Radiofrequency ablation of stage IA non-small cell lung cancer in medically inoperable patients: Results from the American College of Surgeons Oncology Group Z4033 (Alliance) trial

Damian E. Dupuy, Hiran C. Fernando, Shauna Hillman, Thomas Ng, Angelina D. Tan, Amita Sharma, William S. Rilling, Kelvin Hong, Joe B. Putnam

Research output: Contribution to journalArticle

Abstract

BACKGROUND This study evaluated the 2-year overall survival rate, adverse event rate, local control rate, and impact on pulmonary function tests for medically inoperable patients with stage IA non-small cell lung cancer (NSCLC) undergoing computed tomography (CT)-guided radiofrequency ablation (RFA) in a prospective, multicenter trial. METHODS Fifty-four patients (25 men and 29 women) with a median age of 76 years (range, 60-89 years) were enrolled from 16 US centers; 51 patients were eligible for evaluation (they had biopsy-proven stage IA NSCLC and were deemed medically inoperable by a board-certified thoracic surgeon). Pulmonary function tests were performed within the 60 days before RFA and 3 and 24 months after RFA. Adverse events were recorded and categorized. Patients were followed with CT and fludeoxyglucose positron emission tomography. Local control rate and recurrence patterns were analyzed. RESULTS The overall survival rate was 86.3% at 1 year and 69.8% at 2 years. The local tumor recurrence-free rate was 68.9% at 1 year and 59.8% at 2 years and was worse for tumors > 2 cm. In the 19 patients with local recurrence, 11 were re-treated with RFA, 9 underwent radiation, and 3 underwent chemotherapy. There were 21 grade 3 adverse events, 2 grade 4 adverse events, and 1 grade 5 adverse event in 12 patients within the first 90 days after RFA. None of the grade 4 or 5 adverse events were attributable to RFA. There was no significant change in the forced expiratory volume in the first second of expiration or the diffusing capacity of lung for carbon monoxide after RFA. A tumor size less than 2.0 cm and a performance status of 0 or 1 were associated with statistically significant improved survival of 83% and 78%, respectively, at 2 years. CONCLUSIONS RFA is a single, minimally invasive procedure that is well tolerated in medically inoperable patients, does not adversely affect pulmonary function tests, and provides a 2-year overall survival rate that is comparable to the rate reported after stereotactic body radiotherapy in similar patients.

Original languageEnglish (US)
Pages (from-to)3491-3498
Number of pages8
JournalCancer
Volume121
Issue number19
DOIs
StatePublished - Oct 1 2015

Fingerprint

Non-Small Cell Lung Carcinoma
Respiratory Function Tests
Survival Rate
Recurrence
Lung Volume Measurements
Neoplasms
Radiosurgery
Forced Expiratory Volume
Carbon Monoxide
Multicenter Studies
Thorax
Tomography
Radiation
Biopsy
Drug Therapy
Survival

Keywords

  • ablation
  • elderly
  • non-small cell lung cancer (NSCLC)
  • radiofrequency ablation (RFA)
  • stereotactic body radiotherapy (SBRT)

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Radiofrequency ablation of stage IA non-small cell lung cancer in medically inoperable patients : Results from the American College of Surgeons Oncology Group Z4033 (Alliance) trial. / Dupuy, Damian E.; Fernando, Hiran C.; Hillman, Shauna; Ng, Thomas; Tan, Angelina D.; Sharma, Amita; Rilling, William S.; Hong, Kelvin; Putnam, Joe B.

In: Cancer, Vol. 121, No. 19, 01.10.2015, p. 3491-3498.

