Abstract
Concurrent chemoradiotherapy is the standard treatment for patients with locally advanced lung cancer. The most common dose-limiting adverse effect of thoracic radiotherapy (RT) is radiation pneumonia (RP). A randomized comparison study was designed to investigate targeted percutaneous microwave ablation at pulmonary lesion combined with mediastinal RT with or without chemotherapy (ablation group) in comparison with RT (target volume includes pulmonary tumor and mediastinal node) with or without chemotherapy (RT group) for the treatment of locally advanced non-small cell lung cancers (NSCLCs). From 2009 to 2012, patients with stage IIIA or IIIB NSCLCs who refused to undergo surgery or were not suitable for surgery were enrolled. Patients were randomly assigned to the RT group (n = 47) or ablation group (n = 51). Primary outcomes were the incidence of RP and curative effectiveness (complete response, partial response, and stable disease); secondary outcome was the 2-year overall survival (OS). Fifteen patients (31.9 %) in the RT and two (3.9 %) in the ablation group experienced RP (P < 0.001). The ratio of effective cases was 85.1 versus 80.4 % for mediastinal lymph node (P = 0.843) and 83.0 versus 100 % for pulmonary tumors (P = 0.503), respectively, for the RT and ablation groups. Kaplan–Meier analysis demonstrated 2-year OS rate of NSCLC patients in ablation group was higher than RT group, but no statistical difference (log-rank test, P = 0.297). Percutaneous microwave ablation followed by RT for inoperable stage III NSCLCs may result in a lower rate of RP and better local control than radical RT treatments.
References
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.
Becker N, Motsch E, Gross ML, Eigentopf A, Heussel CP, Dienemann H, et al. Randomized study on early detection of lung cancer with MSCT in Germany: study design and results of the first screening round. J Cancer Res Clin Oncol. 2012;138:1475–86.
Shao Q, Li J, Li F, Wang S, Wang W, Liu S, et al. Clinical investigation into the initial diagnosis and treatment of 1168 lung cancer patients. Oncol Lett. 2015;9:563–8.
Shtivelman E, Hensing T, Simon GR, Dennis PA, Otterson GA, Bueno R, et al. Molecular pathways and therapeutic targets in lung cancer. Oncotarget. 2014;5:1392–433.
Chermiti Ben Abdallah F, Ben Ali G, Sadok Boudaya M, Mlika M, Chtourou A, Taktak S, et al. Treatment and prognosis of advanced stage non-small-cell lung cancer. Rev Mal Respir. 2014;31:214–20.
Al-Shahrabani F, Vallbohmer D, Angenendt S, Knoefel WT. Surgical strategies in the therapy of non-small cell lung cancer. World J Clin Oncol. 2014;5:595–603.
Chang JY, Kestin LL, Barriger RB, Chetty IJ, Ginsburg ME, Kumar S et al. ACR appropriateness criteria(R) nonsurgical treatment for locally advanced non-small-cell lung cancer: good performance status/definitive intent. Oncology (Williston Park). 2014; 28: 706–10, 12, 14 passim.
Laine AM, Westover KD, Choy H. Radiation therapy as a backbone of treatment of locally advanced non-small cell lung cancer. Semin Oncol. 2014;41:57–68.
Vansteenkiste J, De Ruysscher D, Eberhardt WE, Lim E, Senan S, Felip E et al. Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013; 24 Suppl 6: vi89–98.
Dang J, Li G, Zang S, Zhang S, Yao L. Comparison of risk and predictors for early radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with radiotherapy with or without surgery. Lung Cancer. 2014;86:329–33.
Selek U, Bolukbasi Y, Welsh JW, Topkan E. Intensity-modulated radiotherapy versus 3-dimensional conformal radiotherapy strategies for locally advanced non-small-cell lung cancer. Balkan Med J. 2014;31:286–94.
de Baere T, Farouil G, Deschamps F. Lung cancer ablation: what is the evidence? Semin Interv Radiol. 2013;30:151–6.
Yilmaz S, Adas YG, Hicsonmez A, Andrieu MN, Akyurek S, Gokce SC. Evaluation of the radiation pneumonia development risk in lung cancer cases. Asian Pac J Cancer Prev. 2014;15:7371–5.
