278. Local Ablative Therapy of Primary and Metastatic Lung Tumors: Single-Center Experience with a Newly Established Multidisciplinary Lung Ablation Clinic
University of Pittsburgh Medical Center
Pittsburgh, PA
United States - Contact Me
Arjun Pennathur, MD FACS
Associate Professor of Cardiothoracic Surgery
Sampson Family Professor in Thoracic Surgical Oncology
Department of Cardiothoracic Surgery
Massachusetts General Hospital
Boston, MA
United States - Contact Me
Dr. Florian J. Fintelmann is a physician-scientist in the Department of Radiology at Massachusetts General Hospital (MGH) in Boston, MA, and Associate Professor of Radiology at Harvard Medical School. Prior to his appointment in the Division of Thoracic Imaging and Intervention in 2014, Dr. Fintelmann completed Radiology Residency and Fellowship training at MGH. Dr. Fintelmann heads the Thoracic Percutaneous Ablation Program at MGH and the MGH Radiology Research Scholar Visiting Fellowship Program. Dr. Fintelmann directs The Fintelmann Lab, a collaborative interdisciplinary research team focused on improving cancer care through quantitative image analysis, machine learning, and image-guided minimally invasive interventions (https://fintelmannlab.mgh.harvard.edu). Dr. Fintelmann's research has attracted multiple grants, including the 2019 American Roentgen Ray Society Scholarship. Dr. Fintelmann has mentored 35+ trainees and junior faculty, including Masters and PhD-students, and published 70+ original research papers.
Abstract
Methods: This retrospective cohort study included consecutive patients with primary lung cancer or pulmonary metastases evaluated in a LAC from its inception in 2/2020 to 10/2022. Thoracic surgeons, radiation oncologists, interventional pulmonologists, and thoracic radiologists experienced in interventional procedures met weekly for 1 hour with input from medical oncologists as needed to discuss imaging and management of patients referred for consideration of percutaneous image-guided thermal ablation (IGTA). Decision-making and treatment recommendation were prospectively recorded. Treatments received within 12 months after the visit were abstracted from the EMR following IRB approval.
Results: 287 patients (male, n=120 [42%]; median age 69 years; 60% ECOG 0 [range 0-3]) with primary lung cancer (n=125 [44%]) or pulmonary metastases (18% sarcoma; 11% colorectal cancer, 5% renal cell carcinoma) were reviewed in 97 LAC sessions. 38 (13%) of patients were reviewed more than once. Pre referral, 137 (48%), 126 (44%), 66 (23%), and 42 (15%) had received systemic therapy or resection, stereotactic ablative radiotherapy (SABR), or IGTA to the lung, respectively. Treatment recommendations considered 1) histology; 2) tumor biology; 3) location, size, and the number of lesions; 4) patient age, co-morbidities, and ECOG status; and 5) lesion-specific risk of complications associated with each modality. Local ablative therapy was recommended for 183 patients (64%), including surgery, SABR, and IGTA, for 24 (8.4%), 43 (15%), and 71 (25%), respectively. Two or more modalities were considered equally appropriate for 45 patients (16%). 170 patients (59%) received local therapy, including surgery for 34 (12%), SABR for 50 (17%), and IGTA for 70 (24%). Multimodal therapy occurred in 14 patients (5%), including 5 treated with SABR, then IGTA; 3 with IGTA then SABR; 3 with surgery then SABR; 2 with surgery then IGTA; 1 with surgery, then SABR, then IGTA. Systemic therapy was recommended for 51 patients (18%), including 26 (9%) who also received local therapy.
Conclusions: Multidisciplinary evaluation of patients with primary and metastatic lung tumors referred for IGTA demonstrated that 17% underwent SABR and 12% underwent resection instead, while 5% required multimodal therapy highlighting the importance of a multidisciplinary LAC.