Usefulness of percutaneous microwave ablation for large non‑small cell lung cancer: A preliminary report

Pusceddu,Claudio; Melis,Luca; Sotgia,Barbara; Guerzoni,Daniela; Porcu,Alberto; Fancellu,Alessandro

doi:10.3892/ol.2019.10375

Usefulness of percutaneous microwave ablation for large non‑small cell lung cancer: A preliminary report

Authors:
- Claudio Pusceddu
- Luca Melis
- Barbara Sotgia
- Daniela Guerzoni
- Alberto Porcu
- Alessandro Fancellu
View Affiliations

Affiliations: Division of Interventional Radiology, Department of Oncological Radiology, Oncological Hospital A. Businco, I-09121 Cagliari, Italy, Department of Medical Oncology, Oncological Hospital A. Businco, I-09121 Cagliari, Italy, Department of Clinical, Surgical and Experimental Sciences, Unit of General Surgery 2‑Clinica Chirurgica, University of Sassari, I‑07100 Sassari, Italy
Published online on: May 20, 2019 https://doi.org/10.3892/ol.2019.10375
Pages: 659-666
Copyright: © Pusceddu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The role of microwave ablation (MWA) in patients with non‑small cell lung cancer (NSCLC) remains ill‑defined. This retrospective study evaluated the oncological outcomes of CT-guided MWA in patients with large NSCLC. Kaplan‑Meier analysis was used to evaluate overall survival (OS) and cancer‑specific survival (CSS). The log‑rank test was used to compare survival between patients with an NSCLC size greater or smaller than 4 cm. The likelihood of local tumor progression (LTP) was analyzed using a multivariable regression model. A total of 53 patients with 65 tumors were analyzed. The mean tumor size was 5.0±1.8 cm. At the 1‑month CT scan, complete tumor ablation was observed in 44.6% of cases. In 18.5% of cases a redo‑MWA session was carried out, while in 4.6%, a third MWA was necessary to obtain complete tumor necrosis. The mean follow‑up was 28.1±20.6 months with a median duration of 21.5 months. The 1‑year, 2‑year, 3‑year and 5‑year OS rates were 78.2, 48.3, 34.8 and 18.3%, respectively. The median CSS was 25 months (95% CI 15.5‑34.5). The 1‑year, 2‑year, 3‑year and 5‑year CSS rates were 84.3, 53.7, 42.1 and 30.0%, respectively. OS in patients with tumor size ≥4 cm was significantly lower when compared with those having smaller tumors (P=0.03). LTP was observed in 19 patients (35.8%). Incomplete tumor ablation [odds ratio (OR) 6.57; P<0.05] and tumor size ≥4 cm (OR 0.18; P<0.05) were significant independent predictors of LTP. In conclusion, CT‑guided MWA may represent a useful tool in the multimodality treatment of patients with large advanced NSCLC.