Wei Z, Ye X, Yang X, Zheng A, Huang G, Li W, et al. Microwave ablation in combination with chemotherapy for the treatment of advanced non-small cell lung cancer. Cardiovasc Intervent Radiol. 2015;38:135–42.
Carrafiello G, Mangini M, Fontana F, Ierardi AM, De Marchi G, Rotolo N, et al. Microwave ablation of lung tumours: single-centre preliminary experience. Radiol Med. 2014;119:75–82.
Belfiore G, Ronza F, Belfiore MP, Serao N, di Ronza G, Grassi R, et al. Patients’ survival in lung malignancies treated by microwave ablation: our experience on 56 patients. Eur J Radiol. 2013;82:177–81.
Sonntag PD, Hinshaw JL, Lubner MG, Brace CL, Lee FT, Jr. Thermal ablation of lung tumors. Surg Oncol Clin N Am. 2011; 20: 369–87, ix.
Brace CL, Hinshaw JL, Laeseke PF, Sampson LA, Lee FT Jr. Pulmonary thermal ablation: comparison of radiofrequency and microwave devices by using gross pathologic and CT findings in a swine model. Radiology. 2009;251:705–11.
Acksteiner C, Steinke K. Percutaneous microwave ablation for early-stage non-small cell lung cancer (NSCLC) in the elderly: a promising outlook. J Med Imaging Radiat Oncol. 2015;59:82–90.
Yang X, Ye X, Zheng A, Huang G, Ni X, Wang J, et al. Percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: clinical evaluation of 47 cases. J Surg Oncol. 2014;110:758–63.
Liu H, Steinke K. High-powered percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: a preliminary study. J Med Imaging Radiat Oncol. 2013;57:466–74.
Rami-Porta R, Crowley JJ, Goldstraw P. The revised TNM staging system for lung cancer. Ann Thorac Cardiovasc Surg. 2009;15:4–9.
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.
Cox JD, Stetz J, Pajak TF. Toxicity criteria of the radiation therapy oncology group (RTOG) and the European organization for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341–6.
Albain KS, Swann RS, Rusch VW, Turrisi AT 3rd, Shepherd FA, Smith C, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet. 2009;374:379–86.
Zarogoulidis K, Zarogoulidis P, Darwiche K, Boutsikou E, Machairiotis N, Tsakiridis K, et al. Treatment of non-small cell lung cancer (NSCLC). J Thorac Dis. 2013;5(Suppl 4):S389–96.
Ghaye B. Percutaneous ablation of malignant thoracic tumors. JBR-Btr. 2013;96:142–54.
Roberton BJ, Liu D, Power M, Wan JM, Stuart S, Klass D, et al. Pulmonary ablation: a primer. Can Assoc Radiol J. 2014;65:177–85.
Sharma A, Abtin F, Shepard JA. Image-guided ablative therapies for lung cancer. Radiol Clin North Am. 2012;50:975–99.
Vogl TJ, Naguib NN, Gruber-Rouh T, Koitka K, Lehnert T, Nour-Eldin NE. Microwave ablation therapy: clinical utility in treatment of pulmonary metastases. Radiology. 2011;261:643–51.
Grieco CA, Simon CJ, Mayo-Smith WW, DiPetrillo TA, Ready NE, Dupuy DE. Percutaneous image-guided thermal ablation and radiation therapy: outcomes of combined treatment for 41 patients with inoperable stage I/II non-small-cell lung cancer. J Vasc Interv Radiol. 2006;17:1117–24.
Zheng A, Wang X, Yang X, Wang W, Huang G, Gai Y, et al. Major complications after lung microwave ablation: a single-center experience on 204 sessions. Ann Thorac Surg. 2014;98:243–8.
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Xu, X., Ye, X., Liu, G. et al. Targeted percutaneous microwave ablation at the pulmonary lesion combined with mediastinal radiotherapy with or without concurrent chemotherapy in locally advanced non-small cell lung cancer evaluation in a randomized comparison study. Med Oncol 32, 227 (2015). https://doi.org/10.1007/s12032-015-0672-1
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DOI: https://doi.org/10.1007/s12032-015-0672-1