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He JY, Yang L, Wang DD. Efficacy and Safety of thermal ablation for Patients With stage I non-small cell lung cancer. Acad Radiol 2024:S1076-6332(24)00349-0. [PMID: 38942645 DOI: 10.1016/j.acra.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 06/30/2024]
Abstract
RATIONALE AND OBJECTIVES The objective of this study was to measure the safety and efficacy of thermal ablation, including radiofrequency ablation (RFA) and microwave ablation (MWA), for patients with stage I non-small cell lung cancer (NSCLC). MATERIALS AND METHODS The databases PubMed was searched from inception to November 2023 to identify relevant studies. Statistical analyses were performed with R version 3. 6. 3. RESULTS Thirty-three studies involving 1400 patients were finally included. According to our study, the incidence of patients with stage I NSCLC who were older than 60 years old was 98 % (95 % CI [94-100 %]); the lesions were mostly located in RUL (Right Upper Lobe) and LUL (Left Upper Lobe), and the incidence of the two sites was 29 % (95 % CI [23-35 %]) and 27 % (95 % CI [21-33 %]), respectively; the types of lung cancers mainly included adenocarcinoma, squamous carcinoma, and large-cell lung cancer, of which adenocarcinoma accounted for the largest proportion of 63 % (95 % CI [56-70 %]); the causes of death were mainly categorized into cancer-related (57 %, 95 %CI[40-74 %]) and noncancer-related (40 %, 95 %CI [23-58 %]); the common complications in the postoperative period were pneumothorax and pain, with the incidence of 33 % (95 %CI[24-44 %]) and 33 % (95 %CI[19-50 %]), and the rate of the postoperative complications in MWA was slightly higher than those in RFA; the local recurrence rate was 23 % (95 %CI[17-29 %]) and the distant recurrence rate was 18 % (95 %CI[7-32 %]); the pooling result showed the rate of 1-, 2-, 3-, and 5-year survival rate were 96 %, 81 %, 68 %, and 42 %, the Cancer-specific survival (CSS) rates at 1, 2, 3, and 5 years were 98 %, 88 %, 75 %, and 58 %, Disease-free survival (DFS) rates at 1, 2, 3, and 5 years were 87 %, 63 %, 57 %, and 42 %, there were no significant differences existed between the RFA group and MWA group in survival rate, CSS and DFS. CONCLUSION Ablation therapy is safe and effective for stage I NSCLC patient. MWA and RFA have comparable efficacy, safety, and prognosis, which could be recommended for patients with stageⅠNSCLC, especially for patients who cannot tolerate open surgery.
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Affiliation(s)
- Jin-Ying He
- Department of Radiology, Qingdao Municipal Hospital China
| | - Ling Yang
- Department of Interventional Oncology, Qingdao Municipal Hospital China
| | - Dong-Dong Wang
- Department of Interventional Oncology, Qingdao Municipal Hospital China.