View Figures

View References

1	Malvezzi M, Carioli G, Bertuccio P, Boffetta P, Levi F, La Vecchia C and Negri E: European cancer mortality predictions for the year 2017, with focus on lung cancer. Ann Oncol. 28:1117–1123. 2017. View Article : Google Scholar : PubMed/NCBI
2	Lewis J, Gillaspie EA, Osmundson EC and Horn L: Neoadjuvant approaches to locally advanced non-small cell lung cancer. Front Oncol. 8:52018. View Article : Google Scholar : PubMed/NCBI
3	Ou W, Li N, Wang SY, Li J, Liu QW, Huang QA and Wang BX: Phase 2 trial of neoadjuvant bevacizumab plus pemetrexed and carboplatin in patients with unresectable stage III lung adenocarcinoma (GASTO 1001). Cancer. 122:740–747. 2016. View Article : Google Scholar : PubMed/NCBI
4	Liu H and 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. 57:466–474. 2013. View Article : Google Scholar : PubMed/NCBI
5	Moya-Horno I, Viteri S, Karachaliou N and Rosell R: Combination of immunotherapy with targeted therapies in advanced non-small cell lung cancer (NSCLC). Ther Adv Med Oncol. 10:17588340177450122018. View Article : Google Scholar : PubMed/NCBI
6	AmericanCancer Society: Cancer Facts & Figures. 2017, https://www.cancer.org/cancer/non-small-cell-lung-cancer/detection-diagnosisstaging/survival-rates.html
7	Nour-Eldin NA, Exner S, Al-Subhi M, Naguib NNN, Kaltenbach B, Roman A and Vogl TJ: Ablation therapy of non-colorectal cancer lung metastases: Retrospective analysis of tumour response post-laser-induced interstitial thermotherapy (LITT), radiofrequency ablation (RFA) and microwave ablation (MWA). Int J Hyperthermia. 33:820–229. 2017.PubMed/NCBI
8	Zhong L, Sun S, Shi J, Cao F, Han X, Bao X and You Q: Clinical analysis on 113 patients with lung cancer treated by percutaneous CT-guided microwave ablation. J Thorac Dis. 9:590–597. 2017. View Article : Google Scholar : PubMed/NCBI
9	Wolf FJ, Grand DJ, Machan JT, Dipetrillo TA, Mayo-Smith WW and Dupuy DE: Microwave ablation of lung malignancies: Effectiveness, CT findings, and safety in 50 patients. Radiology. 247:871–879. 2008. View Article : Google Scholar : PubMed/NCBI
10	Vogl TJ, Naguib NN, Gruber-Rouh T, Koitka K, Lehnert T and Nour-Eldin NE: Microwave ablation therapy: Clinical utility in treatment of pulmonary metastases. Radiology. 261:643–651. 2011. View Article : Google Scholar : PubMed/NCBI
11	Zheng A, Ye X, Yang X, Huang G and Gai Y: Local efficacy and survival after microwave ablation of lung tumors: A retrospective study in 183 patients. J Vasc Interv Radiol. 27:1806–1814. 2016. View Article : Google Scholar : PubMed/NCBI
12	Pusceddu C, Melis L, Ballicu N, Meloni P, Sanna V, Porcu A and Fancellu A: Cryoablation of primary breast cancer in patients with metastatic disease: considerations arising from a single-centre data analysis. Biomed Res Int. 2017:38390122017. View Article : Google Scholar : PubMed/NCBI
13	Pusceddu C, Melis L, Sotgia B, Fancellu A and Meloni GB: Computed tomography-guided cryoablation of local recurrence after primary resection of pancreatic adenocarcinoma. Clin Pract. 5:7412015. View Article : Google Scholar : PubMed/NCBI
14	Pusceddu C, Sotgia B, Fele RM and Melis L: Treatment of bone metastases with microwave thermal ablation. J Vasc Interv Radiol. 24:229–233. 2013. View Article : Google Scholar : PubMed/NCBI
15	Palussière J, Catena V and Buy X: Percutaneous thermal ablation of lung tumors-Radiofrequency, microwave and cryotherapy: Where are we going? Diagn Interv Imaging. 98:619–625. 2017. View Article : Google Scholar : PubMed/NCBI
16	Wang H, Littrup PJ, Duan Y, Zhang Y, Feng H and Nie Z: Thoracic masses treated with percutaneous cryotherapy: Initial experience with more than 200 procedures. Radiology. 235:289–298. 2005. View Article : Google Scholar : PubMed/NCBI
17	Hegenscheid K, Behrendt N, Rosenberg C, Kuehn JP, Ewert R, Hosten N and Puls R: Assessing early vascular changes and treatment response after laser-induced ther- motherapy of pulmonary metastases with perfusion CT: Initial experience. AJR Am J Roentgenol. 194:1116–1123. 2010. View Article : Google Scholar : PubMed/NCBI
18	Belfiore G, Ronza F, Belfiore MP, Serao N, di Ronza G, Grassi R and Rotondo A: Patients' survival in lung malignancies treated by microwave ablation: Our experience on 56 patients. Eur J Radiol. 82:177–181. 2013. View Article : Google Scholar : PubMed/NCBI
19	Pusceddu C, Melis L, Fancellu A, Melis M and Meloni GB: Feasibility and safety of percutaneous radiofrequency, microwave or cryoablation for unresectable thoracic malignancies in close proximity to heart and large vessels. Ann Surg Oncol. 20:S1072013.
