IR Playbook pp 405-415 | Cite as

Lung, Kidney, and Bone Ablation

  • David M. MauroEmail author


Percutaneous ablation has become a mainstay of oncologic treatment within numerous organ systems, including the respiratory, genitourinary, and musculoskeletal systems. Utilizing a variety of ablation modalities, such as radiofrequency ablation, microwave ablation, and cryoablation, interventional radiologists can achieve excellent oncologic results for select patients with primary or metastatic disease. Patient selection, procedural planning, and disease surveillance are crucial to success. Technology continues to rapidly progress from its initial usage in the early 1990s to today with markedly improved results and fewer complications. Data supports the use of percutaneous lung ablation for the significant population of patients with non-small cell lung cancer who are not surgical candidates. Small renal cell carcinomas are frequently being treated using percutaneous ablation with outcomes approaching that of partial nephrectomy. Ablation has become the primary treatment modality for osteoid osteomas. Pain palliation can be effectively achieved through ablation in patients with osseous metastatic disease. As a minimally invasive approach with a low major complication profile, percutaneous ablation utilization is increasing and is now an invaluable tool for the interventional oncologist.


Percutaneous ablation Radiofrequency ablation Microwave ablation Cryoablation Irreversible electroporation Renal cell carcinoma Primary lung cancer Metastatic lung cancer Osteoid osteoma Osseous metastasis Interventional oncology Renal mass Bone Lung mass Tumor Interventional radiology 