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Gits HC, Khosravi Flanigan MA, Kapplinger JD, Reisenauer JS, Eiken PW, Breen WG, Vu LH, Welch BT, Harmsen WS, Day CN, Olivier KR, Park SS, Garces YI, Hallemeier CL, Merrell KW, Ashman JB, Schild SE, Grams MP, Lucido JJ, Shen KR, Cassivi SD, Wigle D, Nichols FC, Blackmon S, Tapias LF, Callstrom MR, Owen D. Sublobar Resection, Stereotactic Body Radiation Therapy, and Percutaneous Ablation Provide Comparable Outcomes for Lung Metastasis-Directed Therapy. Chest 2024; 165:1247-1259. [PMID: 38103730 DOI: 10.1016/j.chest.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Prolonged survival of patients with metastatic disease has furthered interest in metastasis-directed therapy (MDT). RESEARCH QUESTION There is a paucity of data comparing lung MDT modalities. Do outcomes among sublobar resection (SLR), stereotactic body radiation therapy (SBRT), and percutaneous ablation (PA) for lung metastases vary in terms of local control and survival? STUDY DESIGN AND METHODS Medical records of patients undergoing lung MDT at a single cancer center between January 2015 and December 2020 were reviewed. Overall survival, local progression, and toxicity outcomes were collected. Patient and lesion characteristics were used to generate multivariable models with propensity weighted analysis. RESULTS Lung MDT courses (644 total: 243 SLR, 274 SBRT, 127 PA) delivered to 511 patients were included with a median follow-up of 22 months. There were 47 local progression events in 45 patients, and 159 patients died. Two-year overall survival and local progression were 80.3% and 63.3%, 83.8% and 9.6%, and 4.1% and 11.7% for SLR, SBRT, and PA, respectively. Lesion size per 1 cm was associated with worse overall survival (hazard ratio, 1.24; P = .003) and LP (hazard ratio, 1.50; P < .001). There was no difference in overall survival by modality. Relative to SLR, there was no difference in risk of local progression with PA; however, SBRT was associated with a decreased risk (hazard ratio, 0.26; P = .023). Rates of severe toxicity were low (2.1%-2.6%) and not different among groups. INTERPRETATION This study performs a propensity weighted analysis of SLR, SBRT, and PA and shows no impact of lung MDT modality on overall survival. Given excellent local control across MDT options, a multidisciplinary approach is beneficial for patient triage and longitudinal management.
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Affiliation(s)
- Hunter C Gits
- Departments of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - William G Breen
- Departments of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Linh H Vu
- Pulmonary and Critical Care Medicine, and Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - William S Harmsen
- Pulmonary and Critical Care Medicine, and Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Courtney N Day
- Pulmonary and Critical Care Medicine, and Biostatistics and Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Sean S Park
- Departments of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Michael P Grams
- Departments of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - J John Lucido
- Departments of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | | | - Dawn Owen
- Departments of Radiation Oncology, Mayo Clinic, Rochester, MN.
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Bartlett EC, Rahman S, Ridge CA. Percutaneous image-guided thermal ablation of lung cancer: What is the evidence? Lung Cancer 2023; 176:14-23. [PMID: 36571982 DOI: 10.1016/j.lungcan.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Thermal ablation techniques have now been used for more than twenty years in the treatment of primary lung tumours, predominantly non-small cell lung cancer (NSCLC). Although primarily used for the treatment of early-stage disease in non-surgical patients, thermal ablation is now also being used in selected patients with oligometastatic and oligoprogressive disease. This review discusses the techniques available for thermal ablation, the evidence for use of thermal ablation in primary lung tumours in early- and advanced-stage disease and compares thermal ablation to alternative treatment strategies.
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Affiliation(s)
- E C Bartlett
- Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), Department of Radiology, Sydney Street, London SW3 6NP, United Kingdom.
| | - S Rahman
- Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), Department of Radiology, Sydney Street, London SW3 6NP, United Kingdom
| | - C A Ridge
- Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), Department of Radiology, Sydney Street, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College, London SW3 6LY, United Kingdom
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4
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Yang H, Li M, Liu T, Luo L. Clinical efficacy of thermal ablation for the treatment of pulmonary carcinoid tumor: a propensity-matched analysis. Int J Hyperthermia 2023; 40:2225817. [PMID: 37364893 DOI: 10.1080/02656736.2023.2225817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVE To investigate the clinical efficacy of thermal ablation in the treatment of pulmonary carcinoid (PC) tumor. METHODS Data of patients with inoperable PC diagnosed from 2000 to 2019 were obtained from the SEER database and analyzed according to different therapeutic modality: thermal ablation vs non-ablation. Propensity score matching (PSM) was used to reduce intergroup differences. Kaplan-Meier curves and the log-rank test were used to compare intergroup differences of overall survival (OS) and lung cancer-specific survival (LCSS). Cox proportional risk models were used to reveal prognostic factors. RESULTS After PSM, the thermal ablation group had better OS (p < .001) and LCSS (p < .001) than the non-ablation group. Subgroup analysis stratified by age, sex, histologic type and lymph node status subgroups showed similar survival profile. In the subgroup analysis stratified by tumor size, the thermal ablation group showed better OS and LCSS than those of the non-ablation group for tumors ≤3.0 cm, not statistically significant for tumors >3.0 cm. Subgroup analysis by M stage showed that thermal ablation was superior to non-ablation in OS and LCSS for patients with M0 stage, but no significant difference was found in subgroups with distant metastatic disease. Multivariate analysis showed that thermal ablation was an independent prognostic factor for OS (HR: 0.34, 95% CI: 0.25-0.46, p < .001) and LCSS (HR: 0.23, 95%CI: 0.12-0.43, p < .001). CONCLUSION For patients with inoperable PC, thermal ablation might be a potential treatment option, especially in M0-stage with tumor size ≤3 cm.