Research output: Contribution to journalArticle

Dupuy, Damian E. ; Fernando, Hiran C. ; Hillman, Shauna ; Ng, Thomas ; Tan, Angelina D. ; Sharma, Amita ; Rilling, William S. ; Hong, Kelvin ; Putnam, Joe B. / Radiofrequency ablation of stage IA non-small cell lung cancer in medically inoperable patients : Results from the American College of Surgeons Oncology Group Z4033 (Alliance) trial. In: Cancer. 2015 ; Vol. 121, No. 19. pp. 3491-3498.
@article{dc8f213c19d64c5daa481e1efc3589ae,
title = "Radiofrequency ablation of stage IA non-small cell lung cancer in medically inoperable patients: Results from the American College of Surgeons Oncology Group Z4033 (Alliance) trial",
abstract = "BACKGROUND This study evaluated the 2-year overall survival rate, adverse event rate, local control rate, and impact on pulmonary function tests for medically inoperable patients with stage IA non-small cell lung cancer (NSCLC) undergoing computed tomography (CT)-guided radiofrequency ablation (RFA) in a prospective, multicenter trial. METHODS Fifty-four patients (25 men and 29 women) with a median age of 76 years (range, 60-89 years) were enrolled from 16 US centers; 51 patients were eligible for evaluation (they had biopsy-proven stage IA NSCLC and were deemed medically inoperable by a board-certified thoracic surgeon). Pulmonary function tests were performed within the 60 days before RFA and 3 and 24 months after RFA. Adverse events were recorded and categorized. Patients were followed with CT and fludeoxyglucose positron emission tomography. Local control rate and recurrence patterns were analyzed. RESULTS The overall survival rate was 86.3{\%} at 1 year and 69.8{\%} at 2 years. The local tumor recurrence-free rate was 68.9{\%} at 1 year and 59.8{\%} at 2 years and was worse for tumors > 2 cm. In the 19 patients with local recurrence, 11 were re-treated with RFA, 9 underwent radiation, and 3 underwent chemotherapy. There were 21 grade 3 adverse events, 2 grade 4 adverse events, and 1 grade 5 adverse event in 12 patients within the first 90 days after RFA. None of the grade 4 or 5 adverse events were attributable to RFA. There was no significant change in the forced expiratory volume in the first second of expiration or the diffusing capacity of lung for carbon monoxide after RFA. A tumor size less than 2.0 cm and a performance status of 0 or 1 were associated with statistically significant improved survival of 83{\%} and 78{\%}, respectively, at 2 years. CONCLUSIONS RFA is a single, minimally invasive procedure that is well tolerated in medically inoperable patients, does not adversely affect pulmonary function tests, and provides a 2-year overall survival rate that is comparable to the rate reported after stereotactic body radiotherapy in similar patients.",
keywords = "ablation, elderly, non-small cell lung cancer (NSCLC), radiofrequency ablation (RFA), stereotactic body radiotherapy (SBRT)",
author = "Dupuy, {Damian E.} and Fernando, {Hiran C.} and Shauna Hillman and Thomas Ng and Tan, {Angelina D.} and Amita Sharma and Rilling, {William S.} and Kelvin Hong and Putnam, {Joe B.}",
year = "2015",
month = "10",
day = "1",
doi = "10.1002/cncr.29507",
language = "English (US)",
volume = "121",
pages = "3491--3498",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "19",

}

TY - JOUR

T1 - Radiofrequency ablation of stage IA non-small cell lung cancer in medically inoperable patients

T2 - Results from the American College of Surgeons Oncology Group Z4033 (Alliance) trial

AU - Dupuy, Damian E.

AU - Fernando, Hiran C.

AU - Hillman, Shauna

AU - Ng, Thomas

AU - Tan, Angelina D.

AU - Sharma, Amita

AU - Rilling, William S.

