Radiofrequency ablation for early-stage nonsmall cell lung cancer

Takao Hiraki, Hideo Gobara, Toshihiro Iguchi, Hiroyasu Fujiwara, Yusuke Matsui, Susumu Kanazawa, Takao Hiraki, Hideo Gobara, Toshihiro Iguchi, Hiroyasu Fujiwara, Yusuke Matsui, Susumu Kanazawa

Abstract

This review examines studies of radiofrequency ablation (RFA) of nonsmall cell lung cancer (NSCLC) and discusses the role of RFA in treatment of early-stage NSCLC. RFA is usually performed under local anesthesia with computed tomography guidance. RFA-associated mortality, while being rare, can result from pulmonary events. RFA causes pneumothorax in up to 63% of cases, although pneumothorax requiring chest drainage occurs in less than 15% of procedures. Other severe complications are rare. After RFA of stage I NSCLC, 31-42% of patients show local progression. The 1-, 2-, 3-, and 5-year overall survival rates after RFA of stage I NSCLC were 78% to 100%, 53% to 86%, 36% to 88%, and 25% to 61%, respectively. The median survival time ranged from 29 to 67 months. The 1-, 2-, and 3-year cancer-specific survival rates after RFA of stage I NSCLC were 89% to 100%, 92% to 93%, and 59% to 88%, respectively. RFA has a higher local failure rate than sublobar resection and stereotactic body radiation therapy (SBRT). Therefore, RFA may currently be reserved for early-stage NSCLC patients who are unfit for sublobar resection or SBRT. Various technologies are being developed to improve clinical outcomes of RFA for early-stage NSCLC.

