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Review
. 2022;101(7):666-674.
doi: 10.1159/000522544. Epub 2022 Mar 22.

Microwave Ablation for Malignant Central Airway Obstruction: A Pilot Study

Michal Senitko  1   2 , Catherine L Oberg  3 , George E Abraham  1 , William B Hillegass  4 , Israh Akhtar  5   6 , Erik Folch  7
Affiliations
Review

Microwave Ablation for Malignant Central Airway Obstruction: A Pilot Study

Michal Senitko et al. Respiration. 2022.

Abstract

Background: Malignant central airway obstruction (CAO) is a debilitating complication of primary lung cancer and pulmonary metastases. Therapeutic bronchoscopy is used to palliate symptoms and/or bridge to further therapy. Microwave ablation (MWA) heats tissue by creating an electromagnetic field around an ablation device. We present a pilot study utilizing endobronchial MWA via flexible bronchoscopy as a novel modality for the management of malignant CAO.

Methods: Therapeutic bronchoscopy with a flexible MWA probe was performed in 8 cases. We reviewed tumor size, previous ablative techniques, number of applications, ablation time, amount of energy delivered, rate of successful recanalization, complications, and 30-day follow-up.

Results: Successful airway recanalization was achieved in all cases. No complications were noted. In 1 case, tumor in-growth within a silicone stent was ablated with no damage to the stent.

Discussion: Endobronchial MWA is a novel technique for tumor destruction while maintaining an airway axis. The oven effect and air gap around a tumor allow for safe and effective tissue devitalization and hemostasis without a thermal effect on structures surrounding the airway.

Keywords: Airway obstruction; Bronchoscopic treatment; Interventional bronchoscopy; Lung cancer; Microwave ablation; Tracheobronchial obstruction; Tumor ablation.

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Conflict of interest statement

M.S. has been a scientific consultant for Medtronic Inc., MedWave Inc., and Optellum Inc. G.E.A. has been a scientific consultant for AstraZeneca. E.F. has been a scientific consultant for Boston Scientific, Medtronic, and Cook. E.F. has received an institutional grant from Intuitive Surgical. C.L.O., W.B.H., and I.A. have nothing to disclose.

Figures

Fig. 1
Fig. 1
Characteristics of MWA with ablation zones, oven effect, and thermal sink effect.
Fig. 2
Fig. 2
MWA of a tracheal tumor completely obstructing a silicone stent. a Ball valve tracheal tumor completely obstructing the proximal end of a silicone stent. b Partial ablation of tracheal tumor, revealing tumor inside and outside of the stent. c Tumor inside stent has been ablated. MWA catheter inside tumor between stent and airway wall. d Postablation of tumor inside and outside of silicone stent.
Fig. 3
Fig. 3
MWA of a LMS bronchus tumor. a Tumor completely obstructing the LMS bronchus with a microwave catheter placed in the center. b Postablation of LMS tumor. Notice an air gap between the tumor and airway mucosa. c Patent LMS bronchus after ablation and tumor removal. d LMS tumor cored out in one piece. LMS, left mainstem.
Fig. 4
Fig. 4
a Endobronchial biopsy of right mainstem bronchus tumor. H&E, ×200: Sheets of malignant cells with hyperchromatic nuclei and dense cytoplasm, and foci of necrosis. b Postablation endobronchial biopsy of right mainstem bronchial wall. H&E, ×200: fragments of unremarkable bronchial wall with submucosal glands. No malignancy identified.
Fig. 5
Fig. 5
Distribution of energy application times in each ablation case.
Fig. 6
Fig. 6
Number of microwave applications in each ablation case.
See this image and copyright information in PMC

References

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