The patient was 77 years old, admitted with a cough for half a month, with a history of hypertension, diabetes mellitus and tuberculosis. On CT examination, a right lower lung occupancy with nature to be determined, right upper lung tuberculosis, and right pleural effusion were seen. No tumor metastasis was found in other areas.
In December 2011, a right pleural effusion and a right upper lung lesion considered to be tuberculosis were seen on CT.
Right pleural effusion, right upper lung tuberculosis.
Occupation of the right lower lung, lung cancer was considered.
The patient was old and frail and refused surgery. After repeated discussions with the patient and family, we decided to perform right lower lung tumor biopsy plus microwave ablation.
The patient was placed in the lateral position and first 22G fine needle puncture was performed to locate the tumor.
The 17G biopsy needle and microwave needle were used to puncture the tumor, and the tumor tissue was first taken for pathology, followed by microwave ablation of the lesion.
No pneumothorax or bleeding was seen after the needle was removed at the end of ablation.
After the ablation, the patient had chest tightness and CT scan showed an increase in pleural effusion, and the tumor did not show any enhancement.
The pathology was adenocarcinoma, and the genetic test was EGFR wild type.
The patient was discharged in a stable condition after the pleural effusion was reduced by ultrasound chest tube drainage.
On review 3 months later, there was no pneumothorax and a very small amount of pleural effusion in the right chest.
Enhancement scan did not show any enhancement of the tumor.
In May 2012, there seemed to be surviving tissue at the edge of the tumor, PET-CT was performed, and no obvious hypermetabolism was seen, and the follow-up was continued.
The tumor appeared to be alive at the edge, and it was suggested to ablate again or to follow up, PET-CT was performed, and no significant hypermetabolism was seen, and the follow-up was continued.
In April 2014, local stabilization was achieved, during which two pet-CT examinations were performed and no recurrent tumor was detected.
In October 2014, pet-CT revealed new hypermetabolic small nodular foci in the right diaphragm and right lung, lung cancer metastasis was considered, and argon helium knife cryoablation was performed after discussion with the patient. The frozen ice ball could be seen to have covered the right diaphragm nodule foci.
A new small nodular foci in the ascending parietal aspect of the right lung.
A 22G fine needle trial was performed first.
The 22G fine needle is trialed medial to the lesion, ensuring that the Ar-He knife needle is on the outside of the fine needle to ensure that the Ar-He knife needle does not puncture a large vessel.
Two Ar-He knife cryoablation needles were used to puncture the tumor and perform cryoablation treatment.
On review in December 2014, there was no enhancement of the right lung and right diaphragm lesions, suggesting complete ablation.
There was no enhancement of the right lung tumor.
The original right lower lung tumor was stable.
There was no enhancement of the right diaphragm tumor.
April 2015 The right lung tumor was largely absorbed.
Stable original right lower lung tumor.
No enhancement of the right diaphragmatic nodule.
The patient developed in December 2011 and is currently (2015) tumor-free and continues to be closely followed.
Point of view.
The patient’s lung occupancy was discovered in 2011, and pathology should have been taken first before deciding the next treatment plan, but the patient was frail in old age, and after discussion with the family, a more aggressive plan of biopsy plus ablation was adopted, which has not been accepted by the mainstream so far. This method can only be used if the physician is certain about the preoperative diagnosis and the type of biopsy.
After the microwave ablation, the patient did not undergo chemotherapy, but had intermittent oral ERSA, and the local tumor did not progress during several reviews, indicating that the effect of microwave ablation treatment was satisfactory.
Two years later, the patient was considered to have metastases in the right lung and right diaphragm by PET-CT. At this time, the patient was already eighty years old, and the patient was considered to be painless with argon helium knife without anesthesia, which was easily tolerated. After treatment, the patient was reviewed twice and the imaging was now suggestive of tumor-free survival.
Radiofrequency, microwave, argon helium knife and radioactive particle implantation are highly effective in the local treatment of lung cancer, providing new minimally invasive and efficient treatment options for lung cancer patients who are not indicated for surgery or who refuse surgery.
Unfortunately, there are still not many physicians who can recognize the advantages of these treatments, which may be related to the fact that there are too few physicians who can master these techniques. Perhaps in ten years, lung cancer ablation and particle implantation will be recognized and adopted by mainstream physicians in the same way as liver cancer ablation is now.