Background/Objectives: Accurate assessment of pulmonary function is essential before planning radical lung cancer treatment. While spirometry reflects global lung function, perfusion imaging provides detailed information on regional perfusion patterns. This study aimed to characterize the pre-treatment profile of patients and compare the impact of surgical resection, radiotherapy, and thermal ablation on global pulmonary function and regional perfusion using SPECT/CT. Methods: In this prospective study of 68 patients, pre- and post-treatment assessments were conducted using lung perfusion SPECT/CT. While the entire cohort underwent imaging, longitudinal global pulmonary function (spirometry and gas diffusion) was analyzed for 45 patients who completed the three-month follow-up. Quantitative analysis included perfusion percentages and lung volumes, while a semi-quantitative scoring system evaluated the severity of perfusion defects. Results: In the overall cohort, the affected lung perfusion and volume significantly decreased (p = 0.002). Subgroup analysis revealed that the surgical resection group experienced significant reductions in perfusion (from 54.0% to 41.0%, p = 0.002) and volume (p < 0.001) of the affected lung, whereas no statistically significant changes were observed in the thermal ablation and radiotherapy groups (p > 0.05). Notably, 60.3% of patients presented with perfusion defects before treatment. Post-treatment spirometry parameters, particularly FEV1% (threshold 83.5%, AUC = 0.783), served as reliable predictors of persistent perfusion impairment. Conclusions: Radiotherapy and thermal ablation are lung-perfusion-sparing treatments compared to surgical resection. The high prevalence of pre-existing perfusion defects emphasizes the importance of incorporating lung perfusion SPECT/CT into routine pre-treatment evaluation to optimize treatment selection.

Background and Objectives: Lung cancer and pulmonary metastases are major causes of cancer-related mortality. Surgery is a standard curative approach, but many patients are ineligible due to age, comorbidities, or treatment preference. This study aimed to evaluate the safety, effectiveness, and quality-of-life outcomes of thermal ablation versus surgery and stereotactic body radiotherapy (SBRT) for malignant lung lesions. Materials and Methods: A prospective, non-randomized study was conducted on 68 patients with primary or metastatic lung tumours treated by surgery (n = 19), SBRT (n = 29), or thermal ablation (n = 20). The key outcomes included recurrence rates and patterns, disease-free and overall survival, complications, hospitalization, and health-related quality of life (HRQoL). Results: Surgery demonstrated the lowest total and regional recurrence rates (21.1% and 10.5%, respectively), significantly lower than SBRT (57.1% and 42.9%, respectively; p < 0.05). Additionally, surgery led to the longest disease-free survival but was associated with the highest complication rate (78.9%) and the greatest HRQoL decline. SBRT had fewer complications (17.2%) and moderate HRQoL outcomes. Thermal ablation showed no significant differences in recurrence (45.0% of total recurrence) or survival compared to surgery or SBRT, with a moderate complication rate (45.0%) and the most favorable HRQoL outcomes. Major complications were rare and comparable across all groups. Conclusions: Thermal ablation demonstrated comparable disease control and quality-of-life outcomes to SBRT, with lower complication rates. While surgery remains superior in local disease control, its invasiveness and impact on quality of life underscore the importance of minimally invasive treatments in multidisciplinary management of malignant lung lesions.

Background: Complications, particularly pneumothorax, are common following lung interventions and occasionally necessitate further examinations, extend hospital stays, increase treatment costs, and result in long-term health impairment or even death. A few lung intervention tract sealants have been explored to reduce procedure-related complications. Objectives: The primary objective of this prospective non-randomized study was to assess the complication rates and risk factors for computed tomography-guided lung microwave ablation (MWA) with autologous blood clot as a tract sealant. Methods: Twenty-one patients underwent a total of 26 MWA sessions for lung malignancy followed by injection of the patient’s clotted venous blood into the ablation tract while retracting the coaxial needle. Ablation tract sealing was successful in all MWA sessions. Results: Pneumothorax was the only complication observed in five (19.2%) sessions, with one patient (3.8%) requiring chest tube insertion. The male sex was a statistically significant risk factor for pneumothorax (p = 0.042), and patients with lung emphysema had almost fivefold higher odds of developing pneumothorax (OR 4.8; 95% CI, 0.617–37.351; p = 0.281). Conclusions: This study concludes that pneumothorax is the primary complication following lung MWA, and the male sex is a risk factor. Ablation tract sealing with autologous venous blood is a straightforward and inexpensive technique that can reduce the incidence of procedure-related pneumothorax.