Computerized tomography-Guided Microwave Ablation of Patients with Stage I Non-small Cell Lung Cancers: A Single-Institution Retrospective Study

Objectives: The objective of the study was to retrospectively investigate the safety and efficacy of computerized tomography-guided microwave ablation (MWA) in the treatment of Stage I non-small cell lung cancers (NSCLCs). Material and Methods: This retrospective, single-center study evaluated 21 patients (10 males and 11 females; mean age 73.8 ± 8.2 years) with Stage I peripheral NSCLCs treated with MWA between 2010 and 2020. All patients were surveyed for metastatic disease. Clinical success was defined as absence of FDG avidity on follow-up imaging. Tumor growth within 5 mm of the original ablated territory was defined as local recurrence. Welch t-test and Fisher’s exact test were used for univariate analysis. Hazard ratio (HR) and odds ratio (OR) were determined using Cox regression and Firth logistic regression. Significance was P < 0.05. Data are expressed as mean ± standard deviation. Results: Ablated tumors had longest dimension 17.4 ± 5.4 mm and depth 19.7 ± 15.1 mm from the pleural surface. Median follow-up was 20 months (range, 0.6–56 months). Mean overall survival (OS) following lung cancer diagnosis or MWA was 26.2 ± 15.4 months (range, 5–56 months) and 23.7 ± 15.1 months (range, 3–55 months). OS at 1, 2, and 5 years was 67.6%, 61.8%, and 45.7%, respectively. Progression-free survival (PFS) was 19.1 ± 16.2 months (range, 1–55 months). PFS at 1, 2, and 5 years was 44.5%, 32.9%, and 32.9%, respectively. Technical success was 100%, while clinical success was observed in 95.2% (20/21) of patients. One patient had local residual disease following MWA and was treated with chemotherapy. Local control was 90% with recurrence in two patients following ablation. Six patients (28.6%) experienced post-ablation complications, with pneumothorax being the most common event (23.8% of patients). Female gender was associated with 90% reduction in risk of death (HR 0.1, P = 0.014). Tumor longest dimension was associated with a 10% increase in risk of death (P = 0.197). Several comorbidities were associated with increased hazard. Univariate analysis revealed pre-ablation forced vital capacity trended higher among survivors (84.7 ± 15.2% vs. 73 ± 21.6%, P = 0.093). Adjusted for age and sex, adenocarcinoma, and neuroendocrine histology trended toward improved OS (OR: 0.13, 0.13) and PFS (OR: 0.88, 0.37) compared to squamous cell carcinoma. Conclusion: MWA provides a safe and effective alternative to stereotactic brachytherapy resulting in promising OS and PFS in patients with Stage I peripheral NSCLC. Larger sample sizes are needed to further define the effects of underlying comorbidities and tumor biology.

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Prognostic role of VEGF, EGFR, COX-2, cERB-b2 and ER-alpha in stage 1 non-small cell lung cancers

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.7696 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 7696-7696

Author(s):

C. Sadasiwan ◽

S. Medendorp ◽

R. Sreedhar ◽

A. Raji ◽

M. Blum ◽

...

Keyword(s):

Odds Ratio ◽

Univariate Analysis ◽

Survival Rates ◽

Small Cell ◽

Stage I ◽

Smoking History ◽

Small Cell Lung ◽

Lung Cancers ◽

Cox 2 ◽

Er Alpha

7696 Introduction: Five-year survival rates for pathologic stage one NSCLC are between 57–67%. We looked at VEGF, EGFR, COX-2, cERB-b2 and ER-a in relationship to predicting recurrence. Methods: Tumors from 65 consecutive patients with stage I NSCLC were included. After marking representative areas on the slides, tissue microarrays were prepared and stained immunohistochemically using commercially available antibodies. The scoring was done by the pathologist and the principal investigator and is calculated as the product of staining intensity, the percentage of positively stained tumor cells and extent of membrane involvement. Results: 27 (42%) males/38 (58%) females. 75% stage IA/25% stage IB. Median smoking history was 40 pack-years (range 0–160pyr). 77% adenocarcinomas/23% squamous cell carcinomas. 19 (29%) patients had a recurrence of which 14 (74%) recurred locally and 5 (26.%) recurred at distant sites. The most common site of recurrence was the lung. Median time to recurrence was 30 months (range 4–97 mos). Scores for the molecular markers are reported in table 1 . Logistic regression of all the variables on multivariate analysis showed that VEGF scores predicted recurrence (p=0.021, Odds Ratio of 1.021). Scores of >200 for VEGF were even more discriminatory. (p =0.034, Odds Ratio of 7.22). The rate of recurrence in this subgroup of patients was 39.5% as opposed to a rate of 14.8% among those with scores of less than 200. EGFR, COX-2, cERB-B2 and ER alpha were not found to be significant predictors of recurrence. Table 1 . Univariate analysis: Conclusion: VEGF scores predict risk of recurrence in stage I Non Small Cell Lung Cancers. We propose the use of high scores of VEGF, in Stage I Non Small Cell Carcinoma using immunohistochemistry to select those patients who are likely to recur. No significant financial relationships to disclose. [Table: see text]

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Comparison between computed tomography-guided percutaneous microwave ablation and thoracoscopic lobectomy for stage I non-small cell lung cancer

Thoracic Cancer ◽

10.1111/1759-7714.12842 ◽

2018 ◽

Vol 9 (11) ◽

pp. 1376-1382 ◽

Cited By ~ 2

Author(s):

Yongzheng Wang ◽

Bin Liu ◽

Pikun Cao ◽

Wujie Wang ◽

Wei Wang ◽

...

Keyword(s):

Computed Tomography ◽

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Microwave Ablation ◽

Small Cell ◽

Stage I ◽

Small Cell Lung ◽

Thoracoscopic Lobectomy ◽

Percutaneous Microwave Ablation

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Pulmonary Ablation: A Primer

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2013.01.003 ◽

2014 ◽

Vol 65 (2) ◽

pp. 177-185 ◽

Cited By ~ 5

Author(s):

Benjamin J. Roberton ◽

David Liu ◽

Mark Power ◽

John M.C. Wan ◽

Sam Stuart ◽

...

Keyword(s):

Lung Cancer ◽

Thermal Ablation ◽

Microwave Ablation ◽

Practical Knowledge ◽

Early Stage ◽

Treatment Options ◽

Small Cell ◽

Small Cell Lung ◽

Image Guided

Percutaneous image-guided thermal ablation is safe and efficacious in achieving local control and improving outcome in the treatment of both early stage non–small-cell lung cancer and pulmonary metastatic disease, in which surgical treatment is precluded by comorbidity, poor cardiorespiratory reserve, or unfavorable disease distribution. Radiofrequency ablation is the most established technology, but new thermal ablation technologies such as microwave ablation and cryoablation may offer some advantages. The use of advanced techniques, such as induced pneumothorax and the popsicle stick technique, or combining thermal ablation with radiotherapy, widens the treatment options available to the multidisciplinary team. The intent of this article is to provide the reader with a practical knowledge base of pulmonary ablation by concentrating on indications, techniques, and follow-up.

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