Percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: clinical evaluation of 47 cases

Abstract

Purpose: To retrospectively evaluate safety and effectiveness of CT-guided percutaneous microwave ablation (MWA) in 47 patients with medically inoperable stage I peripheral non-small cell lung cancer (NSCLC).

Methods: From February 2008 to October 2012, 47 patients with stage I medically inoperable NSCLC were treated in 47 MWA sessions. The clinical outcomes were evaluated. Complications after MWA were also summarized.

Results: At a median follow-up period of 30 months, the median time to the first recurrence was 45.5 months. The local control rates at 1, 3, 5 years after MWA were 96%, 64%, and 48%, respectively. The median cancer-specific and median overall survivals were 47.4 and 33.8 months. The overall survival rates at 1, 2, 3, and 5 years after MWA were 89%, 63%, 43%, and 16%, respectively. Tumors ≤3.5 cm were associated with better survival than were tumors >3.5 cm. The complications after MWA included pneumothorax (63.8%), hemoptysis (31.9%), pleural effusion (34%), pulmonary infection (14.9%), and bronchopleural fistula (2.1%).

Conclusions: MWA is safe and effective for the treatment of medically inoperable stage I peripheral NSCLC.

Keywords: CT-guided; microwave ablation; non-small cell lung cancer; percutaneous.

© 2014 Wiley Periodicals, Inc.

Figures

Figure 1

Male, 72-year-old patient with 3.4× 2.0cm left lung cancer (adenocarcinoma) complete response from microwave ablation (MWA) based on modified response evaluation criteria in solid tumors (RECIST) criteria. a. Tumor lesion (arrow) seen on CT immediately prior to MWA; b. The microwave antenna was punctured into lesion (arrow); c. Ablated lesion with surrounding ground-glass opacity seen on repeat CT scan immediately post-MWA. d. Follow-up CT scan at 12 months shows a fibrous scar at the site of the ablated lesion (arrow).

Figure 2

Male, 72-year-old patient with 3.0× 2.5cm left lung cancer (adenocarcinoma) complete response from microwave ablation (MWA) based on modified response evaluation RECIST criteria. a. Tumor lesion (arrow) seen on CT immediately prior to MWA; b. The microwave antenna was punctured into lesion (arrow); c. 6 months after ablation, lesion slightly shrinking (arrow); d: 12 months after ablation, lesions significantly shrinking (arrow); Surrounding ground-glass opacity seen on repeat CT scan immediately post-MWA. d. Follow-up CT scan at 12 months shows a fibrous scar at the site of the ablated lesion (arrow). e. 36 months after ablation, lesion become fiber cord (arrow); f. 60 months after ablation, the lesion disappeared (arrow).

Figure 3

Female, 70-year-old patient with 5.0× 4.5cm right lung cancer (squamous) complete response from microwave ablation (MWA) based on modified response evaluation RECIST criteria. a. Tumor lesion (arrow) seen on CT immediately prior to MWA.; b. Two microwave antenna puncture into the lesion (arrow); c. Ablated lesion with surrounding ground-glass opacity seen on repeat CT scan immediately post-MWA.d.6 months after ablation, lesion slightly shrinking (arrow); e: 12 months after ablation, lesions significantly shrinking (arrow); f: Follow-up CT scan at 24 months shows a fibrous scar at the site of the ablated lesion (arrow).

Figure 4

Male, 76-year-old patient with 3.5× 3.0cm left lobe NSCLC (adenocarcinoma) who had complete response from microwave ablation (MWA) based on modified RECIST criteria. (a) Tumor lesion (arrow) seen on CT immediately prior to MWA. b. Microwave antenna puncture into the lesion (arrow). (b) Ablated lesion (arrow) with surrounding ground-glass opacity seen on repeat CT scan 3 h post-MWA. (c) Follow-up CT scan at 1 month shows a cavitating structure developing at the site of the ablated lesion (arrow). (d) CT scan at 6 months shows a cystic structure at the ablation site (arrow). (e) CT scan at 24 months shows the cystic structure shrinking (arrow).

Figure 5

Overall survival in the cohort of 47 patients was 89% at 1 year, 63% at 2 years, 43% at 3 years, and 16 % at 5 years; median survival was 33.8 months.

Figure 6

Overall 1-, 2-, 3 and 5-year survivals, stratified by tumor size, were 91%, 72%, 59% and 36% for tumors ≤3.5 cm, and 88%, 53%, 27% and 0% for tumors >3.5cm. (P=0.016).

Figure 7

17 patients died of tumor. The median cancer-specific survival was 47.4 months (95% CI: 25.7-69.1 months).