SIR: RF Ablation Extends Survival in Lung Cancer

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WASHINGTON, March 17 -- Radiofrequency ablation of small malignant lung lesions appears to offer survival of at least two years for nearly three-quarters of patients not suitable for surgery, a French researcher said here. In 244 patients, 70% were still alive two years after the procedure and 38.8% had no viable malignant lung tissue, according to Thierry de Baere, M.D., of Institut Gustave-Roussy, near Paris. The survival rates are comparable to those with surgical resection, Dr. de Baere said at the Society of Interventional Radiology meeting. "We have great hopes to be able to replace surgery in some patients," Dr. de Baere said.
He said the procedure -- in which a physician threads an RF ablation device into the lesion through a catheter and destroys the tissue with heat -- has few side effects, requires shorter hospital stays than surgery, and leaves most of the lung intact.
"The treatment can be repeated when needed because it's quite safe and can preserve lung function," Dr. de Baere said.
The investigators studied 244 patients with either lung metastases from primary tumor at another site (195 patients) or primary non-small-cell lung cancer (49 patients). At the end of two years, 72% of those with lung metastases and 64% of those with primary tumors were still alive, Dr. de Baere reported.
The study found that of those with primary tumors who survived, 85% had no viable tumors on imaging at one year and 77% had nothing visible at two years.
The study also found:
The rate of local progression at two years for tumors less than two cm was 8.2%, compared with 19.4% for larger tumors. The difference was borderline significant at P=0.057.
Overall, at one year 57.5% of the patients had no viable lung tumors and at two years 38.8% had no viable lung tumors.
One-year survival was 88.7% and two-year survival was 70.3%
Dr. de Baere said the study was not a randomized trial and therefore can't be used to make reliable comparisons with surgical techniques.
But he said the data in this study are strong enough that patients who are not deemed to be good surgical candidates should ask if RF ablation might be another option.
One of the main attractions of the RF procedure is that it is easy on the patient, according to Suresh Vedantham, M.D., of Washington University in St. Louis.
"You really have to think about the patient population (in the study)," Dr. Vedantham said.
"These are mostly smokers, with heart problems and emphysema, and even if they could undergo surgery, their recovery time would be very long," he said.
"They quality of life during that process would be very, very poor," he said. "The ability to do this without having to go to the operating room would be a major advance."
Dr. Vedantham, who moderated a press conference at which Dr. de Baere discussed the study, was not involved in the research.
Primary source: Journal of Vascular and Interventional RadiologySource reference:de Baere T, et al "Long-term follow-up after percutaneous pulmonary radiofrequency ablation" J Vasc Interv Radiol 2008; 19(2) Supplement S: Abstract 106.