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Affiliation(s)
- Hao Yang
- Department of Internal Medicine, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Mengqi Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tong Liu
- Chongqing Bishan Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Ling Luo
- Department of Internal Medicine, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
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Chen D, Zhao M, Xiang X, Liang J. Percutaneous local tumor ablation vs. stereotactic body radiotherapy for early-stage non-small cell lung cancer: a systematic review and meta-analysis. Chin Med J (Engl) 2022; 135:00029330-990000000-00031. [PMID: 35830244 PMCID: PMC9532043 DOI: 10.1097/cm9.0000000000002131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Percutaneous local tumor ablation (LTA) and stereotactic body radiotherapy (SBRT) have been regarded as viable treatments for early-stage lung cancer patients. The purpose of this study was to compare the efficacy and safety of LTA with SBRT for early-stage non-small cell lung cancer (NSCLC). METHODS PubMed, Embase, Cochrane library, Ovid, Google scholar, CNKI, and CBMdisc were searched to identify potential eligible studies comparing the efficacy and safety of LTA with SBRT for early-stage NSCLC published between January 1, 1991, and May 31, 2021. Hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were applied to estimate the effect size for overall survival (OS), progression-free survival (PFS), locoregional progression (LP), and adverse events. RESULTS Five studies with 22,231 patients were enrolled, including 1443 patients in the LTA group and 20,788 patients in the SBRT group. The results showed that SBRT was not superior to LTA for OS (HR = 1.03, 95% CI: 0.87-1.22, P = 0.71). Similar results were observed for PFS (HR = 1.09, 95% CI: 0.71-1.67, P = 0.71) and LP (HR = 0.66, 95% CI: 0.25-1.77, P = 0.70). Subgroup analysis showed that the pooled HR for OS favored SBRT in patients with tumors sized >2 cm (HR = 1.32, 95% CI: 1.14-1.53, P = 0.0003), whereas there was no significant difference in patients with tumors sized ≤2 cm (HR = 0.93, 95% CI: 0.64-1.35, P = 0.70). Moreover, no significant differences were observed for the incidence of severe adverse events (≥grade 3) (OR = 1.95, 95% CI: 0.63-6.07, P = 0.25) between the LTA group and SBRT group. CONCLUSIONS Compared with SBRT, LTA appears to have similar OS, PFS, and LP. However, for tumors >2 cm, SBRT is superior to LTA in OS. Prospective randomized controlled trials are required to determine such findings. INPLASY REGISTRATION NUMBER INPLASY202160099.