20	Zheng A, Wang X, Yang X, Wang W, Huang G, Gai Y and Ye X: Major complications after lung microwave ablation: A single-center experience on 204 sessions. Ann Thorac Surg. 98:243–248. 2014. View Article : Google Scholar : PubMed/NCBI
21	Pusceddu C, Melis L, Ballicu N, Sotgia B, Melis M, Sanna V, Meloni GB, Porcu A and Fancellu A: Percutaneous microwave ablation under CT guidance for hepatocellular carcinoma: A single institutional experience. J Gastrointest Cancer. 49:295–301. 2018. View Article : Google Scholar : PubMed/NCBI
22	Carrafiello G, Mangini M, Fontana F, Ierardi AM, De Marchi G, Rotolo N, Chini C, Cuffari S and Fugazzola C: Microwave ablation of lung tumors: Single-centre preliminary experience. Radiol Med. 119:75–82. 2014. View Article : Google Scholar : PubMed/NCBI
23	Yang X, Ye X, Zheng A, Huang G, Ni X, Wang J, Han X, Li W and Wei Z: Percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: Clinical evaluation of 47 cases. J Surg Oncol. 110:758–763. 2014. View Article : Google Scholar : PubMed/NCBI
24	Macchi M, Belfiore MP, Floridi C, Serra N, Belfiore G, Carmignani L, Grasso RF, Mazza E, Pusceddu C, Brunese L and Carrafiello G: Radiofrequency versusmicrowave ablation for treatment of the lung tumors: LUMIRA (lung microwave radiofrequency) randomized trial. Med Oncol. 34:962014. View Article : Google Scholar
25	Lackey A and Donington JS: Surgical management of lung cancer. Semin Intervent Radiol. 30:133–140. 2013. View Article : Google Scholar : PubMed/NCBI
26	Narsule CK, Sridhar P, Nair D, Gupta A, Oommen RG, Ebright MI, Litle VR and Fernando HC: Percutaneous thermal ablation for stage IA non-small cell lung cancer: Long-term follow-up. J Thorac Dis. 9:4039–4045. 2017. View Article : Google Scholar : PubMed/NCBI
27	Yang X, Ye X, Huang G, Han X, Wang J, Li W, Wei Z and Meng M: Repeated percutaneous microwave ablation for local recurrence of inoperable Stage I nonsmall cell lung cancer. J Cancer Res Ther. 13:683–688. 2017. View Article : Google Scholar : PubMed/NCBI
28	Maxwell AWP, Healey TT and Dupuy DE: Microwave ablation of lung tumors near the heart: A retrospective review of short-term procedural safety in ten patients. Cardiovasc Intervent Radiol. 40:1401–1407. 2017. View Article : Google Scholar : PubMed/NCBI
29	De Tollenaere C, Lievens Y, Vandecasteele K, Vermaelen K and Surmont V: Unresectable stage III non-small-cell lung cancer: Have we made any progress? World J Respirol. 5:140–151. 2015. View Article : Google Scholar
30	Stinchcombe TE and Bogart JA: Novel approaches of chemoradiotherapy in unresectable stage IIIA and stage IIIB non-small cell lung cancer. Oncologist. 17:682–693. 2012. View Article : Google Scholar : PubMed/NCBI
31	Caglar HB, Baldini EH, Othus M, Rabin MS, Bueno R, Sugarbaker DJ, Mentzer SJ, Jänne PA, Johnson BE and Allen AM: Outcomes of patients with stage III nonsmall cell lung cancer treated with chemotherapy and radiation with and without surgery. Cancer. 115:4156–4166. 2009. View Article : Google Scholar : PubMed/NCBI
32	Wang H, Zhang J, Shi F, Zhang C, Jiao Q and Zhu H: Better cancer specific survival in young small cell lung cancer patients especially with AJCC stage III. Oncotarget. 8:34923–34934. 2017.PubMed/NCBI
33	Lu Q, Cao W, Huang L, Wan Y, Liu T, Cheng Q, Han Y and Li X: CT-guided percutaneous microwave ablation of pulmonary malignancies: Results in 69 cases. World J Surg Oncol. 10:802012. View Article : Google Scholar : PubMed/NCBI
34	NCCN guidelines for Non-Small Cell Lung Cancer (Ver. 4.2018-April 2018). https://www.nccn.org/store/login/login.aspxReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf
35	Postmus PE, Kerr KM, Oudkerk M, Senan S, Waller DA, Vansteenkiste J, Escriu C and Peters S; ESMO Guidelines Committee, : Early and locally advanced non-small- cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 28 (Suppl 4):iv1–iv21. 2017. View Article : Google Scholar : PubMed/NCBI
36	Howington JA, Blum MG, Chang AC, Balekian AA and Murthy SC: Treatment of stage I and II non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143 (5 Suppl). e278S–e313S. 2013. View Article : Google Scholar
37	Wei Z, Ye X, Yang X, Zheng A, Huang G, Li W, Wang J, Han X, Meng M and Ni Y: Microwave ablation combined with EGFR-TKIs versus only EGFR-TKIs in advanced NSCLC patients with EGFR-sensitive mutations. Oncotarget. 8:56714–56725. 2017. View Article : Google Scholar : PubMed/NCBI
38	Ni Y, Bi J, Ye X, Fan W, Yu G, Yang X, Huang G, Li W, Wang J, Han X, et al: Local microwave ablation with continued EGFR tyrosine kinase inhibitor as a treatment strategy in advanced non-small cell lung cancers that developed extra-central nervous system oligoprogressive disease during EGFR tyrosine kinase inhibitor treatment: A pilot study. Medicine (Baltimore). 95:e39982016. View Article : Google Scholar : PubMed/NCBI