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OBJECTIVE: Thermal ablation, using radiofrequency ablation (RFA) or microwave ablation (MWA), can be used to treat medically inoperable patients with non-small cell lung cancer (NSCLC). We report long-term outcomes following thermal ablation from a single center in patients with Stage IA NSCLC.
METHODS: Medically inoperable patients with Stage IA NSCLC underwent RFA or MWA. Follow-up imaging included serial CT scans every 3 months and PET scans every 6 months for 24 months, and then at reduced frequency. Factors influencing the incidence of local progression (LP) at the ablation site and overall survival (OS) were analyzed.
RESULTS: From July 2005 through September 2009, 21 patients underwent 25 ablations (21 RFA, 4 MWA). Fifteen patients had T1a (≤2cm) and 6 had T1b (>2-3cm) tumors. Mean age was 69 (42-84) years. Ten patients were women. The mean nodule diameter was 1.88 (0.8-3) cm. NSCLC was biopsy-confirmed in 17 patients, and 4 were suspicious on biopsy. The median percent-predicted FEV₁ was 39%, and D_LCO was 47%. Mean follow-up was 42 months. Three-year overall survival (OS) was 52% (median 39 months) and was not significantly different between nodules diagnosed as NSCLC or suspicious (36 months vs. 51 months, p=0.20), T1a nodules compared to T1b nodules (36 months vs. 39 months, p=0.29), or nodules treated with RFA compared to MWA (36 vs. 50 months, p=0.80). LP occurred in 10 patients (47.6%). Median time to LP was 35 months, and was not significantly different between T1a nodules compared to T1b nodules (22 vs. 35 months, p=0.94) or RFA compared to MWA (35 vs. 17 months, p=0.18). OS was not impacted by LP (median 32 vs. 39 months with and without LP, p=0.68). Repeat ablation was performed in 3 patients (once in 2 patients, and twice in 1 patient who remains disease free at 40 months). Mean local progression time following repeat ablation was 14.75 months.
CONCLUSIONS: Thermal ablation was effective for treating medically inoperable patients with Stage IA NSCLC. The 3-year overall survival exceeded 50% and local progression did not impact overall survival. Thermal ablation remains a viable option for high risk patients with NSCLC.