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Affiliation(s)
- Dongjie Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518172, China
| | - Man Zhao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518172, China
| | - Xiaoyong Xiang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518172, China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518172, China
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Park HS, Detterbeck FC, Madoff DC, Bade BC, Kumbasar U, Mase VJ, Li AX, Blasberg JD, Woodard GA, Brandt WS, Decker RH. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 4: systematic review of evidence involving SBRT and ablation. J Thorac Dis 2022; 14:2412-2436. [PMID: 35813762 PMCID: PMC9264060 DOI: 10.21037/jtd-21-1826] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation], weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods A PubMed systematic review from 2000-2021 of outcomes after SBRT or thermal ablation vs. resection is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results Short-term outcomes are meaningfully better after SBRT than resection. SBRT doesn't affect quality-of-life (QOL), on average pulmonary function is not altered, but a minority of patients may experience gradual late toxicity. Adjusted non-randomized comparisons demonstrate a clinically relevant detriment in long-term outcomes after SBRT vs. surgery. The short-term benefits of SBRT over surgery are accentuated with increasing age and compromised patients, but the long-term detriment remains. Ablation is associated with a higher rate of complications than SBRT, but there is little intermediate-term impact on quality-of-life or pulmonary function tests. Adjusted comparisons show a meaningful detriment in long-term outcomes after ablation vs. surgery; there is less difference between ablation and SBRT. Conclusions A systematic, comprehensive summary of evidence regarding Stereotactic Body Radiotherapy or thermal ablation vs. resection with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making.
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Affiliation(s)
- Henry S. Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - David C. Madoff
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Vincent J. Mase
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew X. Li
- Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Justin D. Blasberg
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Roy H. Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
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7
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Li Y, Yang F, Huang YY, Wang T. Sublobar resection versus ablation for stage I non-small-cell lung cancer: a meta-analysis. J Cardiothorac Surg 2022; 17:17. [PMID: 35148795 PMCID: PMC8832807 DOI: 10.1186/s13019-022-01766-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background Stage I non-small-cell lung cancer (NSCLC) can be treated by both ablation and sublobar resection (SR). This meta-analysis was therefore designed to better compare the relative safety and efficacy of these two approaches to treating stage I NSCLC. Materials and methods Relevant studies published through November 2020 in the Cochrane Library, Embase, and PubMed databases were identified for analyses which were conducted with RevMan v5.3. Results In total, 816 potentially relevant articles were identified, of which 8 were ultimately included in the final meta-analysis. Patients in the SR group exhibited a signficantly lower pooled local recurrence (LR) rate (5.0% vs. 25.4%, P < 0.0001), although pooled distant recurrence (DR) rates were similar in both groups (25.7% vs. 23.1%, P = 0.75). The pooled hazard ratio (HR) for overall survival (OS) (HR: 1.23; 95% CI: 1.13–1.33, P < 0.00001), progression-free survival (PFS) (HR: 1.34; 95% CI: 1.15–1.55, P = 0.0002), and cancer-specific survival (HR: 1.39; 95% CI: 1.15–1.70, P = 0.0009) all indicated better survival outcomes among patients that underwent HR treatment, while pooled complication rates were similar in both groups (27.7% vs. 43.8%, P = 0.27). Patients that underwent ablation exhibited significantly shorter pooled post-operative hospitalization relative to those in the SR group (MD: 5.93; 95% CI: 0.78–11.07, P = 0.02). No evidence of publication bias was detected through funnel plot analyses. Conclusions SR treatment of stage I NSCLC patients was associated with a lower LR rate and longer survival as compared to ablation.
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Affiliation(s)
- Yong Li
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Fang Yang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ya-Yong Huang
- Department of Radiology, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, China.
| | - Tao Wang
- Department of Radiology, Xuzhou Central Hospital, 199 South Jiefang Road, Xuzhou, China
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Current Management of Oligometastatic Lung Cancer and Future Perspectives: Results of Thermal Ablation as a Local Ablative Therapy. Cancers (Basel) 2021; 13:cancers13205202. [PMID: 34680348 PMCID: PMC8534236 DOI: 10.3390/cancers13205202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/25/2022] Open
Abstract
A growing body of evidence shows improved overall survival and progression-free survival after thermal ablation in non-small cell lung carcinoma (NSCLC) patients with a limited number of metastases, combined with chemotherapy or tyrosine kinase inhibitors or after local recurrence. Radiofrequency ablation and microwave ablation are the most evaluated modalities, and target tumor size <3 cm (and preferably <2 cm) is a key factor of technical success and efficacy. Although thermal ablation offers some advantages over surgery and radiotherapy in terms of repeatability, safety, and quality of life, optimal management of these patients requires a multidisciplinary approach, and further randomized controlled trials are required to help refine patient selection criteria. In this article, we present a comprehensive review of available thermal ablation modalities and recent results supporting their use in oligometastatic and oligoprogressive NSCLC disease along with their potential future implications in the emerging field of immunotherapy.