References

    1. Vrdoljak E, Miše K, Sapunar D, Rozga A, Marušić M. Survival analysis of untreated patients with non-small-cell lung cancer. Chest. 1994;106(6):1797–1800.
    1. McGarry RC, Song G, des Rosiers P, Timmerman R. Observation-only management of early stage, medically inoperable lung cancer. Chest. 2002;121(4):1155–1158.
    1. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. The Annals of Thoracic Surgery. 1995;60(3):615–623.
    1. Bach PB, Cramer LD, Warren JL, Begg CB. Racial differences in the treatment of early-stage lung cancer. The New England Journal of Medicine. 1999;341(16):1198–1205.
    1. Qiao X, Tullgren O, Lax I, Sirzen F, Lewensohn R. The role of radiotherapy in treatment of stage I non-small cell lung cancer. Lung Cancer. 2003;41(1):1–11.
    1. Dupuy DE, Zagoria RJ, Akerley W, Mayo-Smith WW, Kavanagh PV, Safran H. Percutaneous radiofrequency ablation of malignancies in the lung. The American Journal of Roentgenology. 2000;174(1):57–59.
    1. Ahmed M, Liu Z, Afzal KS, et al. Radiofrequency ablation: effect of surrounding tissue composition on coagulation necrosis in a canine tumor model. Radiology. 2004;230(3):761–767.
    1. Nguyen CL, Scott WJ, Young NA, Rader TR, Giles LR, Goldberg M. Radiofrequency ablation of primary lung cancer: results from an ablate and resect pilot study. Chest. 2005;128(5):3507–3511.
    1. Ambrogi MC, Fontanini G, Cioni R, Faviana P, Fanucchi O, Mussi A. Biologic effects of radiofrequency thermal ablation on non-small cell lung cancer: results of a pilot study. The Journal of Thoracic and Cardiovascular Surgery. 2006;131(5):1002–1006.
    1. Lee JM, Jin GY, Goldberg SN, et al. Percutaneous radiofrequency ablation for inoperable non-small cell lung cancer and metastases: preliminary report. Radiology. 2004;230(1):125–134.
    1. Fernando HC, de Hoyos A, Landreneau RJ, et al. Radiofrequency ablation for the treatment of non-small cell lung cancer in marginal surgical candidates. The Journal of Thoracic and Cardiovascular Surgery. 2005;129(3):639–644.
    1. Pennathur A, Luketich JD, Abbas G, et al. Radiofrequency ablation for the treatment of stage I non-small cell lung cancer in high-risk patients. The Journal of Thoracic and Cardiovascular Surgery. 2007;134(4):857–864.
    1. Simon CJ, Dupuy DE, DiPetrillo TA, et al. Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients. Radiology. 2007;243(1):268–275.
    1. Hiraki T, Gobara H, Iishi T, et al. Percutaneous radiofrequency ablation for clinical stage I non-small cell lung cancer: results in 20 nonsurgical candidates. The Journal of Thoracic and Cardiovascular Surgery. 2007;134(5):1306–1312.
    1. Lencioni R, Crocetti L, Cioni R, et al. Response to radiofrequency ablation of pulmonary tumours: a prospective, intention-to-treat, multicentre clinical trial (the RAPTURE study) The Lancet Oncology. 2008;9(7):621–628.
    1. Lanuti M, Sharma A, Digumarthy SR, et al. Radiofrequency ablation for treatment of medically inoperable stage I non-small cell lung cancer. The Journal of Thoracic and Cardiovascular Surgery. 2009;137(1):160–166.
    1. Zemlyak A, Moore WH, Bilfinger TV. Comparison of survival after sublobar resections and ablative therapies for stage I non-small cell lung cancer. Journal of the American College of Surgeons. 2010;211(1):68–72.
    1. Hiraki T, Gobara H, Mimura H, Matsui Y, Toyooka S, Kanazawa S. Percutaneous radiofrequency ablation of clinical stage I non-small cell lung cancer. The Journal of Thoracic and Cardiovascular Surgery. 2011;142(1):24–30.
    1. Huang L, Han Y, Zhao J, et al. Is radiofrequency thermal ablation a safe and effective procedure in the treatment of pulmonary malignancies? European Journal of Cardio-Thoracic Surgery. 2011;39(3):348–351.
    1. Ambrogi MC, Fanucchi O, Cioni R, et al. Long-term results of radiofrequency ablation treatment of stage I non-small cell lung cancer: a prospective intention-to-treat study. Journal of Thoracic Oncology. 2011;6(12):2044–2051.
    1. Simon TG, Beland MD, Machan JT, Dipetrillo T, Dupuy DE. Charlson comorbidity index predicts patient outcome, in cases of inoperable non-small cell lung cancer treated with radiofrequency ablation. European Journal of Radiology. 2012;81(12):4167–4172.
    1. Lanuti M, Sharma A, Willers H, Digumarthy SR, Mathisen DJ, Shepard JO. Radiofrequency ablation for stage I non-small cell lung cancer: management of locoregional recurrence. The Annals of Thoracic Surgery. 2012;93(3):921–927.
    1. Lee H, Jin GY, Han YM, et al. Comparison of survival rate in primary non-small-cell lung cancer among elderly patients treated with radiofrequency ablation, surgery, or chemotherapy. CardioVascular and Interventional Radiology. 2012;35(2):343–350.
    1. Onishi H, Kuriyama K, Komiyama T, et al. Clinical outcomes of stereotactic radiotherapy for stage I non-small cell lung cancer using a novel irradiation technique: patient self-controlled breath-hold and beam switching using a combination of linear accelerator and CT scanner. Lung Cancer. 2004;45(1):45–55.
    1. Nagata Y, Takayama K, Matsuo Y, et al. Clinical outcomes of a phase I/II study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame. International Journal of Radiation Oncology Biology Physics. 2005;63(5):1427–1431.
    1. Zimmermann FB, Geinitz H, Schill S, et al. Stereotactic hypofractionated radiation therapy for stage I non-small cell lung cancer. Lung Cancer. 2005;48(1):107–114.
    1. Nyman J, Johansson KA, Hultén U. Stereotactic hypofractionated radiotherapy for stage I non-small cell lung cancer—mature results for medically inoperable patients. Lung Cancer. 2006;51(1):97–103.
    1. Timmerman R, McGarry R, Yiannoutsos C, et al. Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. Journal of Clinical Oncology. 2006;24(30):4833–4839.
    1. Onishi H, Shirato H, Nagata Y, et al. Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. Journal of Thoracic Oncology. 2007;2(7, supplement 3):S94–S100.
