Key challenges and future prospects of microwave ablation in the treatment of small pulmonary nodules and early lung cancer

Abstract

Driven by the rapid development of minimally invasive surgical techniques, the treatment of small lung nodules and early lung cancer has ushered in epoch-making changes. In particular, Microwave ablation (MWA) technology, as a potential treatment for the treatment of small lung nodules and early lung cancer, received high attention in the industry. MWA, with its unique advantages of minimally invasive, rapid recovery and low complication rate, is gradually subverting the traditional nodule/early lung cancer treatment model. However, although MWA has achieved remarkable results in the clinical treatment process, it still faces some key challenges. The purpose of this article is to explore these key challenges in depth and to look into the future development of microwave ablation in the treatment of pulmonary nodules/early lung cancer.

Microwave ablation is a minimally invasive treatment that uses microwave energy to generate heat, effectively destroy tumor cells while maximizing the preservation of surrounding healthy lung tissue. Its significant effectiveness and safety have been widely recognized in the industry, providing an alternative for lung nodules and early lung cancer patients who are not suitable for surgery and cannot tolerate surgery. However, there are still several challenges in clinical practice:

1. Precise location and puncture of pulmonary nodules and lung cancer. It is a challenge to accurately identify and puncture small lung nodules and early lung cancer, especially the aerated organs in the bidirectional movement of exhalation and inhalation in the lung at this moment, and the difficulty of accurate positioning and puncture is much higher than that of other organs. Our team first proposed the concept of "tumor ablation area". Firstly, the concept of multi-dimensional properties of "tumor lesion area (GTR)" and "post-ablation target area (PTZ)" in ablation was proposed, which laid a theoretical foundation for accurate ablation and complete ablation. The technical indexes such as puncture point marking, puncture diameter, target skin distance, tumor lesion area and ablation parameters were quantified. With the wide application and promotion of clinical assisted robot technology, intelligent surgical navigation robot + MWA will become a safe, reliable and extremely minimally invasive solution in the future, which can conduct real-time interactive navigation throughout the operation, short operation time, accurate positioning and puncture, effectively reduce the number of needle insertion, and reduce the risk of pneumothorax and bleeding.
2. Real-time thermal field monitoring and control. Ensuring that heat is evenly distributed during ablation, while avoiding thermal damage to surrounding healthy tissue, is a major challenge in our clinical treatment. Real-time thermal monitoring systems and improved algorithms for controlling ablation areas are essential to prevent complications and optimize treatment outcomes. Our team took the lead in proposing the concept of "tumor ablation zone", first proposed the concept of multi-dimensional properties of "tumor lesion area (GTR)" and "post-ablation target area (PTZ)" for ablation, which laid a theoretical foundation for accurate ablation and complete ablation. At the same time, we created a "three-dimensional visualization planning system" and carried out multi-mode thermal field simulation to simulate the entire ablation process. In the future, the development of a monitoring system that can monitor the temperature and range of the ablation site in real time will greatly promote the accuracy of ablation technology and achieve a higher level of precision ablation therapy.
3. Reduce complications. Although MWA is considered efficient and safe, there are potential risks, including pneumothorax, hemorrhage, pleural effusion and thermal damage to the surrounding structure. Our team developed a new coaxial double-slit rigid water-cooled 19G ablation antenna to reduce the occurrence of complications, and the incidence of pneumothorax, hemorrhage and pleural effusion decreased by 29.0%, 28.9% and 9.9%, respectively. Future development of smaller, more accurate antennas and advanced thermal monitoring systems will be critical to reducing complications and improving patient safety.
4. Reduce in situ recurrence and enhance the distant effect. The integration of multidisciplinary treatment plans requires collaborative research efforts by multidisciplinary teams of oncologists, pathologists, radiologists and surgeons. The use of MWA in combination with chemotherapy, radiotherapy or immunotherapy can effectively reduce the rate of recurrence in situ while enhancing the distant effect. Going forward, we intend to conduct large-scale randomized clinical trials to verify the safety and efficacy of these regiments.
5. Further standardize the technical system. In order to promote the further standardization of the technical system, our team has played a leading role in the successful development and release of 7 domestic and foreign industry guidelines, consensus and norms. These include the world's first "Clinical practice guidelines on image guided thermal ablation of primary and metastatic lung tumors (2022 edition). Looking ahead, our team will continue to focus on deepening research to ensure that the technology system is more complete to meet clinical needs and promote the improvement of medical quality.

On the historic occasion of the founding of the International Health Sciences Journal, we offer our best wishes and congratulations. We call on scholars and experts to give full play to the unique role of the International Health Sciences Journal as an academic exchange platform, and actively contribute to disseminate their valuable research results to all parts of the world. We believe that this will bring great benefits to researchers and clinicians, while also strongly promoting technological progress and innovation in the field of minimally invasive therapy. Let us work together to contribute to the prosperity and development of this sector.