Comparison between radiofrequency ablation and sublobar resections for the therapy of stage I non-small cell lung cancer: a meta-analysis

Abstract

Background Sublobar resection (SLR) and radiofrequency ablation (RFA) are the two minimally invasive procedures performed for treating stage I non-small cell lung cancer (NSCLC). This study aimed to compare SLR and RFA for the treatment of stage I NSCLC using the meta-analytical method. Methods We searched PubMed and Embase for articles published till December 2019 to evaluate the comparative studies and assess the survival and progression-free survival rates and postoperative complications (PROSPERO registration number: CRD42018087587). A meta-analysis was performed by combining the outcomes of the reported incidences of short-term morbidity and long-term mortality. The fixed or random effects model was utilized to calculate the pooled odds ratios (OR) and the 95% confidence intervals. Results Four retrospective studies were considered in the course of this study. The studies included a total of 309 participants; 154 were assigned to the SLR group, and 155 were assigned to the RFA group. Moreover, there were statistically significant differences between the one- and three-year survival rates and one- and three-year progression-free survival rates for the two groups, which were in favor of the SLR group. Among the post-surgical complications, pneumothorax and pleural effusion were more common for the SLR group, while cardiac abnormalities were prevalent in the RFA group. There was no difference in prevalence of hemoptysis between SLR and RFA groups, which might be attributed to the limited study sample size. Conclusion Considering the higher survival rates and disease control in the evaluated cases, surgical resection is the preferred treatment method for stage I NSCLC. RFA can be considered a valid alternative in patients not eligible for surgery and in high-risk patients as it is less invasive and requires shorter hospital stay.

Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation of Non–Small Cell Lung Cancer and Metastatic Disease to the Lungs

“…Reported outcomes for IGTA therapy of stage IA lung cancer are impacted by several factors, including varied patient follow-up across studies and overall patient characteristics, including the heterogeneity of the patient population, lack of differentiation between stages when reporting outcomes, and inclusion of only medically inoperable patients in several studies. In those studies that have included patient follow-up to 5 years, OS has ranged from 26% to 91% (17,(62)(63)(64)(65)(66)(67). One-and 3-year OS rates have ranged from 78% to 91% and 36% to 78%, respectively (17,(62)(63)(64)(65)(66)(67).…”

“…In those studies that have included patient follow-up to 5 years, OS has ranged from 26% to 91% (17,(62)(63)(64)(65)(66)(67). One-and 3-year OS rates have ranged from 78% to 91% and 36% to 78%, respectively (17,(62)(63)(64)(65)(66)(67).…”

“…(17,68,69,71,74,75,79,(82)(83)(84)(85)(86)(87)(88)(89)(90)(91), all values are Outcomes of Image-Guided Thermal Ablation for Stage 1A Lung Tumors(17,(62)(63)(64)(65)(66)(67) Outcomes of Image-Guided Thermal Ablation for Metastatic Disease(17,(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82) …”

Advances and controversies in the management of early stage non-small cell lung cancer

“…Because air is a poor conductor of electricity and a good thermal insulator, the lung is theoretically an ideal site for the application of RFA as the surrounding parenchyma is barely affected[ 59 ]. The use of RFA to treat lung tumors was first described by Dupuy et al [ 60 ] in 2000.…”

“…The main advantages of RFA over surgery are that it is minimally invasive (percutaneous technique performed with local anesthesia), can be administered on an outpatient basis or under 24-h hospitalization, and does not require thoracotomy[ 59 ].…”