Comparison of therapeutic results from radiofrequency ablation and stereotactic body radiotherapy in solitary lung tumors measuring 5 cm or smaller

Ochiai, Satoru; Yamakado, Koichiro; Kodama, Hiroshi; Nomoto, Yoshihito; Noriko,; Takaki, Haruyuki; Sakuma, Hajime

doi:10.1007/s10147-014-0741-z

Cited by 21 publications

(25 citation statements)

References 37 publications

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“…This clinical evidence leads us to believe that RFA may become a new treatment modality following surgery, radiotherapy, and systemic therapy. However, the efficacy of RFA still needs to be validated in prospective, randomized, multi‐center clinical trials, and comparison with other treatment, including surgery, ablation and SBRT is necessary.…”

Section: Discussionmentioning

confidence: 99%

“…72 This clinical evidence leads us to believe that RFA may become a new treatment modality following surgery, radiotherapy, and systemic therapy. However, the efficacy of RFA still needs to be validated in prospective, randomized, multi-center clinical trials, 73 and comparison with other treatment, including surgery, [74][75][76][77] ablation 78 and SBRT [79][80][81][82] is necessary. In summary, the effectiveness and safety of RFA for the treatment of pulmonary tumors has been well demonstrated by clinical trials.…”

Section: Discussionmentioning

confidence: 99%

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Expert consensus on image‐guided radiofrequency ablation of pulmonary tumors: 2018 edition

Liu

Fan

et al. 2018

Thoracic Cancer

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Lung cancer ranks first in incidence and mortality in China. Surgery is the primary method to cure cancer, but only 20–30% of patients are eligible for curative resection. In recent years, in addition to surgery, other local therapies have been developed for patients with numerous localized primary and metastatic pulmonary tumors, including stereotactic body radiation therapy and thermal ablative therapies through percutaneously inserted applicators. Percutaneous thermal ablation of pulmonary tumors is minimally invasive, conformal, repeatable, feasible, cheap, has a shorter recovery time, and offers reduced morbidity and mortality. Radiofrequency ablation (RFA), the most commonly used thermal ablation technique, has a reported 80–90% rate of complete ablation, with the best results obtained in tumors < 3 cm in diameter. Because the clinical efficacy of RFA of pulmonary tumors has not yet been determined, this clinical guideline describes the techniques used in the treatment of localized primary and metastatic pulmonary tumors in nonsurgical candidates, including mechanism of action, devices, indications, techniques, potential complications, clinical outcomes, post‐ablation surveillance, and use in combination with other therapies. In the future, the role of RFA in the treatment of localized pulmonary tumors should ultimately be determined by evidence from prospective randomized controlled trials comparing sublobar resection or stereotactic body radiation therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Expert consensus on image‐guided radiofrequency ablation of pulmonary tumors: 2018 edition

Liu

Fan

et al. 2018

Thoracic Cancer

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“…Schlijper et al (1) reviewed 27 studies and identified that the treatment-related mortality rates for RFA and surgery were 0 and 1.4-2.4%, respectively, whereas morbidity rates were reported inconsistently but appeared to be the lower for surgery. The study by Ochiai et al (9) was conducted to compare the clinical outcomes of RFA with those of SBRT. The RFA and SBRT groups showed a similar 3-year local tumor progression (9.6 vs. 7.0%, p=0.746) and OS rates (86.4 vs. 79.6%, p=0.738).…”

Section: Discussionmentioning

confidence: 99%

A prospective clinical trial of radiofrequency ablation for pulmonary metastases

Wang

Xia

Wang

et al. 2015

Molecular and Clinical Oncology

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Abstract. Pulmonary oligometastases can be treated by local treatment options, such as resection, radiofrequency ablation (RFA), and radiotherapy, in selected patients. In the present study, 67 patients with 115 pulmonary metastases were treated, and all the lesions were treated by RFA and followed with a computed tomography scan. The local control, overall survival (OS), progression-free survival (PFS) and treatment-related toxicity were observed. Median follow-up duration after the initial RFA was 24 months (range, 3-39 months). The median PFS from RFA was 14 months [95% confidence interval (CI), 11.6-16.4]. The 6-, 12-and 18-month PFS rates were 82.1, 55.7 and 27.5%, respectively. The median OS rate from RFA was 24 months (95% CI, 18.2-29.8). The 1-, 2-and 3-year OS rates were 83.6, 46.3 and 14.3%, respectively. Primary tumor was significantly correlated to PFS and OS on multivariate analysis, and other variates showed no significance. Therefore, RFA is safe for patient treatment and can be considered as a promising treatment option for patients with pulmonary metastases. IntroductionThe lung is a main site of metastatic disease for the majority of solid tumors and local treatments have been playing an emerging role in combination with systemic therapies. In oligometastatic (1-3 pulmonary nodules) and clinically selected patients (good performance status and absent or stable extra-thoracic disease), surgery can be considered as the standard option, with good results in terms of local control and survival rate (1).Patients with pulmonary metastases often receive multiple surgeries due to the fact that not all the metastatic disease is Wdetectable at first presentation and the high likelihood of recurrence. Therefore, invasive therapies have been explored to treat patients with oligometastatic disease in an effort to improve the long-term survival rate and quality of life in patients who are not able to undergo surgery. Radiofrequency ablation (RFA) is one such technique that generates tissue heating to necrose tumors in situ and has been proved to be safe and effective in treating selected patients with certain solid tumors unsuitable for surgical resection (2).In addition, several studies have shown that RFA was as effective as surgical resection in selected patients with primary pulmonary tumors (3-5). Patients and methods Patient characteristics.Between January 2011 and September 2014, 67 patients with 115 lung metastases were enrolled in the prospective trial. Patient characteristics are listed in Table I. The decision to perform RFA was made by a multidisciplinary team and approved by the Ethics Committee of the Fudan University Shanghai Cancer Center and the patients.The selection criteria for RFA were: i) 1-3 lung metastases at the treatment time, with a maximum tumor diameter <50 mm; ii) minimum distance was 10 mm apart from the big trachea, primary bronchi, esophagus, great vessels and heart; iii) medically inoperable or patients refused surgery; iv) absent or controlled extra-thoracic disease [at com...

