1) To develop specificities of lung tissue following heating. 2) To specify technical differences between Radiofrequency ablation and microwave ablation applied to lung tumors. 3) To define the best indications for each technique. 4) To list the limits, indications and contraindications for each technique. 5) To identify whether some development are awaited and might increase indications.

1) Highlight the results of Cryoablation and the potential role for ablation in primary lung cancer and metastatic diseases. 2) Identify the Strength of Cryoablation in the lung. 3) Compare Ablative Technique in the Lung.

T.Vogl@em.uni-frankfurt.de

To evaluate tumor response, local tumor control and patient survival after the treatment of secondary lung malignancies using transpulmonary chemoemboilzation (TPCE) and transarterial chemoperfusion (TACP) in a palliative indication.

±In this retrospective study 161 patients (mean 55.3±13.8 years; 82 females/79 males) who had failied previous systemic chemotherapy were treated with either repetitive TPCE (n=92) or TACP (n=69) between August 2004 and April 2017 for unresectable pulmonary metastases. The median number of sessions was 5 per patient, the median number of nodules 16 and bilateral lung involvement 85.1%. The chemotherapeutic agents used were Mitomycin C, Cisplatin, Gemcitabine and/or Irinotecan. Nine patients received other combinations according to their physicians' recommendations. Either the tumor-supplying pulmonary arteries were catheterized followed by injection of the chemotherapeutic agents, iodized oil and microspheres (TPCE group) or the chemotherapy was non-selectively injected intra-arterielly opposite the orifices of the main tumor-supplying arteries (TACP group). The response was assessed using the revised RECIST criteria.

After evaluation of the tumor response partial response (PR) was achieved in 8.7% (n=14), stable disease (SD) in 65.2% (n=105) and progressive disease (PD) in 26.1% (n=42). The estimated mean survival time and time to progression were 19.7±2 and 7.1±0.7 for the TPCE group and 15.6±1.6 and 6.5±0.6 for the TACP group, respectively. Patients who underwent TPCE had a non significantly longer mean survival time than the TACP group. Patients with PR and SD had a significantly (p<0.05) better survival (mean: 25±4.4 and 19±1.8 months, respectively) than those with PD (mean 14±2.3 months).

Both TPCE and TACP are feasible treatment options for patients with secondary lung malignancies with acceptable local control and survival rates. A more favorable initial response to the locoregionally delivered chemotherapy might be a positive predictor for survival.

TACP and TPCE improve local tumor control and prolong survival in patients with pulmonary metastases

1) Understand the difference in treatment options for lung cancer.

1) Describe the surgical technique of pulmonary metastasectomy. 2) Compare efficacy and utility of surgical metastasectomy to that of ablation and radiation. 3) Discuss the strategy of combining surgical metastasectomy and ablation to manage pulmonary metastases.

To determine the potential benefit of local and systemic therapy in lung carcinoid tumors.

Data from lung carcinoid patients receiving surgical resection, external beam radiation therapy, thermal ablation or systemic therapy alone was acquired from the 2004-2015 National Cancer Database (NCDB). Patient and tumor characteristics across different treatment strategies were compared using univariate Wilcoxon test. Overall survival (OS) was evaluated via multivariable Cox proportional hazards models. Comparison was made between SBRT, thermal ablation, surgical resection and compared with systemic therapy alone.

34,205 patients from the NCDB database fulfilled inclusion criteria (SBRT n = 5,489; surgery n= 9,025; TA n = 67; systemic therapy alone n = 19,624.) Treatments differed across patient demographics and disease characteristics, with higher likelihood of TA in older male Caucasians with high comorbidities, and late-stage disease with small diameter. Prior to multivariable adjustment, SBRT, surgical resection, and thermal ablation all demonstrated superior OS compared to systemic therapy alone (compared to systemic therapy alone: SBRT HR = 0.56, 95% CI: 0.54-0.58, p < 0.001; surgical resection HR = 0.19, 95% CI: 0.18-0.20, p < 0.001; TA HR = 0.58, 95% CI: 0.44-0.76, p < 0.001). SBRT and surgical resection treatment demonstrated superior survival compared to systemic therapy alone after multivariable adjustment (SBRT HR = 0.74, 95% CI: 0.70-0.77, p < 0.001; surgical resection HR = 0.39, 95% CI: 0.37-0.41). Additional independent predictors of survival (p-values of <0.05) were patients with one or more comorbidities, male gender, Caucasian race, age, low cancer stage and grade, small tumor diameter, and type of treatment facility.

Patients with lung carcinoid tumor who received SBRT, surgical resection or TA demonstrated prolonged survival when compared to those patients who received systemic therapy only. The limited number of patients receiving TA limits the ability to determine survival significance after multivariable analysis, and more research in this area is required to determine its utility in prolonging survival in these patients.

Locoregional therapies demonstrate increased survival benefits when used in patients with carcinoid lung tumors. TA and SBRT demonstrate similar effectiveness in prolonging overall survival in patients with carcinoid lung cancer.

fintelmann@mgh.harvard.edu

1) Discuss strategies to start and grow a lung ablation program at your institution. 2) Outline a path to move from lung biopsy and fiducial placement to thermal ablation. 3) Discuss the role of interdisciplinary collaboration, case selection and patient management.