Outcomes after Image-guided Radiofrequency Ablation for Treatment of Stage I NSCLC in High-risk Patients by a Thoracic Surgical Service in More than 100 patients: Analysis of Prognostic Variables

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Abstract Submission 

Arjun Pennathur (1), Ian Christie (2), James Luketich (2), Matthew Schuchert (2), William Gooding (3), Omar Awais (2), Ryan Levy (2), Inderpal Sarkaria (2), Neil Christie (2), Arjun Pennathur (1)

(1) University Of Pittsburgh Medical Center, Pittsburgh, PA, (2) University of Pittsburgh Medical Center, Pittsburgh, PA, (3) UPMC Hillman Cancer Center, Pittsburgh, PA

*Arjun Pennathur    -  Contact Me
University Of Pittsburgh Medical Center

Ian Christie    -  Contact Me
University of Pittsburgh Medical Center

*James Luketich    -  Contact Me
University of Pittsburgh Medical Center

*Matthew Schuchert    -  Contact Me
University of Pittsburgh Medical Center

William Gooding    -  Contact Me
UPMC Hillman Cancer Center

Omar Awais    -  Contact Me
University of Pittsburgh Medical Center

♦Ryan Levy    -  Contact Me
University of Pittsburgh Medical Center

*Inderpal Sarkaria    -  Contact Me
University of Pittsburgh Medical Center

Neil Christie    -  Contact Me
University of Pittsburgh Medical Center

*Arjun Pennathur    -  Contact Me
University Of Pittsburgh Medical Center

Ian Christie    -  Contact Me
University of Pittsburgh Medical Center

Objective: Surgical resection is the standard treatment for stage 1 NSCLC, however some patients have comorbidities precluding surgery. The AATS recently published an Expert Consensus Document on the risk assessment and treatment for high-risk patients with Stage I NSCLC, including image-guided-computed-tomography (CT)-guided radiofrequency ablation (RFA) as a treatment option in these patients. The long term oncologic results and the prognostic factors associated with survival after CT-RFA have not been fully evaluated. Our objectives were to evaluate the outcomes of CT-guided RFA for high-risk stage I NSCLC patients, and factors associated with survival.
Methods: We reviewed outcomes of CT-guided RFA in biopsy proven stage I NSCLC in high-risk patients. All procedures were performed by thoracic surgeons under image (CT) guidance. The primary endpoint studied was overall survival (OS). Kaplan-Meier plots were constructed using Greenwood confidence limits. Analysis of individual covariates associated with OS was performed with univariate proportional hazards regression and log rank test.
Results: A total of 111 patients (49 men; 62 women; median age 74 years, range 51-95), underwent CT-guided RFA for NSCLC (stage 1A n=91; stage 1B n=20; median size 2 cm). At a median follow-up of 40 months, the estimated 2-year overall-survival was 69% (CI = 60% - 78%), and 3-year OS was 58% (49% – 69%), with a median survival of 3.5 years (CI = 2.9 – 4.7 years). The survival of Stage 1A was significantly better than stage IB (p = .011). For patients with tumor size less than 2 cm, the 2-year overall-survival was 86% (CI 75% -97%), and 5-year overall-survival was 51% (CI 36% -72%), with an increased median survival of 8.11 years (CI 3.5 – not reached) compared to larger tumors (p = .001;Figure). Covariates that were associated with overall-survival included stage (p = .011), size (p=0.001), histology (squamous vs. adeno; p = .0052), and age (p = .0546).
Conclusions: While surgical resection remains the standard, image-guided RFA provides an alternate treatment option for high-risk patients with Stage 1 NSCLC who are not surgical candidates. Analysis of covariates associated with survival showed that size of the lesion was an important prognostic factor. Further, stage, histology, and age were all associated with survival after RFA. Additional prospective studies with RFA are required to further define patient selection in this high-risk group of patients.

Lung Cancer