Stereotactic body radiotherapy versus percutaneous local tumor ablation for early-stage non-small cell lung cancer

Ager, Bryan J.; Wells, Stacey; Gruhl, J.D.; Stoddard, Gregory J.; Tao, Randa; Kokeny, Kristine E.; Hitchcock, Ying J.

doi:10.1016/j.lungcan.2019.09.009

Cited by 33 publications

(30 citation statements)

References 41 publications

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“…[ 13 , 16 , 24 - 29 ] There are no studies directly comparing MWA to SABR and the available data are limited to retrospective meta-analyses. [ 30 , 31 ] The local control and OS in these studies are comparable to SABR. [ 30 , 32 ] This suggests that MWA may provide an alternative treatment for patients with early-stage, inoperable NSCLC who cannot receive or would like to avoid SABR.…”

Section: Discussionmentioning

confidence: 65%

Computerized tomography-Guided Microwave Ablation of Patients with Stage I Non-small Cell Lung Cancers: A Single-Institution Retrospective Study

Nance

Khazi²,

Kaifi³

et al. 2021

JCIS

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Objectives: The objective of the study was to retrospectively investigate the safety and efficacy of computerized tomography-guided microwave ablation (MWA) in the treatment of Stage I non-small cell lung cancers (NSCLCs). Material and Methods: This retrospective, single-center study evaluated 21 patients (10 males and 11 females; mean age 73.8 ± 8.2 years) with Stage I peripheral NSCLCs treated with MWA between 2010 and 2020. All patients were surveyed for metastatic disease. Clinical success was defined as absence of FDG avidity on follow-up imaging. Tumor growth within 5 mm of the original ablated territory was defined as local recurrence. Welch t-test and Fisher’s exact test were used for univariate analysis. Hazard ratio (HR) and odds ratio (OR) were determined using Cox regression and Firth logistic regression. Significance was P < 0.05. Data are expressed as mean ± standard deviation. Results: Ablated tumors had longest dimension 17.4 ± 5.4 mm and depth 19.7 ± 15.1 mm from the pleural surface. Median follow-up was 20 months (range, 0.6–56 months). Mean overall survival (OS) following lung cancer diagnosis or MWA was 26.2 ± 15.4 months (range, 5–56 months) and 23.7 ± 15.1 months (range, 3–55 months). OS at 1, 2, and 5 years was 67.6%, 61.8%, and 45.7%, respectively. Progression-free survival (PFS) was 19.1 ± 16.2 months (range, 1–55 months). PFS at 1, 2, and 5 years was 44.5%, 32.9%, and 32.9%, respectively. Technical success was 100%, while clinical success was observed in 95.2% (20/21) of patients. One patient had local residual disease following MWA and was treated with chemotherapy. Local control was 90% with recurrence in two patients following ablation. Six patients (28.6%) experienced post-ablation complications, with pneumothorax being the most common event (23.8% of patients). Female gender was associated with 90% reduction in risk of death (HR 0.1, P = 0.014). Tumor longest dimension was associated with a 10% increase in risk of death (P = 0.197). Several comorbidities were associated with increased hazard. Univariate analysis revealed pre-ablation forced vital capacity trended higher among survivors (84.7 ± 15.2% vs. 73 ± 21.6%, P = 0.093). Adjusted for age and sex, adenocarcinoma, and neuroendocrine histology trended toward improved OS (OR: 0.13, 0.13) and PFS (OR: 0.88, 0.37) compared to squamous cell carcinoma. Conclusion: MWA provides a safe and effective alternative to stereotactic brachytherapy resulting in promising OS and PFS in patients with Stage I peripheral NSCLC. Larger sample sizes are needed to further define the effects of underlying comorbidities and tumor biology.

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Section: Discussionmentioning

confidence: 65%

Computerized tomography-Guided Microwave Ablation of Patients with Stage I Non-small Cell Lung Cancers: A Single-Institution Retrospective Study

Nance

Khazi²,

Kaifi³

et al. 2021

JCIS

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“…The MWA indicated the similar therapeutic effect with lobectomy, with the 1, 3 and 5-year OS rate of MWA were 100, 92.6, and 50.0% while that OS rate of lobectomy were 100, 90.7, and 46.3%, respectively [15]. Moreover, Ager et al [32] compared the OS between radiotherapy and ablation by the National Cancer Database of America, and revealed that no OS difference is found in patients with tumor sizes 2.0 cm in a median follow-up of 26.2 months despite radiotherapy is associated with the improved OS. However, no significant difference in OS was seen between early-stage NSCLC patients treated with RFA and radiotherapy from another population-based study [33].…”