  1. 1.
    American Cancer Society. Cancer facts & figures 2016. Atlanta: American Cancer Society; 2016.Google Scholar
  2. 2.
    Detterbeck FC, Boffa DJ, Kim AW, Tanoue LT. The eight edition lung cancer stage classification. Chest. 2017;151(1):193–203.CrossRefPubMedGoogle Scholar
  3. 3.
    Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer. 1950;3:74–85.CrossRefPubMedGoogle Scholar
  4. 4.
    Vikram R, Beland MD, Blaufox MD, Moreno CC, Gore JL, Harvin HJ, et al. ACR appropriateness criteria renal cell carcinoma staging. J Am Coll Radiol. 2016;13:518–25.CrossRefPubMedGoogle Scholar
  5. 5.
    Natali GL, Paolantonia G, Fruhwirth R, Alvaro G, Parapatt GK, Toma P, Rollo M. Paediatric musculoskeletal interventional radiology. Br J Radiol. 2016;89(1057):20150369.CrossRefPubMedGoogle Scholar
  6. 6.
    Rosenthal D, Callstrom MR. Critical review and state of the art in interventional oncology: benign and metastatic disease involving bone. Radiology. 2012;262(3):765–80.CrossRefPubMedGoogle Scholar
  7. 7.
    Foster RC, Stavas JM. Bone and soft tissue ablation. Semin Interv Radiol. 2014;31:167–79.CrossRefGoogle Scholar
  8. 8.
    Kurup AN, Callstrom MR. Ablation of musculoskeletal metastases: pain palliation, fracture risk reduction, and oligometastatic disease. Tech Vasc Interv Radiol. 2013;16(4):253–61.CrossRefPubMedGoogle Scholar
  9. 9.
    Truong MT, Ko JP, Rossi SE, Rossi I, Viswanathan C, Bruzzi JF, Marom EM, et al. Update in the evaluation of the solitary pulmonary nodule. Radiographics. 2014;34:1658–79.CrossRefPubMedGoogle Scholar
  10. 10.
    Remzi M, Ozsoy M, Klingler HC, Susani M, Waldert M, Seitz C, et al. Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter. J Urol. 2006;176(3):896–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Khiatani V, Dixon RG. Renal ablation update. Semin Interv Radiol. 2014;31:157–66.CrossRefGoogle Scholar
  12. 12.
    Kneisl JS, Simon MA. Medical management compared with operative treatment for osteoid-osteoma. J Bone Joint Surg Am. 1992;74(2):179–85.CrossRefPubMedGoogle Scholar
  13. 13.
    National Comprehensive Cancer Network. Non-small cell lung cancer (Version 4.2017). Accessed 13 Feb 2017.Google Scholar
  14. 14.
    Robinson LA, Ruckdeschel JC, Wagner H Jr, Stevens CW, American College of Chest Physicians. Treatment of non-small cell lung cancer-stage IIIA: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132(3, Suppl):243S–65S.CrossRefPubMedGoogle Scholar
  15. 15.
    Alexander ES, Dupuy DE. Lung cancer ablation: technologies and techniques. Semin Interv Radiol. 2013;20:141–50.CrossRefGoogle Scholar
  16. 16.
    National Comprehensive Cancer Network. Kidney cancer (Version 2.2017). Accessed 13 Feb 2017.Google Scholar
  17. 17.
    Taylor BL, Stravropoulos SW, Guzzo TJ. Ablative therapy for small renal masses. Urol Clin N Am. 2017;44:223–31.CrossRefGoogle Scholar
  18. 18.
    Thompson RH, Atwell T, Schmit G, Lohse CM, Kurup AN, Weisbrod A, et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol. 2015;67(2):252–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Hui GC, Tuncali K, Tatli S, Morrison PR, Silverman SG. Comparison of percutaneous and surgical approaches to renal tumor ablation: metaanalysis of effectiveness and complication rates. J Vasc Interv Radiol. 2008;19(9):1311–20.CrossRefPubMedGoogle Scholar
  20. 20.
    Rosenthal DI, Hornicek FJ, Wolfe MW, Jennings LC, Gebhardt MC, Mankin HJ. Percutaneous radiofrequency coagulation of osteoid osteoma compared with operative treatment. J Bone Joint Surg Am. 1998;80(6):815–21.CrossRefPubMedGoogle Scholar
  21. 21.
    Lanza E, Thouvenin Y, Viala P, Sconfienza LM, Poretti D, Cornalba G, Sardanelli F, et al. Osteoid osteoma treated by percutaneous thermal ablation: when do we fail? A systematic review and guidelines for future reporting. Cardiovasc Intervent Radiol. 2014;37(6):1530–9.CrossRefPubMedGoogle Scholar
  22. 22.
    van der Linden E, Kroft LJM, Dijkstra S. Treatment of vertebral tumor with posterior wall defect using image-guided radiofrequency ablation combined with vertebroplasty: preliminary results in 12 patients. J Vasc Interv Radiol. 2007;18:741–8.CrossRefPubMedGoogle Scholar
  23. 23.
    McGahan JP, Browning PD, Brock JM, Tesluk H. Hepatic ablation using radiofrequency electrocautery. Investig Radiol. 1990;25(3):267–70.CrossRefGoogle Scholar
  24. 24.
    Rossi S, Fornari F, Pathies C, Buscarini L. Thermal lesions induced by 480 KHz localized current field in Guinea pig and pig liver. Tumori. 1990;76(1):54–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Rosenthal DI, Alexander A, Rosenberg AE, Springfield D. Ablation of osteoid osteomas with a percutaneous placed electrode: a new procedure. Radiology. 1992;183(1):29–33.CrossRefPubMedGoogle Scholar
  26. 26.
    Goldberg SN, Gazelle GS, Compton SS, Mcloud TC. Radiofrequency tissue ablation in the rabbit lung: efficacy and complications. Acad Radiol. 1995;2:776–84.CrossRefPubMedGoogle Scholar
  27. 27.
    Uchida M, Imaide Y, Sugimoto K, Uehara H, Watanabe H. Percutaneous cryosurgery for renal tumors. Br J Urol. 1995;75(2):132–6. discussion 136-137.CrossRefPubMedGoogle Scholar
