What is the key question?

• Is the use of bronchoscopic laser interstitial thermal therapy (BLITT) for ablation of lung parenchyma feasible and safe in normal animal lungs? What are the radiologic and pathologic consequences of BLITT?

What is the bottom line?

• The diagnosis of medically “inoperable” early lung cancer is expected to rise in our aging population and following the widespread implementation of lung cancer screening. While stereotactic body radiation therapy is the current standard, local recurrence rates are high.
• Recent advances in peripheral bronchoscopy made it an ideal platform for ablation of small peripheral tumors.
• This study investigated the tissue-ablative effect of a diode laser bronchoscopically applied by a laser delivery fiber (LDF) with wide aperture on porcine lung parenchyma.
• Laser was tested ex vivo and in vivo and identified the round-tip LDF to be the most suitable.
• Activated at 25 Watts for 20 seconds, ten ablations were performed in 5 pigs. Relatively large areas of ablation of normal lung parenchyma were achieved with BLITT as evidenced by computed tomography (median size on long axis of 26 mm at day 1 and 34 mm at day 3) and by necropsy (area of central char measuring from 0.8×0.7×0.9 cm to 2.4×3.5×1.2 cm, surrounded by a gray-brown to dark red area).
• There were no significant peri-procedural complications (one ablation resulted in a pneumothorax).

Why read on?

• BLITT may be suitable for patients with inoperable early lung cancer or lung metastases presenting with small lung tumors. Future human trials are needed to prove safety and feasibility.