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Yan P, Lyu X, Wang S, Dong S, Zhu Z, Cheng B, Sun Y, Jiang Q, Liu J, Li F. Insufficient ablation promotes the metastasis of residual non-small cell lung cancer (NSCLC) cells via upregulating carboxypeptidase A4. Int J Hyperthermia 2021; 38:1037-1051. [PMID: 34233564 DOI: 10.1080/02656736.2021.1947530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Thermal ablation is a potentially curative therapy for early-stage non-small cell lung cancer (NSCLC). Early recurrence after thermal ablation necessitates our attention. METHODS The invasion and migration abilities of NSCLC after sublethal heat stimulus were observed in vitro and in vivo. Sublethal thermal stimulus molecular changes were identified by RNA sequencing. A xenograft model of NSCLC with insufficient ablation was established to explore the epithelial-to-mesenchymal transition (EMT) and metastasis-related phenotypes alteration of residual tumors. RESULTS In vitro, the invasion and migration abilities of NSCLC cells were enhanced 72 h after 44 °C and 46 °C thermal stimulus. Epithelial-mesenchymal transition (EMT) phenotypes were also upregulated under these conditions. RNA sequencing revealed that the expression of carboxypeptidase A4 (CPA4) was significantly upregulated after thermal stimulus. Significant upregulation of CPA4 and EMT phenotypes was also found in the xenograft model of insufficient NSCLC ablation. The EMT process and invasion and migration abilities can be reversed by silencing CPA4. CONCLUSIONS This study demonstrates that sublethal heat stimulus caused by insufficient ablation can promote EMT and enhance the metastatic capacity of NSCLC. CPA4 plays an important role in these biological processes. Inhibition of CPA4 might be of great significance for improving early-stage NSCLC survival after ablation.
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Affiliation(s)
- Peng Yan
- Department of Oncology, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoli Lyu
- Soochow University Medical College, Suzhou, China.,Radiation and Damage Monitoring Laboratory, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Sinian Wang
- Radiation and Damage Monitoring Laboratory, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Suhe Dong
- Radiation and Damage Monitoring Laboratory, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Zheng Zhu
- Radiation and Damage Monitoring Laboratory, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Bo Cheng
- Department of Pathology, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Yuping Sun
- Proton Center, Shandong Cancer Hospital and Institute, Jinan, China
| | - Qisheng Jiang
- Soochow University Medical College, Suzhou, China.,Radiation and Damage Monitoring Laboratory, PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Jie Liu
- Department of Oncology, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fengsheng Li
- Soochow University Medical College, Suzhou, China.,Radiation and Damage Monitoring Laboratory, PLA Rocket Force Characteristic Medical Center, Beijing, China
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Genshaft SJ, Suh RD, Abtin F, Baerlocher MO, Chang AJ, Dariushnia SR, Devane AM, Faintuch S, Himes EA, Lisberg A, Padia S, Patel S, Tam AL, Yanagawa J. Society of Interventional Radiology Multidisciplinary Position Statement on Percutaneous Ablation of Non-small Cell Lung Cancer and Metastatic Disease to the Lungs: Endorsed by the Canadian Association for Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology. J Vasc Interv Radiol 2021; 32:1241.e1-1241.e12. [PMID: 34332724 DOI: 10.1016/j.jvir.2021.04.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To state the Society of Interventional Radiology's position on the use of image-guided thermal ablation for the treatment of early stage non-small cell lung cancer, recurrent lung cancer, and metastatic disease to the lung. MATERIALS AND METHODS A multidisciplinary writing group, with expertise in treating lung cancer, conducted a comprehensive literature search to identify studies on the topic of interest. Recommendations were drafted and graded according to the updated SIR evidence grading system. A modified Delphi technique was used to achieve consensus agreement on the recommendation statements. RESULTS A total of 63 studies, including existing systematic reviews and meta-analysis, retrospective cohort studies, and single-arm trials were identified. The expert writing group developed and agreed on 7 recommendations on the use of image-guided thermal ablation in the lung. CONCLUSION SIR considers image-guided thermal ablation to be an acceptable treatment option for patients with inoperable Stage I NSCLC, those with recurrent NSCLC, as well as patients with metastatic lung disease.
