Radiofrequency ablation for stage I non-small-cell lung cancer in the functionally inoperable patient

Abstract

SUMMARY Aim: Surgical resection represents the gold standard for the treatment of early-stage non-small-cell lung cancer (NSCLC). However, approximately a fifth of the patients cannot afford a major lung resection because of functional limits related to one or more comorbidities. Radiofrequency ablation (RFA) has been described since 2004 for the palliative treatment of lung neoplasms as an alternative to external beam radiotherapy. We report the results of a retrospective analysis on a series of patients who underwent RFA for stage I NSCLC in a single referral center. Materials & methods: All patients referred for a suspected lung cancer underwent computed tomography (CT) scan of the thorax, PET–CT scanning and complete functional evaluation. Patients with a clinical stage I lung cancer and considered not eligible for surgery due to one or more of the following conditions were included: advanced-stage chronic obstructive pulmonary disease (forced respiratory volume in 1 s <40% of predicted value, carbon monoxide diffusion <40% and a need for continuous [24 h] oxygen administration) and heart failure (New York Heart Association class III and IV). Tumor dimension should be <3.5 cm in its major diameter. All lung RFA were performed under CT guidance using a 15 G trocar containing extendible electrodes that deploy from the tip of the trocar (Le Veen Needle Electrode; Radio Therapeutics Corporation, CA, USA). Results: From January 2009 to June 2013, 22 patients (17 males) underwent 24 procedures of RFA for stage Ia NSCLC. The mean diameter of the lesions was 2.48 ± 0.7 cm (range: 1.1–3.2 cm). The patient was considered not suitable for surgery for advanced stage heart disease (New York Heart Association class >3) in nine cases, and for advanced chronic obstructive pulmonary disease in the remaining 13 cases (forced respiratory volume in 1 s <40% of predicted value, carbon monoxide diffusion <40% and a need for continuous [24 h] oxygen administration). Treatment was successfully performed in all cases. The whole procedure was completed with a mean time of 25 min (range: 18–32 min). No mortality was observed. We registered a complication in five out of 24 procedures (20.8%). We observed six cases of local tumor progression out of 24 lesions treated (25%) according to the modified Response Evaluation Criteria In Solid Tumors criteria and PET–CT assessment. No difference in local tumor progression was related to dimension of the lesion; in particular, we did not observe any difference between Ia and Ib tumors. In two cases, systemic relapse was observed and at present, 12 patients were alive. Four patients died of cancer relapse, three patients died for complications related to chronic obstructive pulmonary disease and three for heart failure. Median overall survival time was 36.5 months, with an overall proportion survival of 83% at 1 year, 64% at 2 years and 48% at 3 years. Disease-free interval was 23 months with a disease-free proportion survival of 78% at 1 year, 51% at 2 years and 39% at 3 years. Conclusion: RFA for treatment of lung cancer in functionally inoperable patients proved to be feasible, reproducible, with low morbidity. The limit of the procedure, in our opinion, is its strictly local effect and reported limited efficacy in treating greater lesions.