RFA For Stage 1 NSCLC

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Radiofrequency Ablation Plus Radiation for Inoperable Stage I NSCLC

According to an article recently published in the journal Chest, the combination of radiofrequency ablation plus radiation therapy appears promising for the treatment of inoperable stage I non-small cell lung cancer.

Lung cancer remains the leading cause of cancer-related deaths in the US. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. “Non-small cell” refers to the type of cell within the lung where the cancer originated.

Stage I NSCLC refers to cancer that has not spread from its site of origin. Cure rates for stage I NSCLC are high if the cancer can be completely removed by surgery, followed by chemotherapy and/or radiation therapy to kill any undetectable cancer cells that may remain in the body.

Unfortunately, stage I NSCLC is not able to be removed by surgery in some cases, either due to the cancer’s anatomical location or the patient’s overall health. These patients typically undergo treatment with radiation therapy. Being unable to undergo surgery reduces chances for a cure for these patients; researchers continue to evaluate ways to improve survival for patients with inoperable stage I NSCLC.

Radiofrequency ablation (RFA) is a minimally invasive technique that uses heat to destroy cancer cells. During RFA, an electrode is placed directly into the tumor; the procedure is guided by a CT scan, ultrasound, or laparoscopy. The electrode’s high frequency radio waves create intense heat, which destroys the cancer cells.

RFA is being explored in the treatment of several types of cancer, including lung, kidney, and liver cancers. Previous studies of RFA have most often focused on patients who are unable to tolerate surgery or those whose cancer is considered inoperable; however, studies evaluating RFA are now including more patients with lung cancer.

Researchers from Brown Medical School recently conducted a clinical trial to evaluate the safety and effectiveness of RFA plus standard radiation therapy for the treatment of inoperable stage I NSCLC. This trial included 24 patients who were ineligible for surgery. The average age of patients was 76 years. All patients were treated with RFA followed by three-dimensional conformal radiation therapy. All patients were followed for a minimum of 2 years.

There were no treatment-related deaths or severe side effects.

At two years, 50% of the patients were alive.

At 5 years, 39% of patients were alive.

The cause of death in 71% (10 of 14) of patients who died was lung cancer; nine patients had spread of cancer to distant sites in the body.

The researchers concluded that RFA plus radiation therapy appears safe and effective in the treatment of stage I NSCLC in patients who are not able to undergo surgery to remove their cancer. Future trials directly comparing RFA plus radiation to either treatment modality alone will lead to further understanding of the role of this combination in the treatment of stage I NSCLC.

Reference: 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;129:738-745.