Percutaneous Thermal Ablation for Stage IA Non-small Cell Lung Cancer: Long-term Follow-up

Overview

Journal J Thorac Dis

Publisher AME Publishing Company

Specialty Pulmonary Medicine

Date 2017 Dec 23

PMID 29268414

Citations 14

Authors

Chaitan K Narsule

Praveen Sridhar

Divya Nair

Avneesh Gupta

Roy G Oommen

Michael I Ebright

Virginia R Litle

Hiran C Fernando

Affiliations

Soon will be listed here.

Abstract

Background: Surgical resection is the most effective curative therapy for non-small cell lung cancer (NSCLC). However, many patients are unable to tolerate resection secondary to poor reserve or comorbid disease. Radiofrequency ablation (RFA) and microwave ablation (MWA) are methods of percutaneous thermal ablation that can be used to treat medically inoperable patients with NSCLC. We present long-term outcomes following thermal ablation of stage IA NSCLC from a single center.

Methods: Patients with stage IA NSCLC and factors precluding resection who underwent RFA or MWA from July 2005 to September 2009 were studied. CT and PET-CT scans were performed at 3 and 6 month intervals, respectively, for first 24 months of follow-up. Factors associated with local progression (LP) and overall survival (OS) were analyzed.

Results: Twenty-one patients underwent 21 RFA and 4 MWA for a total of 25 ablations. Fifteen patients had T1a and six patients had T1b tumors. Mean follow-up was 42 months, median survival was 39 months, and OS at three years was 52%. There was no significant difference in median survival between T1a nodules and T1b nodules (36 . 39 months, P=0.29) or for RFA and MWA (36 . 50 months, P=0.80). Ten patients had LP (47.6%), at a median time of 35 months. There was no significant difference in LP between T1a and T1b tumors (22 . 35 months, P=0.94) or RFA and MWA (35 . 17 months, P=0.18). Median OS with LP was 32 months compared to 39 months without LP (P=0.68). Three patients underwent repeat ablations. Mean time to LP following repeat ablation was 14.75 months. One patient had two repeat ablations and was disease free at 40-month follow-up.

Conclusions: Thermal ablation effectively treated or controlled stage IA NSCLC in medically inoperable patients. Three-year OS exceeded 50%, and LP did not affect OS. Therefore, thermal ablation is a viable option for medically inoperable patients with early stage NSCLC.

Citing Articles

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Bronchoscopy-Guided High-Power Microwave Ablation in an in vivo Porcine Lung Model.

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Radiofrequency Ablation for Stage I Non-Small Cell Lung Cancer: An Updated Review of Literature from the Last Decade.

Matsui Y, Iguchi T, Tomita K, Uka M, Sakurai J, Gobara H Interv Radiol (Higashimatsuyama). 2022; 5(2):43-49.

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Huang Y, Wang J, Hu Y, Cao P, Wang G, Cai H Front Oncol. 2022; 12:938827.

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References

Henderson M, Hoopes D, Fletcher J, Lin P, Tann M, Yiannoutsos C . A pilot trial of serial 18F-fluorodeoxyglucose positron emission tomography in patients with medically inoperable stage I non-small-cell lung cancer treated with hypofractionated stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys. 2009; 76(3):789-95. PMC: 2823932. DOI: 10.1016/j.ijrobp.2009.02.051. View

Pennathur A, Luketich J, Abbas G, Chen M, Fernando H, Gooding W . Radiofrequency ablation for the treatment of stage I non-small cell lung cancer in high-risk patients. J Thorac Cardiovasc Surg. 2007; 134(4):857-64. DOI: 10.1016/j.jtcvs.2007.04.060. View

Liu H, Steinke K . High-powered percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: a preliminary study. J Med Imaging Radiat Oncol. 2013; 57(4):466-74. DOI: 10.1111/1754-9485.12068. View

Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradley J . Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 2010; 303(11):1070-6. PMC: 2907644. DOI: 10.1001/jama.2010.261. View

Simon C, Dupuy D, DiPetrillo T, Safran H, Grieco C, Ng T . Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients. Radiology. 2007; 243(1):268-75. DOI: 10.1148/radiol.2431060088. View

Acksteiner C, Steinke K . Percutaneous microwave ablation for early-stage non-small cell lung cancer (NSCLC) in the elderly: a promising outlook. J Med Imaging Radiat Oncol. 2014; 59(1):82-90. DOI: 10.1111/1754-9485.12251. View

