Radiofrequency Ablation an Option for Inoperable Early-Stage NSCLC

The use of CT-guided radiofrequency ablation (RFA) is well tolerated and effective among patients with inoperable stage IA non–small-cell lung cancer (NSCLC), according to results of a prospective multicenter trial.

Today, most patients with lung cancer considered to be inoperable are treated with stereotactic body radiotherapy (SBRT) or with image-guided thermal ablation techniques. “RFA’s advantage lies in its ability to locally heat a tumor to a lethal temperature while doing minimal damage to surrounding normal lung tissue,” wrote study authors led by Damian E. Dupuy, MD, of Brown University in Providence, Rhode Island.

In the new study, 54 patients with a median age of 76 years were enrolled, and 51 were included in the analysis. All had biopsy-proven stage IA NSCLC and were deemed medically inoperable. Results of the trial were published in Cancer.

The overall survival (OS) rate in this population was 86.3% at 1 year, and 69.8% at 2 years. At 1 year, 68.9% were local tumor recurrence-free; at 2 years, this rate was 59.8%. The treatment was more effective in those with smaller tumors-the 2-year OS rate was 83% in those with tumors smaller than 2 cm. Among the 19 patients who did have a local recurrence, 11 underwent retreatment with RFA; 9 underwent radiation therapy, and 3 underwent chemotherapy.

In the first 90 days after the procedure, the rate of grade 3–5 adverse events (AEs) attributable to RFA was 11.8%. Two patients had grade 3 pneumothorax that required intervention. No grade 4 or 5 AEs were attributable to RFA. Fifteen patients died during the study, six of them because of their lung cancer.

The researchers also assessed pulmonary function after RFA, and found no significant change with regard to forced expiratory volume in the first second of expiration. There was a significant improvement, meanwhile, in forced vital capacity at 3 and 24 months, vs the baseline.

In an accompanying editorial, Jessica S. Donington, MD, of New York University School of Medicine, wrote that the relatively high local recurrence rate seen in this study does not mean that RFA doesn’t have a place even in higher-risk early-stage NSCLC. “The data presented here go a long way toward helping to make educated treatment decisions,” she wrote. “RFA is very well tolerated and may be the preferred technology for the very frail, previously irradiated, or multifocal patient or for the patient who strongly desires a single-treatment option.” The recurrence rate, however, does “decrease some enthusiasm” for RFA when surgery or SBRT are options.