Two year survival outcomes of a study presented at the SIR annual meeting reported that Radiofrequency ablation (RFA) successfully killed lung tumours inside the body without surgery in 93% of the cases.
Patients also had a 91% cancer-specific survival rate at one and two years, according to results of the prospective, multicenter trial that used radiofrequency heat to "cook" and kill patients' lung tumours,
RFA offers a non-surgical, localised treatment that kills the tumour cells with heat, while sparing nearby healthy lung tissue. Thus, this treatment is much easier on the patient than systemic chemotherapy. Radiofrequency energy can be given without affecting the patient's overall health and most people can resume their usual activities in a few days.
The Radiofrequency Ablation of Pulmonary Tumors Response Evaluation (RAPTURE) trial led by Dr Riccardo Lencioni of the University of Pisa, Italy, had 106 patients (36 women and 70 men) with 186 malignant tumours that were 3.5cm in diameter or smaller were enrolled. Thirty-three patients had non-small cell lung cancer, 53 had colorectal cancer metastasis and 20 had metastasis from other primary malignancies; none were surgical candidates. Under conscious sedation, patients underwent RFA treatment and were then followed for up to 27 months.
Research showed no procedure-related deaths occurred. Major complications consisted of: pneumothorax (27) or pleural effusion (4) requiring treatment, pneumonia (2) and atelectasis (1). At a three-month CT evaluation, complete ablation of the tumour occurred in 173 of 186 tumours - a 93% primary effectiveness rate. Although overall survival of the primary lung cancer patients was 69% at one year and 49% at two years, the survival rates increased dramatically to 91% for one and two years for cancer-only related deaths. For patients with colorectal cancer metastatic to the lung, cancer-only related deaths were 88% at one year and 72% at two years.
Lencioni told Interventional News the strengths of the study included that it was a multicenter study at an international level.
"We have centers from Europe, the US and Australia. It's done in three continents on a large scale," he said.
"The limitations were we don't have a control arm to compare our data. This was the first prospective study in the lung ablation study so it was not designed as a randomised trial," he said.
"But the 91% cancer specific survival rate at one and two years is impressive -these are patients that did not really have any other chance of cure, they were all rejected from surgery."
Many of the patients were so weak they were unfit for conventional treatment from radiation therapy, making radiofrequency among the last of their treatment options. While the study only involved this type of patient group, Lencioni believes radiofrequency could also be effective in stronger patients who were nevertheless non-surgical candidates
He also talked about the improved quality of life for patients undergoing radiofrequency.
"Chemotherapy is a disaster in terms of quality of life - but most of our patients did just one 20 minute treatment and were free of disease. We can improve the survival of non-surgical candidates, I think, and we can keep the quality of life at a very high level," Lencioni said.
"The next step should be a randomised trial comparing RFA to radiation therapy. I think surgery will always be the first option, but for this patient population, lung cancer is usually caused by smoking. And smoking causes a lot of co-morbidities in terms of pulmonary function, vascular disease. So it's very common to have a patient who despite having a lung tumour is not a suitable candidate for surgery."
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