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“…An analysis conducted on the National Cancer Institute's Surveillance, Epidemiology, and End Results database (n=1,897) found OS and cancer specific survival were not significantly different between propensity score matched NSCLC patients treated surgically or by ablation (19). In a comparative study between RFA and SBRT in patients (n=48 and 47, respectively) with NSCLC of <5 cm, 3-year local control and OS rates were similar (20).…”

Section: Editorialmentioning

confidence: 97%

Thermal ablation for the treatment of primary and secondary pulmonary malignancies

Kim

2017

J. Thorac. Dis.

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In the review article entitled "The Role of Percutaneous Image-Guided Thermal Ablation for the Treatment of Pulmonary Malignancies" (1) recently published in the American Journal of Roentgenology (AJR) by Mouli and colleagues, the authors reviewed thermal ablation techniques [radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation] for the treatment of pulmonary malignancies [non-small cell lung cancer (NSCLC) and metastasis] with respect to treatment mechanism, local efficacy, imaging modalities used for guidance, treatment response evaluation, and clinical outcomes. The authors also reviewed the comparative studies of thermal ablations with surgery and stereotactic beam radiotherapy (SBRT).Ablation is a good candidate for treating pulmonary malignancies because lungs have heat and electrical insulating characteristics, which enable larger volumes of tissue to be ablated using thermal energy than is possible for other body tissues (2). Because thermal energy delivery is limited by the heat-sink effect of adjacent blood vessels and airways, the presence of vessels or bronchi greater than 3 mm in diameter within the ablation zone are predictors of incomplete local treatment (3). Ablation zones must exceed tumor dimensions to obtain adequate margins, and in practice, sufficient RFA-induced ground-glass opacity (GGO) indicates complete ablation (4). MWA permit larger ablation zones than RFA because delivers energy simultaneous using multiple probes, and thus, provides larger tumor ablation volumes and faster ablation times. Cryoablation uses compressed argon gas to generate subzero temperatures, but unlike heat-based ablation, cryoablation does not create GGO; instead, it creates iceballs.CT is the preferred imaging modality for guidance during thermal ablation. It provides excellent contrast between tumors and normal lung parenchyma, and multi-planar CT images enable accurate and rapid probe placement. CT is also the modality of choice for postablation follow-up evaluations (Figure 1). Immediately after ablation therapy, targeted lesions are replaced by dense opacity surrounded by GGO (5). GGO margins of <3 mm have been associated with local treatment failure. During the early post-ablation period (<2 months), central dense opacity and surrounding GGO serves as the new "baseline", and any increase in lesion size during follow-up should be considered local progression. However, morphologic evolution occurs in ablation zones and its extent depends on the thermal ablation methods used, for example, RFAtreated lesions show a relatively slow rate of involution, with a 40% decrease in size at 15 months after treatment, whereas cryoablated lesions show more rapid involution on follow-up CT images (6). PET/CT may be helpful for differentiating morphologic evolution and local recurrence, but early PET/CT within 3 months of ablation can be confounded by inflammatory changes. Editorial

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Comparison of therapeutic results from radiofrequency ablation and stereotactic body radiotherapy in solitary lung tumors measuring 5 cm or smaller

Abstract: For lung tumor patients, lung RFA provided local tumor control and survival that were similar to those achieved using SBRT, with equal safety.

Cited by 21 publications

References 37 publications

Expert consensus on image‐guided radiofrequency ablation of pulmonary tumors: 2018 edition

Expert consensus on image‐guided radiofrequency ablation of pulmonary tumors: 2018 edition

A prospective clinical trial of radiofrequency ablation for pulmonary metastases

Thermal ablation for the treatment of primary and secondary pulmonary malignancies

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