Patients with early-stage non-small cell lung cancer (NSCLC) who are not candidates for surgery now have other non-invasive and potentially lifesaving options. In a paper published in the July issue of the Journal of Vascular and Interventional Radiology, 57% of lung cancer patients who were treated with thermal ablation and radiotherapy survived to three years - two years beyond average life expectancy.
The purpose of the study was to evaluate the clinical outcomes of patients with early-stage NSCLC after combined treatment with thermal ablation and radiotherapy, and it showed that the combination therapy may result in an improved survival over either modality alone.
The patients in the study were terminal and had a life expectancy of less than one year. Twenty-seven of 41 patients who underwent thermal ablation subsequently received external-beam radiation, the primary treatment in patients who are considered poor operative candidates. Fourteen patients underwent thermal ablation followed by interstitial brachytherapy. Of the 41 patients, 97.6% survived to six months, 86.8% to one year, 70.4% to two years and 57.1% to three years. The median follow-up was 19.5 months with an average survival of 42.2 months. The patients with tumours smaller than 3cm (n=17) had the best outcomes, with an average survival of 44.4 months.
"Only one third of patients diagnosed with NSCLC are eligible for surgery - the rest face the reality of having less than 12 months to live," said senior author Dr Damian Dupuy, director of ultrasound at Rhode Island Hospital and professor of diagnostic imaging at Brown Medical School in Providence, Rhode Island. "These new outpatient treatments not only are effective but allow us to treat patients who historically have no other options," he added. "Utilising imaging and targeted thermal ablation, we can heat and destroy lung tumours and extend a patient's life.
"Thermal ablation followed by radiotherapy for inoperable stage 1 and 2 non-small cell lung cancer tumours 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.
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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