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Thermal Ablation and Radiotherapy Boost Lung Cancer Survival

Allison Gandey

Medscape Medical News 2006. © 2006 Medscape

July 19, 2006 –- Patients with early-stage non–small cell lung cancer who are not candidates for surgery now have other noninvasive and potentially lifesaving options. In a paper published in the July 1 issue of the Journal of Vascular and Interventional Radiology, 57% of lung cancer patients who were treated with thermal ablation and radiotherapy survived to 3 years — 2 years beyond average life expectancy.

The researchers reporting the study say the combination of minimally invasive thermal ablation and radiotherapy has many implications for the future of oncology. "Percutaneous thermal ablation followed by radiotherapy appears to be well-tolerated, with a low rate of complications that can often be managed on an outpatient basis," they write. "Our results show a potential improvement in survival over either modality alone that may be of benefit to patients diagnosed with inoperable stage 1 or 2 non–small cell lung cancer."

"This is extraordinarily exciting," John Rundback, MD, from Holy Name Hospital in Teaneck, New Jersey, told Medscape. "This shows that for selected patients, there are important nonsurgical options." Dr. Rundback, who is also the chair of the clinical research trials committee for the Society of Interventional Radiology, says that thermal ablation and radiotherapy are too often overlooked. "This used to be for very good reason, because there was insufficient trial evidence, but this is increasingly not the case and patients need to fully understand all of their treatment options, including interventional radiology."

"Only one third of patients diagnosed with non–small cell lung cancer are eligible for surgery — the rest face the reality of having less than 12 months to live," senior author Damian Dupuy, MD, director of ultrasound at Rhode Island Hospital and professor of diagnostic imaging at Brown Medical School in Providence, Rhode Island, told reporters. "These new outpatient treatments not only are effective but allow us to treat patients who historically have no other options," he said. "Utilizing imaging and targeted thermal ablation, we can heat and destroy lung tumors and extend a patient's life. As a physician, it’s so gratifying to be able to provide a treatment that is so beneficial to patients and so easy for them to undergo."

Dupuy and his team looked at 41 patients with inoperable stage 1 and 2 non–small cell lung cancer tumors. They performed 37 radiofrequency ablations and 4 microwave ablations. The primary end points were survival and local recurrence. Ablations were followed by standard fraction external-beam radiation therapy within 90 days (n = 27) or by postprocedural brachytherapy (n = 14).

Relatively Low Rate of Complications

Of the 41 patients, 97.6% survived to 6 months, 86.8% to 1 year, 70.4% to 2 years, and 57.1% to 3 years. The median follow-up was 19.5 months, with an average survival of 42.2 months. The patients with tumors smaller than 3 cm (n = 17) had the best outcomes, with an average survival of 44.4 months.

"Thermal ablation followed by radiotherapy for inoperable stage 1 and 2 non–small cell lung cancer tumors has a relatively low rate of complications that are easily managed," the researchers write. "Combined therapy may result in an improved survival over either modality alone." They note that pneumothorax was the most commonly observed complication. But, they add, this patient cohort almost universally carries an underlying diagnosis of emphysema — a known risk factor for pneumothorax after thoracic procedures.

The investigators point to a number of limitations to their work, including the study's retrospective design and short follow-up periods. During an interview with Medscape, Dr. Rundback added that the extent of comorbidities in the study cohort is also unclear. "But apart from limitations that are so common in studies such as these, Dr. Dupuy did a fabulous job," he said.

Dupuy and his team conclude that longer follow-up and the assessment of long-term outcomes will aid in the selection of patients for whom this combined therapy is appropriate.

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