Radiofrequency Ablation Proves Effective in Treating Malignant Lung Tumours

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Title: Radiofrequency Ablation Proves Effective in Treating Malignant Lung Tumours
URL: http://www.pslgroup.com/dg/223B7E.htm
Doctor's Guide
June 17, 2008

NEW YORK -- June 17, 2008 -- Radiofrequency ablation (RFA) could also be used in patients with lung cancer in the near future, according to promising results from the Radiofrequency Ablation of Pulmonary Tumors Response Evaluation (RAPTURE) study, published early online and in the July edition of The Lancet Oncology.

According to background information from the article, lung cancer is the leading cause of cancer death in both men and women. Non-small-cell lung cancer (NSCLC) constitutes about 80% of primary malignant tumours in the lung.

While surgery is currently the standard of care for early-stage NSCLC, it is not suitable for all patients. Patients rejected for surgery are currently offered radiotherapy or chemotherapy protocols, but long-term outcomes are not fully satisfactory.

Optimised RFA technology produces large volumes of tumour death in a controlled fashion and has become a viable treatment option for nonsurgical patients with liver cancer.

Professor Riccardo Lencioni, Division of Diagnostic and Interventional Radiology, Cisanello University Hospital, Pisa, Italy, and colleagues, conducted a prospective, intention-to-treat, single-arm, multicentre trial, to test the feasibility, safety, and efficacy of percutaneous RFA in treating malignant lung tumours.

Between July 1, 2001, and December 10, 2005, a total of 106 patients with 183 malignant lung tumours that were 3.5 cm in diameter or smaller (mean 1.7 cm) were enrolled in the study. Proof of malignancy was obtained by biopsy in all patients.

Diagnoses included NSCLC in 33 patients, metastasis from colorectal carcinoma in 53 patients, and metastasis from other primary malignancies in 20 patients. All patients were rejected for surgery and were considered unfit for radiotherapy or chemotherapy. Patients underwent RFA and were followed for up to 2 years.

Primary endpoints were technical success (correct placement of ablation device), safety, and confirmed complete response of tumours. Secondary endpoints included overall survival, cancer-specific survival, and quality of life.

The researchers found that a confirmed complete response of tumours lasting at least 1 year was achieved in 75 of 85 assessable patients (88%). Overall survival was 70% at 1 year and 48% at 2 years in patients with NSCLC, and 89% at 1 year and 66% at 2 years in patients with lung metastases from colon cancer. Cancer-specific survival was 92% at 1 year and 73% at 2 years in patients with NSCLC, and 91% at 1 year and 68% at 2 years in patients with lung metastases from colon cancer.

Patients with stage I NSCLC (n = 13) had a 2-year overall survival of 75% and a 2-year cancer-specific survival of 92%. Furthermore, the ablation device was correctly placed in 99% of the patients, and no procedure-related deaths occurred in any of the 137 ablation sessions. Major complications consisted of pneumothorax (n = 27) or pleural effusion (n = 4), which needed drainage. However, there was no significant decline in pulmonary function.

"Our study shows that radiofrequency ablation can be completed successfully in [a] high percentage of patients with small lung tumours," the authors said. "The safety profile of the procedure was also acceptable, with no mortality or life-threatening complications associated with it ... a randomised controlled trial comparing radiofrequency ablation versus standard treatment options is now warranted to prove the clinical benefit of this approach."

SOURCE: The Lancet Oncology

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