the factors associated with success and failure

 

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 EBIR curriculum and corresponds to chapter 2.2.5.3 Non-Vascular Interventional Oncology.

The format of the course is easy to use and interactive by 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).

Upon purchase, access to complete and revisit the course is granted for an enrolment period of 90 days. The certificate of completion will be available beyond the enrolment period in the new myCIRSE area.

Release date: November 2018