Bronchoscopic ablation is progressing as an option for patients with nonoperative early stage or oligometastatic lung cancer. Parallel developments in robotic bronchoscopy, real-time imaging using mobile cone beam CT (CBCT), and improved intraoperative ventilation strategies are opening new pathways to bronchoscopic ablation for peripheral lung tumors.
However, there are still questions about whether the techniques are truly ready for prime time. Panelists will explore the need for improved safety and efficacy data, lessons that can be learned from other disciplines, and pitfalls that might be avoided during Bronchoscopic Ablation of Peripheral Lung Tumors: A Pro-Con Debate, on Wednesday, from 8:30 am to 9:30 am, in Room 315 of the convention center.
“When we look at the clinical trials, we have at least a half-dozen different modalities that we can potentially use in our armamentarium,” said Session Co-Chair, George Z. Cheng, MD, PhD, FCCP. “Our interventional radiology colleagues have been ablating tumors using image-guided techniques for 25 to 30 years. We are now getting to the stage in lung cancer care where we can ask whether we can or we should deliver bronchoscopic-guided ablation to peripheral nodules.”
Dr. Cheng, Director of Interventional Pulmonology, Bronchoscopy, and Pleural Services and Associate Professor of Medicine at the University of California San Diego, will be joined during the session by Session Co-Chair, Momen Wahidi, MD, MBA, FCCP, of Duke University Hospital, and Fabien Maldonado, MD, FCCP, of Vanderbilt University. Calvin Ng, MBBS, DM, FCCP, of The Chinese University of Hong Kong, will argue for the readiness of bronchoscopic ablation for peripheral lung tumors, while Janani Reisenauer, MD, of the Mayo Clinic, will argue against.
“The holy grail of nodule management would be to biopsy the nodule in the bronchoscopy suite, and if pathology determines the nodule is cancerous, then stage the patient,” Dr. Cheng said. “And if we find there is no lymph node involvement, we could provide therapy at the same time, while the patient is still under anesthesia. The patient can get a cancer diagnosis and walk out the door with the cancer already treated.”
Ongoing trials in Hong Kong, the UK, and the US have demonstrated that the concept of bronchoscopic ablation is feasible, he said. Radiofrequency ablation, microwave ablation, and cryoablation of peripheral lung nodules have all been performed successfully by interventional radiologists. Preclinical work also supports bronchoscopic delivery of biologic therapy directly to a nodule as well as the use of oncolytic virus therapy, intratumor injection of high-dose chemotherapy, and other approaches.
Development of robotic bronchoscopy, CBCT, and novel intraprocedural ventilation approaches continued during the COVID pandemic, Dr. Cheng said. Successive advances in the last 3 years mean that peripheral nodules can be accessed with a high degree of confidence, accuracy, and reliability. At the same time, these new approaches have also improved safety and reduced adverse events.
Attendees can expect an update on the current status of the most advanced work in bronchoscopic ablation, including current data gaps and the kinds of trials that might improve both safety and efficacy.
“Our goal is to stimulate conversation and spark people into thinking long and hard about how to best improve bronchoscopic-guided ablation,” Dr. Cheng said. “Once we start talking about it, we bring more people into the discussion and generate more ideas.”
“We all have a common goal—radiation oncologists, medical oncologists, radiologists, surgeons, pulmonologists—to provide an effective multimodality treatment approach for our patients with lung cancer,” he said. “We need to start talking now about where a bronchoscopic-guided ablation approach might best and most effectively be delivered if it were to become a standard of care. It is time to discuss just where and how bronchoscopic ablation of peripheral nodules is going to fit into the spectrum of lung cancer management.”