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Radiofrequency Ablation of Stage 1A NSCLC in Medically Inoperable Patients: Results from ACOSOG Z4033 (Alliance), an NCI Funded Multicenter Trial FREE TO VIEW

Damian Dupuy, MD; Hiran Fernando, MD; Shauna Hillman, MS; Thomas Ng, MD; Angela Tan, BS; Jo-Anne Shepard, MD; William Rilling, MD; Kelvin Hong, MD; Joe Putnam, MD
Author and Funding Information

Rhode Island Hospital/Brown University, Providence, RI

Chest. 2013;144(4_MeetingAbstracts):86A. doi:10.1378/chest.1662862
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SESSION TITLE: Novel Bronchoscopic Treatments

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 29, 2013 at 04:30 PM - 05:30 PM

PURPOSE: Optimal therapy for medically inoperable patients with non-small cell lung cancer (NSCLC) is controversial. A multicenter study (RTOG 0236) for stereotactic body radiation therapy (SBRT) reported 3-yr survivals of 55%. This prospective multicenter study evaluates 2-yr overall survival (OS), adverse event (AE) rate, local control and pulmonary function (PFT) in medically inoperable stage 1A NSCLC patients undergoing CT-guided RFA

METHODS: 54 pts M:F=25:29, mean age/range= 76/60-89 were enrolled from 16 centers . 52 pts were eligible (biopsy proven stage 1A NSCLC, deemed medically inoperable by board certified thoracic surgeon) and 51 pts underwent RFA technique per protocol. PFTs were obtained at baseline, 3 and 24 months after RFA. AEs were categorized according to the Common Terminology Criteria. Follow-up evaluation included contrast CT densitometry and FDG PET. Local control rate and recurrence patterns were analyzed.

RESULTS: OS was 87% at 1-yr and 70% at 2-yr. Local-recurrence free rate was 70% at 1yr and 61% at 2yrs. In 19 patients with local recurrence 11 had repeat RFA, 9 had radiation and 3 chemotherapy. At 30 days there were 6 grade 3 AEs (12%) and no grade 4 or 5 AEs. There was no clinically significant change in the FEV1 or DLCO at 24 months. Tumor size less than 2.0cm (p=0.049) as well as performance status of 0-1 (p=0.041) were associated with statistically significant improved 2-yr survival of 84% and 78%, respectively.

CONCLUSIONS: RFA is well tolerated, with minimal impact on PFT in medically inoperable patients with impaired lung function. Although local recurrence was high, 2-year survival was excellent comparing favorably to other therapies such as SBRT. RFA should continue to play an important role in the treatment of NSCLC

CLINICAL IMPLICATIONS: In patients who are at high risk for surgery due to their medical comorbidities RFA offers a minimally invasive single session outpatient alternative to treating stage IA NSCLC.

DISCLOSURE: Hiran Fernando: Consultant fee, speaker bureau, advisory committee, etc.: CSA medical, Consultant fee, speaker bureau, advisory committee, etc.: Galil Medical, Grant monies (from industry related sources): Deepbreeze Inc The following authors have nothing to disclose: Damian Dupuy, Shauna Hillman, Thomas Ng, Angela Tan, Jo-Anne Shepard, William Rilling, Kelvin Hong, Joe Putnam

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