Abstract
PurposeThe purpose of this study was to evaluate the efficacy, safety and predictive factors of RFA of primary and secondary lung malignancies.Patients and Methods79 patients with 129 primary and secondary lung malignancies were enrolled in a retrospective study. We treated 74 pulmonary metastases of colorectal cancer, 13 malignant melanoma lesions, 13 renal cancer metastases, 5 primary lung malignancies and 24 tumors of other different entities. All patients were considered to be unsuitable candidates for surgery, radiotherapy or chemotherapy. The primary endpoint was local tumor control, secondary endpoints were overall survival, safety and predictive factors, e.g. distance to pleura, vessels and bronchi.ResultsThe median tumor size was 1.2 cm (0.5–3.0 cm). After a median follow-up of 14 months (3–81 months), the LTC was 85.3 %. There were 34 lesions (26.4%) with complete remission, 48 (37.2 %) partial remission, 28 (21.7%) stable disease and 19 lesions (14.7%) with progressive disease. We evaluated an OS of 27 months. Pneumothorax in 19 cases (14.7%) and pleural effusion in 2 cases (1.6 %) were the leading complications (CTCAE, 5 grade III adverse events). The only significant influence regarding the outcome after RFA was the initial tumor size (p = 0.01). Distance to vessel, bronchi, and pleura showed no significant effect (p = 0.81; p = 0.82; p = 0.80).
Highlights
Surgical resection is the standard of care for early stage NSCLC, with overall 5-year survival rates ranging from 40% to 67% for stage I [1, 2] and from 25% to 55% for stage II [1]
The median diameter of all 129 lung tumors was 1.2 cm (0.5 to 3.0 cm; mean 1.3 cm). 41 lesions ranged from 0.5–1 cm in tumor size, 74 lesions ranged from 1– 2cm and 14 lesions ranged from 2–3 cm
Different local therapies are available for patients with NSCLC and secondary oligometastatic disease, including stereotactic body radiation therapy (SBRT, 97.6% local tumor control (LTC) rate) [10], stereotactic radiosurgery with CyberKnife (95% LTC rate) [11] as well as imageguided thermal and non-thermal tumor ablation [12, 13]
Summary
Surgical resection is the standard of care for early stage NSCLC, with overall 5-year survival rates ranging from 40% to 67% for stage I [1, 2] and from 25% to 55% for stage II [1]. For high-surgical-risk patients, several studies reported promising results for minimally invasive therapies such as image-guided radiofrequency ablation (RFA) and laser-induced thermo-ablation (LITT) [4,5,6,7]. Newer local-ablative treatments like microwave ablation (MWA) and high-dose-rate (HDR) brachytherapy gained success in the treatment of pulmonary lesions. Considering organ-specific and tissuerelated conditions in the lung that affect technical success, percutaneous tumor ablation is assured to be a feasible, safe and effective minimally invasive procedure [5, 8, 9]
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