Radiofrequency ablation for cure in medically inoperable stage I lung cancer: A single institution experience
Michael Lanuti, Amita Sharma, Subba R. Digumarthy, Cameron D. Wright, John C. Wain, Douglas J. Mathisen, JoAnne O. Shepard; Thoracic Surgery, MGH, Boston, MA
Comment on this Abstract
Objective: To evaluate the long term results of radiofrequency ablation as primary treatment for medically inoperable early stage lung cancer.
Methods: Thirty-one consecutive patients with biopsy proven non-small cell lung cancer (NSCLC) underwent 37 treatments of CT-guided radiofrequency ablation (RFA) over a 4-year period. All patients were carefully selected after multidisciplinary evaluation and were deemed medically unresectable by a thoracic surgeon. Assessment included pulmonary function, CT-PET within 60 days from diagnosis, and mediastinoscopy for enlarged or FDG-avid lymph nodes. RFA was performed with curative intent using a single or cluster cool-tip F electrode (Radionics). Procedures were conducted primarily under conscious sedation and patients were hospitalized for 23-hour observation.
Results: Treatment was successfully completed in all patients with no 30-day mortality. Local recurrence was confirmed radiographically via CT and/or PET in 13% (4/31) of patients. Two patients were successfully re-treated for technical failures due to pneumothorax and one patient failed re-treatment requiring external beam radiotherapy (XRT) with stable disease. Another patient failed lung RFA and XRT. The mean maximal diameter of the 34 tumors treated was 1.9 ± 1 cm (range 0.8 - 4.4cm). Eighty-one percent (25/31) of patients were alive after a median follow-up of 12.2 ± 10 months. Three patients died of metastatic disease and 3 patients succumbed to pneumonia. The overall 2 and 4-year survival was 60% and 30%, respectively. Median overall and progression free survival was 30 months. There was no significant difference in pulmonary function measured 6 months after ablation. Complications included pneumothorax (9/37), fever (3/37), pneumonia (6/37), mild hemoptysis (8/37), small hemothorax (2/37) and pleural effusion (5/37). Two patients with upper lobe lesions developed transient nerve palsies involving the recurrent laryngeal nerve and ulnar nerve, respectively.
Conclusion: Radiofrequency ablation of medically inoperable early stage lung cancer in carefully selected patients yields encouraging mid-term to long-term results without significant loss of pulmonary function. Local tumor progression appears to be related to RFA treatment of > 3 cm lung tumors. The incidence of major complications remains low. CT-PET needs further validation in the early detection of local failure of RFA-treated NSCLC.
PATIENT CHARACTERISTICS
| RFA TREATMENTS | 37 |
| LUNG TUMORS | 34 |
| MEDIAN AGE | 70 |
| LOCAL FAILURE | 13% (4/31) |
| REPEAT TREATMENT | 3 |
| CLINICAL STAGET1NOT2NO | 28 6 |
| MEDIAN FOLLOW-UP | 12±10 MONTHS |
| DISEASE PROGRESSION | 19% (6/31) |
| DISEASE FREE | 88% (22/25 ALIVE) |
| MEDIAN PROGRESSION FREE SURVIVAL (4 YEARS) | 30 MONTHS |
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