  28. 28.
    Zlotta AR, Wildshutz T, Raviv G, Peny MO, van Gansbeke D, Noel JC, et al. Radiofrequency interstitial tumor ablation (RITA) is a possible new modality for treatment of renal cancer: ex vivo and in vivo experience. J Endourol. 1997;11(4):251–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Knavel EM, Brace CL. Tumor ablation: common modalities and general practices. Tech Vasc Interv Radiol. 2013;13(4):192–200.CrossRefGoogle Scholar
  30. 30.
    Gunn AJ, Gervais DA. Percutaneous ablation of the small renal mass-techniques and outcomes. Semin Interv Radiol. 2014;31:33–41.CrossRefGoogle Scholar
  31. 31.
    de Baere T, Tselikas L, Gravel G, Deschamps F. Lung ablation: best practice/results/response assessment/role alongside other ablative therapies. Clin Radiol. 2017; 72(8):657–664.Google Scholar
  32. 32.
    Dupuy DE, Zagoria RJ, Akerley W, Mayo-Smith WW, Kavanagh PV, Safran H. Percutaneous radiofrequency ablation of malignancies in the lung. AJR Am J Roentgenol. 2000;174(1):57–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Zhu JC, Yan TD, Morris DLA. Systematic review of radiofrequency ablation for lung tumors. Ann Surg Oncol. 2008;15:1765–74.CrossRefPubMedGoogle Scholar
  34. 34.
    de Baere T, Tselikas L, Catena V, Buy X, Deschamps F, Palussiere J. Percutaneous thermal ablation of primary lung cancer. Diagn Interv Imaging. 2016;97(10):1019–24.CrossRefPubMedGoogle Scholar
  35. 35.
    de Baere T, Farouil G, Deschamps F. Lung cancer ablation: what is the evidence? Semin Interv Radiol. 2013;30:151–6.CrossRefGoogle Scholar
  36. 36.
    Simon CJ, Dupuy DE, DiPetrillo TA, Safran HP, Greico CA, Ng T, Mayo-Smith WW. Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients. Radiology. 2007;243(1):268–75.CrossRefPubMedGoogle Scholar
  37. 37.
    Higgins LJ, Hong K. Renal ablation techniques: state of the art. AJR. 2015;205:735–41.CrossRefPubMedGoogle Scholar
  38. 38.
    Atwell TD, Schmit GD, Boorjian SA, Mandrekar J, Kurup AN, Weisbrod AJ, et al. Percutaneous ablation of renal masses measuring 3.0 cm and smaller: comparative local control and complications after radiofrequency ablation and cryoablation. AJR. 2013;200(2):461–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Georgiades CS, Rodriguez R. Efficacy and safety of percutaneous cryoablation for stage 1A/B renal cell carcinoma: results of a prospective, single-arm, 5-year study. Cardiovasc Interv Radiol. 2014;37(6):1494–9.CrossRefGoogle Scholar
  40. 40.
    Gebauer B, Collettini F, Bruger C, Schaser KD, Melcher I, Tunn PU, Streitparth F. Radiofrequency ablation of osteoid osteomas: analgesia and patient satisfaction in long-term follow-up. Rofo. 2013;184(10):959–66.CrossRefPubMedGoogle Scholar
  41. 41.
    Rimondi E, Mavrogenis AF, Rossi G, Ciminar R, Malaguti C, Tranfaglia C, et al. Radiofrequency ablation of non-spinal osteoid osteiomas in 557 patients. Eur Radiol. 2012;22(1):181–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Dupuy DE, Liu D, Hartfeil D, Hanna L, Blume JD, Ahrar K, et al. Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial. Cancer. 2010;116(4):989–97.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Thacker PG, Callstrom MR, Curry TB, Madrekar JN, Atwell TD, Goetz MP, Rubin J. Palliation of painful metastatic disease involving bone with image-guided treatment: comparison of patients’ immediate response to radiofrequency ablation and cryoablation. Am J Roentgenol. 2011;197(2):510–5.CrossRefGoogle Scholar
  44. 44.
    Callstrom MR, Dupuy DE, Solomon SB, Beres RA, Littrup PJ, Davis KW, et al. Percutaneous image-guided cryoablation of painful metastases involving bone: multi-center trial. Cancer. 2013;119(5):1033–41.CrossRefPubMedGoogle Scholar
  45. 45.
    Patel IJ, Davidson JC, Nikolic B, Salazar GM, Schwartzberg MS, Walker TG, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012;23:727–36.CrossRefPubMedGoogle Scholar
  46. 46.
    Kashima M, Yamakado K, Takaki H, Kodama H, Yamada T, Uraki J, et al. Complications after 1000 lung radiofrequency ablation sessions in 420 patients: a single center’s experiences. AJR. 2011;197(4):W576–80.CrossRefPubMedGoogle Scholar
  47. 47.
    Hiraki T, Tajiri N, Mimura H, Yasui K, Gobara H, Mukai T, et al. Pneumothorax, pleural effusion, and chest tube placement after radiofrequency ablation of lung tumors: incidence and risk factors. Radiology. 2006;241:275–83.CrossRefPubMedGoogle Scholar
  48. 48.
    Georgiades C, Rodriguez R. Renal tumor ablation. Tech Vasc Interv Radiol. 2013;16(4):230–8.CrossRefPubMedGoogle Scholar
  49. 49.
    Kurup AN. Percutaneous ablations for small renal masses-complications. Semin Interv Radiol. 2014;31:42–9.CrossRefGoogle Scholar
  50. 50.
    Sheu YR, Hong K. Percutaneous lung tumor ablation. Tech Vasc Interv Radiol. 2013;16(4):239–52.CrossRefGoogle Scholar
  51. 51.
    Iannuccilli JD, Grand DJ, Dupuy DE, Mayo-Smith WW. Percutaneous ablation for small renal masses-imaging follow-up. Semin Interv Radiol. 2014;31(1):50–63.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of North Carolina, Department of RadiologyChapel HillUSA

Personalised recommendations