Safety and preliminary efficacy of percutaneous co-ablation system under local anesthesia for the treatment of malignant lung tumors: A retrospective cohort study.

[BACKGROUND] Lung cancer is a common malignancy with the highest mortality rate. Currently, Image-guided thermal ablation (IGTA) therapy has been widely applied in lung cancer. This study aimed to evaluate the safety and preliminary efficacy of co-ablation therapy in the treatment of malignant pulmonary tumors. The co-ablation system is a novel ablation device that integrates the technical advantages of both cryoablation and high-intensity thermal ablation.

[METHODS] From February 2022 to May 2024, 194 patients (182 with primary lung cancer and 12 with metastatic lung tumor) underwent percutaneous co-ablation for the treatment of malignant lung tumors at our institution. A retrospective study was conducted to analyze the adverse events (AEs), and preliminary efficacy in 205 treatment sessions targeting 224 lesions.

[RESULTS] The median diameter of the targeted tumor was 1.3 cm. All co-ablation procedures were performed under local anesthesia. 55 sessions (26.83 %) experienced AEs (grade 2 or higher), with pneumothorax being the most common (44 sessions, 21.46 %). Grade 3 AEs occurred in 7 sessions (3.41 %), with pneumothorax and pleural effusion being the most common. In multivariate analysis, independent predictors of AEs included severe emphysema [odds ratio (OR) = 3.14; 95 % confidence interval (CI): 1.55-4.74], tumor size (OR = 1.09; 95 % CI: 0.0642-2.11), and number of tumors (OR = 4.60; 95 % CI: 2.83-6.38). Median follow-up time was 6 months. Follow-up assessments of local tumor control (LTC) rates at 3, 6, and 12 months post-ablation revealed that smaller tumor size was associated with higher LTC rates. There was statistical difference for progress-free survival(PFS) between group ≤ 3 cm and group＞3cm of tumor size [NR vs 6 (95 %CI:4.1-7.9) months, P = 0.0045].

[CONCLUSION] Co-ablation is a safe treatment for malignant lung tumors with acceptable AEs rates. The incidence of pneumothorax was comparable to that of conventional cryoablation, whereas pleural effusion and hemoptysis rates were significantly lower. Furthermore, the procedure achieved favorable local control rates and prolonged progression-free survival, particularly for small (≤3 cm) lesions.