Sublobar Resection, Radiofrequency Ablation or Radiotherapy in Stage I Non-Small Cell Lung Cancer

Abstract

Background: The best therapy for patients with stage I non-small cell lung cancer (NSCLC) who are medically unfit for lobectomy or prefer not to undergo surgery has not yet been demonstrated. Objectives: We analyzed data from our prospective database to evaluate the recurrence and survival rates and assess the extent to which the type of treatment explains outcome differences. Methods: This study included 116 patients with histologically proven clinical stage I NSCLC who were treated with sublobar resection (SLR; n = 42), radiofrequency ablation (RFA; n = 25) or radiotherapy (RT; n = 49) between 2009 and 2013. The primary end point was the time to primary tumor recurrence (PR). Kaplan-Meier curves and Cox regression were used to compare the recurrence patterns and survivals after adjustments for potential confounders. Results: The SLR patients were younger and exhibited better performance status. The RT patients had larger tumors. After adjusting for age and tumor size, there were differences between the different treatments in terms of the PR rate, but no differences were observed in overall (OS) or disease-free survival. The hazard ratio for PR comparing SLR versus RT adjusted for age and tumor size was 2.73 (95% confidence interval, CI, 0.72-10.27) and that for SLR versus RFA was 7.57 (95% CI 1.94-29.47). Conclusions: Our study suggests that SLR was associated with a higher primary tumor control rate compared to RFA or RT, although the OSs were not different. These results should be confirmed in prospective trials.

Lung segmentectomy: does it offer a real functional benefit over lobectomy?

“…A fourth study found a significant but tiny reduction of PFT, the mean vital capacity 1 month and 3 months after RFA being at 93% and 95% of the baseline value [59]. Comparison of RFA with sublobar resection and SABR has been performed in two nonrandomised trials [40,60], but patient characteristics, including baseline PFT, differed significantly and none of the studies reported post-RFA PFT. Positioning of the treatment modalities for stage I lung cancer will partly rely on their functional cost, which needs to be carefully evaluated.…”

Sublobar resection is associated with improved outcomes over radiotherapy in the management of high-risk elderly patients with Stage I non-small cell lung cancer: a systematic review and meta-analysis

“…Of these, five studies were excluded because of an inability to obtain the SLR data [16–20] and two studies were excluded because of duplication [21–22]. Ultimately, 16 studies (11,540 patients) [23–38] met our inclusion criteria.…”

“…A majority of the included studies were conducted in the USA, except for two studies [23, 38]. All the patients were diagnosed with Stage I NSCLC, and the median age was 66 years and older.…”

“…A PSM comparison was performed in 9 studies, and a total of 10,870 matched patients were included [25, 27–28, 31–35, 37]. Five studies evaluated the efficacy and safety of SLR versus CFRT for these patients [23–27]; 10 studies were designed to compare SLR versus SBRT [28–37]; and one study evaluated the efficacy and safety of SLR versus CFRT and SBRT [38], as shown in Table 1.…”

Navigation Bronchoscopy-Guided Radiofrequency Ablation for Nonsurgical Peripheral Pulmonary Tumors

“…Stereotactic body radiotherapy is an effective, noninvasive treatment modality but is limited by respiratory movements, requirements for multiple treatments, cost, and the complication of radiation pneumonitis. RFA is a promising alternative treatment method with overall survival data appearing to be similar to sublobar resection and radiotherapy [6][7][8] . RFA has been widely used via a percutaneous method, and complications including pneumothorax, hemothorax, bronchopleural fistula, and pleural effusions are very common ranging from 15.2 to 55.6% [9] .…”