Abstract
Currently, the standard of care for Stage I non-small cell lung cancer (NSCLC) is surgical resection. Although this treatment modality has been demonstrated to have 5-year survival rates approaching 80%, patients who are medically inoperable account for around 18–22% of this population (Raz et al. 2007). Interest has thus turned toward nonsurgical treatments, such as Stereotactic Body Radiation Therapy (SBRT) and ablation, that might improve the otherwise dismal 13–14-month median survival of untreated Stage I disease. Over the past 10 years, data on the safety and efficacy of the three types of ablation which includes radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) have bolstered their place in the armamentarium of minimally invasive therapies. Recent advancements in thermal ablation therapies have overcome some of the anatomic limitations that were initially encountered with RFA (e.g., treatment of only small peripheral lesions located distal to vasculature, large airways, and the mediastinum). The most common complications associated with thermal ablation include pneumothorax, pulmonary hemorrhage, and pleural effusion.
Irrespective of thermal ablative technique, tumor size <3 cm has been found to be the most important factor in predicting local control. Local progression rates in recent literature range from 15% to 44% with mean overall survivals of 34–57 months. Although the safety and efficacy of percutaneous thermal ablation have been documented over the past 20 years, randomized trials are needed to determine the relative benefit of these procedures when compared to alternatives such as SBRT and sublobar resection.
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Notes
- 1.
Local control most commonly refers to tumor at the ablated site with response defined in terms of RECIST or mRECIST criteria. Studies cited in this paragraph use this definition. However, some authors, for example Dupuy et al. (2015), define local control as encompassing any new tumor in the treated lobe.
- 2.
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Kutcher-Diaz, R.B., Harman, A., Varlotto, J. (2023). The Role of Thermal Ablation in the Treatment of Stage I Non-small Cell Lung Cancer. In: Jeremić, B. (eds) Advances in Radiation Oncology in Lung Cancer. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2023_380
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