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Affiliation(s)
- Scott J Genshaft
- Department of Radiologic Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Robert D Suh
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Fereidoun Abtin
- Department of Radiology, Thoracic and Interventional Section, David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | - Albert J Chang
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA
| | - A Michael Devane
- Department of Radiology, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Salomao Faintuch
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Aaron Lisberg
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Siddharth Padia
- Department of Radiology, Section of Interventional Radiology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Sheena Patel
- Society of Interventional Radiology, Fairfax, VA
| | - Alda L Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX
| | - Jane Yanagawa
- Division of Thoracic Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA
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11
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Palussière J, Cazayus M, Cousin S, Cabart M, Chomy F, Catena V, Buy X. Is There a Role for Percutaneous Ablation for Early Stage Lung Cancer? What Is the Evidence? Curr Oncol Rep 2021; 23:81. [PMID: 33948744 DOI: 10.1007/s11912-021-01072-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW For patients with early stage non-small-cell lung cancer (NSCLC), thermal ablation (TA) has become in the least two decades an option of treatment used worldwide for patients with comorbidities who are not surgical candidates. Here, we review data published with different TA techniques: radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation. This paper reviews also the comparison that has been made between TA and stereotactic radiotherapy (SBRT). RECENT FINDINGS A majority of retrospective studies, the absence of comparative studies, and the variety of techniques make difficult to get evident data. Nevertheless, these stand-alone techniques have demonstrated local efficacy for tumors less than 3 cm and good tolerance on fragile patients. Many recent reviews and database analyses show that outcomes after TA (mainly RFA and MWA) are comparable to SBRT in terms of survival rates. For patients who are unfit for surgery, TA has demonstrated interesting results for safety, benefits in overall survival, and acceptable local control.
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Affiliation(s)
- J Palussière
- Imaging Department, Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, France.
| | - M Cazayus
- Imaging Department, Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, France
| | - S Cousin
- Oncology Department, Institut Bergonié, Bordeaux, France
| | - M Cabart
- Oncology Department, Institut Bergonié, Bordeaux, France
| | - F Chomy
- Oncology Department, Institut Bergonié, Bordeaux, France
| | - V Catena
- Imaging Department, Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, France
| | - X Buy
- Imaging Department, Institut Bergonié, 229 cours de l'Argonne, 33076, Bordeaux, France
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Yue TH, Xing W. 125I Seed Brachytherapy Combined with Single-Agent Chemotherapy in the Treatment of Non-Small-Cell Lung Cancer in the Elderly: A Valuable Solution. Onco Targets Ther 2020; 13:10581-10591. [PMID: 33116636 PMCID: PMC7584506 DOI: 10.2147/ott.s272898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of this study was to compare the effectiveness and safety of CT-guided 125I seed brachytherapy combined with single-agent chemotherapy versus combined chemotherapy in the treatment of elderly NSCLC. Materials and Methods We retrospectively analyzed 110 patients (64 men and 46 women; mean age=71.25±7.14 years) who were diagnosed with NSCLC without distant metastases between January 2015 and May 2020. A total of 50 patients received 125I brachytherapy combined with single-agent chemotherapy (group A), whereas 60 patients received combined chemotherapy (group B). The response to therapy and adverse effect were compared between groups. The local response rate was evaluated by CT. Progression-free survival (PFS) and overall survival (OS) data were obtained through clinical follow-up. Results All patients had been treated and were followed-up for 3-60 months. The median OS and PFS were 23.71±1.41 months (95% CI=20.95-26.47) vs 16.12±0.93 months (95% CI=14.31-17.93) (P<0.05) and 15.08±0.85 months (95% CI=13.42-16.74) vs 10.03±0.53 months (95% CI=9.01-11.06) (P<0.05) in group A and group B, respectively. The local response rate and clinical symptoms of patients in group A were significantly relieved when compared with group B. Severe complications were not observed in either group. Conclusion CT-guided 125I seed brachytherapy combined with single-agent chemotherapy is an effective and safe therapy and shows promising results compared to combined chemotherapy alone for NSCLC in the elderly. A randomized study will be needed to assess the superiority of this combined modality treatment.
