Microwave ablation for primary or metastatic cancer in the lung

Lung cancer is one of the most common types of cancer. The symptoms often do not appear until the disease is at an advanced stage, and the prognosis is generally poor. Cancer that begins in the lungs is called primary lung cancer. There are 2 main types of primary lung cancer: small-cell lung cancer (which is fast growing and can spread quickly) and non-small-cell lung cancer (which usually grows and spreads slowly; this includes squamous cell carcinoma, adenocarcinoma and large-cell carcinoma).

Cancer that starts in one part of the body and spreads via the blood stream to the lungs is known as secondary lung cancer (also called metastatic lung cancer or lung metastasis). Common tumours that metastasise to the lungs include breast cancer, colon cancer, prostate cancer, sarcoma, bladder cancer, neuroblastoma and Wilm's tumour.

NICE's guideline on lung cancer describes the treatment of non-small-cell and small-cell lung cancer. The choice of treatment for primary or metastatic cancer in the lung depends on the type, size, position and stage of the cancer, and the patient's overall health. Common treatments for primary or metastatic cancer in the lung include surgery, chemotherapy, radiotherapy, or a combination of these. Other treatments include photodynamic therapy, thermal ablation, immunotherapy and biological therapy.

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 13 sources, which was discussed by the committee. The evidence included 3 systematic reviews and/or meta-analyses, 6 non-randomised comparative studies, 2 case series, 1 case report and 1 review of lung microwave ablation database. It is presented in the summary of key evidence section in the overview. Other relevant literature is in the appendix of the overview.

The professional experts and the committee considered the key efficacy outcomes to be: disease progression, survival, reduction in tumour size, local recurrence and quality of life.

The professional experts and the committee considered the key safety outcomes to be: pneumothorax, pleural effusion, air embolism, bronchopleural fistula with prolonged air leak and bleeding.

Patient commentary was sought but none was received.

The committee was informed that microwave ablation is quicker and may be better tolerated than other ablation techniques.

The committee was informed that evidence on the efficacy of microwave ablation for primary and metastatic lung cancer is similar to other ablation procedures in terms of tumour size reduction. Other ablation procedures are also associated with similar complications.

The committee was informed that microwave ablation is not used to treat small-cell lung cancer.

This procedure may have a role for patients with primary or metastatic lung cancer who are unable to have surgery or whose tumour is not resectable.

There is more than 1 device available for this procedure.