Section: Discussionmentioning

confidence: 70%

Survival prediction for non-small cell lung cancer patients treated with CT-guided microwave ablation: development of a prognostic nomogram

et al. 2021

International Journal of Hyperthermia

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Objectives: To explore the outcomes of CT-guided percutaneous microwave ablation (MWA) in nonsmall cell lung cancer (NSCLC) patients, and then develop an effective nomogram to predict the survival. Methods: NSCLC patients treated with MWA were randomly allocated to either the training cohort or the validation cohort (3:1). The primary outcome measurement was overall survival (OS), whose predictors were identified by univariate and multivariate analyses in the training cohort. Then, a predictive nomogram was developed to predict the OS, with the predictive accuracy evaluated by C-statistic and receiver operating characteristic in both the training and validation cohorts. Results: A total of 234 patients (training cohort: n ¼ 176; validation cohort: n ¼ 58) and 271 tumors with a median OS of 17.0 ± 12.2 months were included. The predictors selected into the nomogram included tumor diameter (hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.37-3.30; p < 0.001), extrapulmonary metastases (HR, 1.77; 95% CI, 1.06-2.95; p ¼ 0.030), tumor stage (HR, 1.38; 95% CI, 1.07-1.79; p ¼ 0.013), tumor type (HR, 2.00; 95% CI, 1.48-2.72; p < 0.001) and post-MWA TKIs (HR, 0.55; 95% CI, 0.34-0.89; p < 0.001), based on the results of univariate and multivariate analyses. The C-statistic showed good predictive performance, with a C-statistic of 0.838 (95% CI, 0.779-0.897) internally and 0.808 (95% CI, 0.695-0.920) externally (training cohort and validation cohort, respectively). Conclusions: The nomogram was effective in predicting the OS in NSCLC patients treated with MWA, and could be applied to identify patients who may benefit most from MWA and be helpful for clinical decision making.

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“…29,31 Other potential toxicities of SBRT include radiation pneumonitis, chest wall pain, rib fracture, oesophagitis, haemorrhage, vascular injury and radiation-induced neuropathy. 32,33 A large study by Ager et al 34 found that patients with comorbidities (Charlson-Deyo score ≥ 1) were more likely to be treated with ablation rather than SBRT. Patient treatment preference, in light of the various and differing potential toxicities of MWA and SBRT, and the preserved lung function post-ablation versus decreased lung function post-SBRT, has a role to play in determining management of inoperable early-stage NSCLC.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcome following microwave ablation of early‐stage non‐small cell lung cancer

Zhao

Steinke

2020

J Med Imag Rad Onc

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Introduction: This study aimed to evaluate the long-term outcome of microwave ablation (MWA) of early-stage non-small cell lung cancer (NSCLC), including response to treatment and survival. Methods: This retrospective study was conducted on consecutive patients who underwent computed tomography-guided MWA of early-stage NSCLC (no evidence of nodal or distant metastasis) from November 2010 to December 2014 at our institution. Data were collected from systematic review of patient charts and imaging. Procedural complications, response to treatment and survival were assessed. Results: 34 early-stage (T1a-T3N0M0) NSCLCs in 30 patients were treated with a total of 41 MWA sessions. There were no intraprocedural or 30-day post-procedural deaths. The most common complication was pneumothorax, encountered in 24 (59%) microwave ablation sessions, six (15%) of which required chest tube insertion. Over a median computed tomography follow-up period of 39 months (range 3-89), 24 (71%) NSCLCs demonstrated local control, while 10 (29%) demonstrated local progression. Nodal/distant progression was more common than local progression, with 15 of the 30 patients (50%) having nodal or distant metastases at follow-up. Patient survival status was followed up over a median period of 56.5 months (range 10-107). Median overall survival and 5-year overall survival were 56.5 months (95% confidence interval, 26-not reached) and 46.7% (95% confidence interval, 31.8-68.4), respectively. Conclusion: MWA is safe and effective at achieving local control of early-stage NSCLC and may prolong patient survival. Nodal or distant metastases were the dominant manifestations of disease progression at long-term follow-up.

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Stereotactic body radiotherapy versus percutaneous local tumor ablation for early-stage non-small cell lung cancer

Cited by 33 publications

References 41 publications

Computerized tomography-Guided Microwave Ablation of Patients with Stage I Non-small Cell Lung Cancers: A Single-Institution Retrospective Study

Computerized tomography-Guided Microwave Ablation of Patients with Stage I Non-small Cell Lung Cancers: A Single-Institution Retrospective Study

Survival prediction for non-small cell lung cancer patients treated with CT-guided microwave ablation: development of a prognostic nomogram

Long‐term outcome following microwave ablation of early‐stage non‐small cell lung cancer

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