AU - Hong, Kelvin

AU - Putnam, Joe B.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - BACKGROUND This study evaluated the 2-year overall survival rate, adverse event rate, local control rate, and impact on pulmonary function tests for medically inoperable patients with stage IA non-small cell lung cancer (NSCLC) undergoing computed tomography (CT)-guided radiofrequency ablation (RFA) in a prospective, multicenter trial. METHODS Fifty-four patients (25 men and 29 women) with a median age of 76 years (range, 60-89 years) were enrolled from 16 US centers; 51 patients were eligible for evaluation (they had biopsy-proven stage IA NSCLC and were deemed medically inoperable by a board-certified thoracic surgeon). Pulmonary function tests were performed within the 60 days before RFA and 3 and 24 months after RFA. Adverse events were recorded and categorized. Patients were followed with CT and fludeoxyglucose positron emission tomography. Local control rate and recurrence patterns were analyzed. RESULTS The overall survival rate was 86.3% at 1 year and 69.8% at 2 years. The local tumor recurrence-free rate was 68.9% at 1 year and 59.8% at 2 years and was worse for tumors > 2 cm. In the 19 patients with local recurrence, 11 were re-treated with RFA, 9 underwent radiation, and 3 underwent chemotherapy. There were 21 grade 3 adverse events, 2 grade 4 adverse events, and 1 grade 5 adverse event in 12 patients within the first 90 days after RFA. None of the grade 4 or 5 adverse events were attributable to RFA. There was no significant change in the forced expiratory volume in the first second of expiration or the diffusing capacity of lung for carbon monoxide after RFA. A tumor size less than 2.0 cm and a performance status of 0 or 1 were associated with statistically significant improved survival of 83% and 78%, respectively, at 2 years. CONCLUSIONS RFA is a single, minimally invasive procedure that is well tolerated in medically inoperable patients, does not adversely affect pulmonary function tests, and provides a 2-year overall survival rate that is comparable to the rate reported after stereotactic body radiotherapy in similar patients.

AB - BACKGROUND This study evaluated the 2-year overall survival rate, adverse event rate, local control rate, and impact on pulmonary function tests for medically inoperable patients with stage IA non-small cell lung cancer (NSCLC) undergoing computed tomography (CT)-guided radiofrequency ablation (RFA) in a prospective, multicenter trial. METHODS Fifty-four patients (25 men and 29 women) with a median age of 76 years (range, 60-89 years) were enrolled from 16 US centers; 51 patients were eligible for evaluation (they had biopsy-proven stage IA NSCLC and were deemed medically inoperable by a board-certified thoracic surgeon). Pulmonary function tests were performed within the 60 days before RFA and 3 and 24 months after RFA. Adverse events were recorded and categorized. Patients were followed with CT and fludeoxyglucose positron emission tomography. Local control rate and recurrence patterns were analyzed. RESULTS The overall survival rate was 86.3% at 1 year and 69.8% at 2 years. The local tumor recurrence-free rate was 68.9% at 1 year and 59.8% at 2 years and was worse for tumors > 2 cm. In the 19 patients with local recurrence, 11 were re-treated with RFA, 9 underwent radiation, and 3 underwent chemotherapy. There were 21 grade 3 adverse events, 2 grade 4 adverse events, and 1 grade 5 adverse event in 12 patients within the first 90 days after RFA. None of the grade 4 or 5 adverse events were attributable to RFA. There was no significant change in the forced expiratory volume in the first second of expiration or the diffusing capacity of lung for carbon monoxide after RFA. A tumor size less than 2.0 cm and a performance status of 0 or 1 were associated with statistically significant improved survival of 83% and 78%, respectively, at 2 years. CONCLUSIONS RFA is a single, minimally invasive procedure that is well tolerated in medically inoperable patients, does not adversely affect pulmonary function tests, and provides a 2-year overall survival rate that is comparable to the rate reported after stereotactic body radiotherapy in similar patients.

KW - ablation

KW - elderly

KW - non-small cell lung cancer (NSCLC)

KW - radiofrequency ablation (RFA)

KW - stereotactic body radiotherapy (SBRT)

UR - http://www.scopus.com/inward/record.url?scp=84941941493&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84941941493&partnerID=8YFLogxK

U2 - 10.1002/cncr.29507

DO - 10.1002/cncr.29507

M3 - Article

C2 - 26096694

AN - SCOPUS:84941941493

VL - 121

SP - 3491

EP - 3498

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 19

ER -