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Affiliation(s)
- Tian-Hua Yue
- Medical Imaging Department, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213000, People's Republic of China.,Department of Interventional Radiology, The Affiliated Jianhu Hospital of Nantong University, Jiangsu, Jianhu 224700, People's Republic of China
| | - Wei Xing
- Medical Imaging Department, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213000, People's Republic of China
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Dong B, Zhu X, Jin J, Chen Y, Ying H, Chen Y, Lu F, Shen W, Wang J, Chen M. Comparison of the outcomes of sublobar resection and stereotactic body radiotherapy for stage T1-2N0M0 non-small cell lung cancer with tumor size ≤ 5 cm: a propensity score matching analysis. J Thorac Dis 2020; 12:5934-5954. [PMID: 33209426 PMCID: PMC7656409 DOI: 10.21037/jtd-20-2367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Surgery and stereotactic body radiotherapy (SBRT) are both suitable treatment options for early stage Non-small cell lung cancer (NSCLC), which accounts for the majority of lung cancer. This study compared the outcomes of sublobar resection (SLR) and SBRT in patients with stage T1-2N0M0 NSCLC with tumor size ≤5 cm. Methods Patients with T1-2N0M0 lung cancer who underwent SLR or SBRT between January, 2012 and December, 2016 were included in this retrospective study. The survival outcomes and toxicity of the SLR and SBRT cohorts were compared using Kaplan-Meier survival plots. In a second exploratory analysis, propensity score matching (PSM) was applied to reduce selection bias between the two groups of patients. Results A total of 121 SLR and 109 SBRT cases were included. The average follow-up was 49.4 months. Prior to PSM, the 5-year overall survival (OS) and cancer-specific survival (CSS) rates in the SLR group (82.8% and 89.0%, respectively) were superior to those in the SBRT group (67.0% and 75.3%; P=0.001 and P=0.013, respectively). There were no statistically significant differences in the five-year locoregional control and disease-free survival (DFS) rates between the groups. PSM identified 40 patients from each treatment group who shared similar characteristics. At 5 years, the OS rates in the SLR and SBRT groups were comparable (79.9% vs. 66.5%, respectively; P=0.154). After PSM, the rates of CSS, locoregional control, and DFS were also similar between the groups (P=0.458, 0.369, and 0.698, respectively). In the SBRT group, one patient developed grade 3 radioactive pneumonitis. No grade >3 toxicities or treatment-related deaths occurred in either group. Conclusions SBRT may be an alternative option to SLR for patients who cannot tolerate lobectomy because of medical comorbidities and has a similar level of effectiveness.
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Affiliation(s)
- Baiqiang Dong
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiation Oncology, Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xuan Zhu
- Department of Radiation Oncology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jianan Jin
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiation Oncology, Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yuanyuan Chen
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiation Oncology, Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Hangjie Ying
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiation Oncology, Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yamei Chen
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiation Oncology, Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Fangxiao Lu
- Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences; Department of X-ray, Cancer Hospital of the University of Chinese Academy of Sciences; Department of X-ray, Zhejiang Cancer Hospital, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, China
| | - Wei Shen
- Hangzhou YITU Healthcare Technology Co., Ltd., Hangzhou, China
| | - Jin Wang
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiation Oncology, Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Ming Chen
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China.,Department of Radiation Oncology, Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
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