Radiofrequency Ablation vs Stereotactic Body Radiotherapy in NSCLC

A new study found no significant difference in overall survival (OS) for patients with early-stage non–small cell lung cancer (NSCLC) treated with either radiofrequency (RF) ablation or stereotactic body radiotherapy (SBRT). The study was published by the Journal of Vascular and Interventional Radiology.

The retrospective study identified cases in the National Cancer Database of patients with stage 1a and stage 1b NSCLC who were treated with RF ablation and SBRT between 2004 and 2014 at a high volume center, defined as those at the 95th percentile and above in volume of cases performed. Of the 4,789 cases that met the inclusion criteria, 335 patients (7.0%) were treated with RF ablation and 4,454 (93%) were treated with SBRT. The mean age of patients in the cohort was 73.6 years.

The medial survival for the cohort was 38.8 months and the median follow up was 42.0 months. Patients treated with RF ablation had significantly more comorbidities (P < 0.001) and higher risk for an unplanned readmission within 30 days (hazard ratio = 11.536; P < 0.001). A multivariate Cox regression analysis found no difference in OS for the unmatched groups (P = 0.285). In the matched groups, no difference was found with 1-, 3-, and 5-year OS of 85.5%, 54.3%, and 31.9% in the SBRT group vs 89.3%, 52.7%, and 27.1% in the RF ablation group (P = 0.835).

“Although no difference in OS was seen between the 2 modalities, patients who received RF ablation were at a significantly higher risk for an unplanned readmission within 30 days compared with patients who receive SBRT. This may be due to complications of RF ablation, including pneumothorax, hemoptysis, and hemorrhage, which usually occur in the short-term,” the authors said.  “Given the equivalence in OS, the decision to proceed with either treatment is best made with the consideration of patient comorbidities (eg, extent of pulmonary reserve and tolerance to lying supine) and tumoral factors (eg, size and proximity to the mediastinum, large airways, and pleura),” they concluded.

--Kelsey Moroz

Reference

Lam A, Yoshida EJ, Bui K, et al. A National Cancer Database analysis of radiofrequency ablation versus stereotactic body radiotherapy in early-stage non-small cell lung cancer. J Vasc Interv Radiol. Jul 27, 2018. pii: S1051-0443(18)31163-1. doi: 10.1016/j.jvir.2018.04.029. [Epub ahead of print].