Suh R, Wallace A, Sheehan R, Heinze S, Goldin J . Unresectable pulmonary malignancies: CT-guided percutaneous radiofrequency ablation--preliminary results. Radiology. 2003; 229(3):821-9. DOI: 10.1148/radiol.2293021756. View

Ambrogi M, Fanucchi O, Cioni R, Dini P, De Liperi A, Cappelli C . Long-term results of radiofrequency ablation treatment of stage I non-small cell lung cancer: a prospective intention-to-treat study. J Thorac Oncol. 2011; 6(12):2044-51. DOI: 10.1097/JTO.0b013e31822d538d. View

Crabtree T, Puri V, Timmerman R, Fernando H, Bradley J, Decker P . Treatment of stage I lung cancer in high-risk and inoperable patients: comparison of prospective clinical trials using stereotactic body radiotherapy (RTOG 0236), sublobar resection (ACOSOG Z4032), and radiofrequency ablation (ACOSOG Z4033). J Thorac Cardiovasc Surg. 2012; 145(3):692-9. DOI: 10.1016/j.jtcvs.2012.10.038. View

10.

Dupuy D . Image-guided thermal ablation of lung malignancies. Radiology. 2011; 260(3):633-55. DOI: 10.1148/radiol.11091126. View

11.

Swensen S, Viggiano R, Midthun D, Muller N, Sherrick A, Yamashita K . Lung nodule enhancement at CT: multicenter study. Radiology. 2000; 214(1):73-80. DOI: 10.1148/radiology.214.1.r00ja1473. View

12.

Yousefi S, Collins B, Reichner C, Anderson E, Jamis-Dow C, Gagnon G . Complications of thoracic computed tomography-guided fiducial placement for the purpose of stereotactic body radiation therapy. Clin Lung Cancer. 2007; 8(4):252-6. DOI: 10.3816/CLC.2007.n.002. View

13.

Hoopes D, Tann M, Fletcher J, Forquer J, Lin P, Lo S . FDG-PET and stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer. Lung Cancer. 2007; 56(2):229-34. DOI: 10.1016/j.lungcan.2006.12.009. View

14.

Higuchi M, Yaginuma H, Yonechi A, Kanno R, Ohishi A, Suzuki H . Long-term outcomes after video-assisted thoracic surgery (VATS) lobectomy versus lobectomy via open thoracotomy for clinical stage IA non-small cell lung cancer. J Cardiothorac Surg. 2014; 9:88. PMC: 4058716. DOI: 10.1186/1749-8090-9-88. View

15.

Dupuy D . Treatment of medically inoperable non-small-cell lung cancer with stereotactic body radiation therapy versus image-guided tumor ablation: can interventional radiology compete?. J Vasc Interv Radiol. 2013; 24(8):1139-45. DOI: 10.1016/j.jvir.2013.04.021. View

16.

Curley S, Izzo F, Delrio P, Ellis L, Granchi J, Vallone P . Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg. 1999; 230(1):1-8. PMC: 1420837. DOI: 10.1097/00000658-199907000-00001. View

17.

Bhagat N, Fidelman N, Durack J, Collins J, Gordon R, LaBerge J . Complications associated with the percutaneous insertion of fiducial markers in the thorax. Cardiovasc Intervent Radiol. 2010; 33(6):1186-91. PMC: 2977074. DOI: 10.1007/s00270-010-9949-0. View

18.

Khullar O, Liu Y, Gillespie T, Higgins K, Ramalingam S, Lipscomb J . Survival After Sublobar Resection versus Lobectomy for Clinical Stage IA Lung Cancer: An Analysis from the National Cancer Data Base. J Thorac Oncol. 2015; 10(11):1625-33. PMC: 5798611. DOI: 10.1097/JTO.0000000000000664. View

19.

Yasui K, Kanazawa S, Sano Y, Fujiwara T, Kagawa S, Mimura H . Thoracic tumors treated with CT-guided radiofrequency ablation: initial experience. Radiology. 2004; 231(3):850-7. DOI: 10.1148/radiol.2313030347. View

20.

Feng W, Liu W, Li C, Li Z, Li R, Liu F . Percutaneous microwave coagulation therapy for lung cancer. Zhonghua Zhong Liu Za Zhi. 2002; 24(4):388-90. View