Thermal ablation for the treatment of stage 1 lung cancer achieves similar overall survival to stereotactic body radiotherapy (SBRT) and should be considered as an appropriate treatment option for early stage disease, according to a retrospective meta-analysis study presented Sunday.
In his presentation, Johannes Uhlig, MD, Yale School of Medicine, and University Medical Center Goettingen, Germany, reported that thermal ablation and SBRT demonstrated comparable overall survival (OS) in all lung cancer subgroups, including adenocarcinoma, non-small cell lung cancer and small cell lung cancer.
"Thermal ablation is a minimally invasive and safe local treatment for early stage lung cancer," Dr. Uhlig said. "Thermal ablation could be performed in one setting typically as an outpatient procedure and could be combined with precision image-guided biopsy, so patients could get a diagnosis with tissue sampling, biomarker studies and treatment of eradicating lung cancer at the same time."
Currently, the established standard of care for early stage lung cancer is SBRT. In this study less than 3% of surgically ineligible patients with early stage lung cancer who receive local cancer treatment were treated with thermal ablation.
SBRT can be used for large and centrally located tumors, but treatment often requires multiple fractions stretching over several days or weeks. According to Dr. Uhlig, SBRT has few early complications, but there are growing concerns about late-onset complications, especially cardiac toxicities.
"Thermal ablation can be performed even in patients with reduced lung function, chronic lung disease and tumors in post-resection and post-radiation field," added Dr. Uhlig. "Given the minimally invasive nature of thermal ablation, there may be low rates of early complications such as pulmonary hemorrhage or pneumothorax, although these are self-limiting in most cases."
Thermal Ablation Results Comparable to SBRT
In this study, which was conducted at the Yale Cancer Center, Dr. Uhlig and his colleagues queried the National Cancer Database for patients with AJCC (American Joint Committee on Cancer) stage 1 lung cancer diagnosed from 2004-2015, and included adenocarcinoma, squamous cell carcinoma (SCC), unspecified non-small cell lung cancer (NSCLC) and other histologies (except carcinoid). Treatment was stratified as thermal ablation (radiofrequency ablation, or grouped laser/cryo ablation) and SBRT.
Of the 55,336 patients in the study, 97.3% received SBRT, while 2.7% received thermal ablation. Histologies included adenocarcinoma (34.9%), SCC (30.0%), NSCLC (15.2%) and others (19.9%).
Patients who received thermal ablation were younger and more likely to be Caucasian, have private insurance, more comorbidities and have smaller adenocarcinoma.
Dr. Uhlig and his colleagues found that thermal ablation and SBRT demonstrated comparable OS in all subgroups: adenocarcinoma (1-year OS: 86% vs 86%; 3-year OS: 49% vs 52%), SCC (1-year OS: 67% vs 67%; 3-year OS: 27% vs 30%), NSCLC (1-year OS: 83% vs 83%; 3-year OS: 49% vs 47%), and other histologies (1-year OS: 85% vs 83%; 3-year OS: 59% vs 50%).
"Thermal ablation shows comparable OS to SBRT in stage 1 lung cancer and should be considered as an alternative treatment option, independent of histological subtypes," concluded Dr. Uhlig and his colleagues.
"We need more studies and data on the comparative effectiveness and cost effectiveness of thermal ablation compared to other treatment options for early-stage lung cancer," Dr. Uhlig said. "Thermal ablations are already available in many local sites for other tumors, such as liver or kidney tumors. Thus, it would be quite straightforward to offer a lung cancer thermal ablation program without heavy capital. We, however, need more local experts in lung cancer, including interventionists who are master clinicians in thermal ablation."