Microwave ablation for primary or metastatic cancer in the lung

Evidence-based recommendations on microwave ablation for primary or metastatic cancer in the lung in adults. This involves inserting a probe into the lung, through the skin of the chest, to send microwaves into the cancer cells. This produces heat, aiming to destroy the cancer (ablation).

# Recommendations
Evidence on the safety of microwave ablation for treating primary lung cancer and metastases in the lung is adequate but shows it can cause infrequent serious complications. Evidence on its efficacy shows it reduces tumour size. But the evidence on improvement in survival, long-term outcomes and quality of life is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
Further research should be randomised controlled trials or disease registry studies. It should report patient selection, disease progression and quality of life, and take account of the effectiveness of managing oligometastatic disease in patients.
Clinicians who want to use microwave ablation to treat primary lung cancer and metastases in the lung should:
Inform the clinical governance leads in their healthcare organisation.
Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public.
Make sure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Audit and review clinical outcomes of all patients having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Make sure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.
People with primary or metastatic lung cancer should be referred to an appropriately constituted multidisciplinary team.
The procedure should only be done in specialist centres by clinicians with specific training in this procedure.# The condition, current treatments and procedure

# The condition
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.

# Current treatments
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.

# The procedure
The procedure is usually done using general anaesthesia, and occasionally using local anaesthesia and sedation. Under imaging guidance, a small probe is advanced through the chest wall and into each targeted lesion. It delivers high-frequency microwave energy to rapidly agitate water molecules in the tissues. This converts energy into heat, which causes tumour necrosis. Patients with larger tumours or multiple lesions may have multiple pulses of energy delivered within a treatment session or have a staged treatment with multiple sessions.
This procedure aims to destroy tumour cells and create localised areas of tissue necrosis with minimal damage to surrounding normal tissues. Microwave ablation is a minimally invasive procedure. It usually lasts 1 to 2 hours with only 5 to 10 minutes of active ablation time.