277. 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

Hiran Fernando Invited Discussant
Allegheny General Hospital
Oakmont, PA 
United States
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Hiran C Fernand


Dr Hiran Fernando is currently the Director of Thoracic Surgery at Allegheny General Hospital, Pittsburgh and a Professor of Surgery at Drexel University. After obtaining fellowships from the Royal College of Surgeons of England and Edinburgh, he undertook additional training in the United States. He previously held faculty appointments at the University of Pittsburgh, Boston University, Virginia Commonwealth University (at the Inova Fairfax medical Campus) before joining the faculty at Allegheny General Hospital.  His clinical interests include lung cancer, esophageal cancer and benign esophageal diseases with a focus on minimally invasive approaches for these diseases. He has published extensively in these areas serving as the principal or co-principal investigator for several multi-center clinical trials.  He is a member of several societies including the AATS, STS, American Surgical Association, ISMICS, ESTS, and the General Thoracic Surgery Club.  He is an Associate Editor for Diseases of the Esophagus and has served on the Editorial Board of the Annals of Thoracic Surgery. He has been a co-author for several guidelines sponsored by the STS and ISMICS.

Ian Christie Abstract Presenter
University of Pittsburgh Medical Center
Pittsburgh, PA 
United States
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Ian Christie is currently a resident at UPMC Medical Education in their integrated cardiothoracic residency in the thoracic surgery tract.  Ian attended medical school at the University of Pittsburgh.  Ian is interested in thoracic oncology, benign foregut, and lung failure and transplantation.

Monday, May 8, 2023: 5:00 PM - 5:15 PM
120 Minutes 
Los Angeles Convention Center 
Room: 408B 


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.

Presentation Duration

7 minute presentation; 7 minute discussion 

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