    1. Baumann P, Nyman J, Hoyer M, et al. Outcome in a prospective phase II trial of medically inoperable stage I non-small-cell lung cancer patients treated with stereotactic body radiotherapy. Journal of Clinical Oncology. 2009;27(20):3290–3296.
    1. Fakiris AJ, McGarry RC, Yiannoutsos CT, et al. Stereotactic body radiation therapy for early-stage non-small-cell lung carcinoma: four-year results of a prospective phase II study. International Journal of Radiation Oncology Biology Physics. 2009;75(3):677–682.
    1. Ricardi U, Filippi AR, Guarneri A, et al. Stereotactic body radiation therapy for early stage non-small cell lung cancer: results of a prospective trial. Lung Cancer. 2010;68(1):72–77.
    1. Timmerman R, Paulus R, Galvin J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. The Journal of the American Medical Association. 2010;303(11):1070–1076.
    1. Onishi H, Shirato H, Nagata Y, et al. Stereotactic body radiotherapy (SBRT) for operable stage I non-small-cell lung cancer: can SBRT be comparable to surgery? International Journal of Radiation Oncology Biology Physics. 2011;81(5):1352–1358.
    1. Lagerwaard FJ, Verstegen NE, Haasbeek CJA, et al. Outcomes of stereotactic ablative radiotherapy in patients with potentially operable stage I non-small cell lung cancer. International Journal of Radiation Oncology Biology Physics. 2012;83(1):348–353.
    1. Shibamoto Y, Hashizume C, Baba F, et al. Stereotactic body radiotherapy using a radiobiology-based regimen for stage I nonsmall cell lung cancer: a multicenter study. Cancer. 2012;118(8):2078–2084.
    1. Crabtree TD, Puri V, Robinson C, et al. Analysis of first recurrence and survival in patients with stage I non-small cell lung cancer treated with surgical resection or stereotactic radiation therapy. The Journal of Thoracic and Cardiovascular Surgery. 2014;147(4):1183–1192.
    1. Crabtree T, Puri V, Timmerman R, et al. Treatment of stage I lung cancer in high-risk and inoperable patients: comparison of prospective clinical trials using stereotactic body radiotherapy (RTOG 0236), sublobar resection (ACOSOG Z4032), and radiofrequency ablation (ACOSOG Z4033) The Journal of Thoracic and Cardiovascular Surgery. 2013;145(3):692–699.
    1. Kim SR, Han HJ, Park SJ, et al. Comparison between surgery and radiofrequency ablation for stage I non-small cell lung cancer. European Journal of Radiology. 2012;81(2):395–399.
    1. Kwan SW, Mortell KE, Talenfeld AD, Brunner MC. Thermal ablation matches sublobar resection outcomes in older patients with early-stage non-small cell lung cancer. Journal of Vascular and Interventional Radiology. 2014;25(1):1–9.
    1. Alexander ES, Machan JT, Ng T, Breen LD, Dipetrillo TA, Dupuy DE. Cost and effectiveness of radiofrequency ablation versus limited surgical resection for stage I non-small-cell lung cancer in elderly patients: is less more? Journal of Vascular and Interventional Radiology. 2013;24(4):476–482.
    1. Sher DJ, Wee JO, Punglia RS. Cost-effectiveness analysis of stereotactic body radiotherapy and radiofrequency ablation for medically inoperable, early-stage non-small cell lung cancer. International Journal of Radiation Oncology Biology Physics. 2011;81(5):e767–e774.
    1. Howington JA, Blum MG, Chang AC, Balekian AA, Murthy SC. Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5, supplement):e278S–e313S.
    1. Donington J, Ferguson M, Mazzone P, et al. American College of Chest Physicians and Society of Thoracic Surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer. Chest. 2012;142(6):1620–1635.
    1. Dupuy DE, DiPetrillo T, Gandhi S, et al. Radiofrequency ablation followed by conventional radiotherapy for medically inoperable stage I non-small cell lung cancer. Chest. 2006;129(3):738–745.
    1. Kodama H, Yamakado K, Takaki H, et al. Lung radiofrequency ablation for the treatment of unresectable recurrent non-small-cell lung cancer after surgical intervention. CardioVascular and Interventional Radiology. 2012;35(3):563–569.
    1. Schoellnast H, Deodhar A, Hsu M, et al. Recurrent non-small cell lung cancer: evaluation of CT-guided radiofrequency ablation as salvage therapy. Acta Radiologica. 2012;53(8):893–899.
    1. Santos RS, Gupta A, Ebright MI, et al. Electromagnetic navigation to aid radiofrequency ablation and biopsy of lung tumors. The Annals of Thoracic Surgery. 2010;89(1):265–268.
    1. Banovac F, Cheng P, Campos-Nanez E, et al. Radiofrequency ablation of lung tumors in swine assisted by a navigation device with preprocedural volumetric planning. Journal of Vascular and Interventional Radiology. 2010;21(1):122–129.
    1. Dodd GD, III, Frank MS, Aribandi M, Chopra S, Chintapalli KN. Radiofrequency thermal ablation: computer analysis of the size of the thermal injury created by overlapping ablations. American Journal of Roentgenology. 2001;177(4):777–782.
    1. Tsushima K, Kolzumi T, Tanabe T, et al. Bronchoscopy-guided radiofrequency ablation as a potential novel therapeutic tool. European Respiratory Journal. 2007;29(6):1193–1200.
    1. Tanabe T, Koizumi T, Tsushima K, et al. Comparative study of three different catheters for CT imaging-bronchoscopy-guided radiofrequency ablation as a potential and novel interventional therapy for lung cancer. Chest. 2010;137(4):890–897.
    1. Wright AS, Sampson LA, Warner TF, Mahvi DM, Lee FT., Jr. Radiofrequency versus microwave ablation in a hepatic porcine model. Radiology. 2005;236(1):132–139.
    1. Yamauchi Y, Izumi Y, Hashimoto K, et al. Percutaneous cryoablation for the treatment of medically inoperable Stage I non-small cell lung cancer. PLoS ONE. 2012;7(3)e33223
    1. Deodhar A, Monette S, Single GW, Jr., et al. Percutaneous irreversible electroporation lung ablation: preliminary results in a porcine model. CardioVascular and Interventional Radiology. 2011;34(6):1278–1287.
    1. Lee EW, Chen C, Prieto VE, Dry SM, Loh CT, Kee ST. Advanced hepatic ablation technique for creating complete cell death: irreversible electroporation. Radiology. 2010;255(2):426–433.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe