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Radiofrequency Ablation for the Treatment of Stage I Non-small Cell Lung Cancer in High-Risk Patients
A. Pennathur1, J. D. Luketich1, G. Abbas1, M. Chen1, H. C. Fernando2, W. E. Gooding1, M. J. Schuchert1, S. Gilbert1, N. A. Christie1, R. J. Landreneau1. 1University of Pittsburgh Medical Center, Pittsburgh, PA, 2Boston Medical Center, Boston, MA,
BACKGROUND: Surgical resection is the standard of care for Stage I non-small cell lung cancer (NSCLC). For high-risk patients, radiofrequency ablation (RFA) is an alternative option. Our objective was to evaluate RFA for Stage I NSCLC in high-risk patients.
METHODS: Stage I NSCLC patients, who were medically inoperable, were offered RFA. Thoracic surgeons evaluated and performed RFA under CT guidance. Response was assessed by CT and PET scan. Time to progression (TTP) and survival were monitored every 3 months.
RESULTS: Nineteen patients underwent RFA over a three-year period. There were 8 men and 11 women with a median age of 78 years (range 68-88). RFA resulted in pneumothorax requiring a pigtail catheter in 15 (79%) patients. An initial complete response was observed in 2 patients (10.5%), partial response in 10 (53%), and stable disease in 5 (26%). Early progression occurred in 2 patients (10.5%). During follow-up, local progression occurred in 8 nodules (42%) and the median TTP was 27 months. The remaining eleven (58%) are locally progression-free at a median follow-up of 13.5 months (3.5-44). There were no procedure-related mortalities, 6 deaths occurred during follow-up. The median follow-up in the remaining patients was 20 months. The probability of survival at 1 year was estimated to be 95% (CI .68-.91), median survival was not reached.
CONCLUSIONS: Our experience indicates RFA is safe in high-risk Stage I NSCLC patients with reasonable results. Surgery offers a better chance of cure for resectable patients. However, RFA offers an alternative option in high-risk patients.
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