Radiofrequency Ablation Effective for Local Control of Lung Cancer
Peggy Peck
Dec. 2, 2004 (Chicago) — Ablation techniques including radiofrequency, microwave, and cryotherapy have been used for several years in liver cancer and more recently in renal carcinoma. Now research from Brown University suggests that conputed tomography–guided radiofrequency ablation (RFA) is a safe and viable option for treating lung cancer.
Damian Dupuy, MD, a professor of diagnostic imaging at Brown Medical School in Providence, Rhode Island, told Medscape that RFA has several advantages over traditional cancer treatments. "Unlike radiation, there is no maximum dose of RFA, so the procedure can be repeated a number of times," he said. "And a treatment costs about the same as a single cycle of chemotherapy."
In the study, which was reported here at the Radiological Society of North America 90th scientific assembly and annual meeting, Dr. Dupuy and colleagues treated 126 lung cancer patients, who had a total of 163 lesions. Sixty-nine of the patients were men and the average age of patients was 68 years. "On average, the tumors were 3.3 cm, but we treated tumors up to 19 cm in diameter," Dr. Dupuy said.
Another advantage of RFA is that it can be used along with more traditional treatments, Dr. Dupuy said. For example, in this study 37 patients also had conventional radiation therapy and 14 had brachytherapy.
In addition to using RFA for local control, it can also be used for palliation, Dr. Dupuy said. In the study, 20 patients received RFA as palliative treatment, and 106 underwent RFA for local control. Most of the 106 local-control patients had successful ablation with a single treatment, but 21 patients needed two treatments, one patient required three treatments, and two patients needed four treatments.
Only patients who were not good candidates for surgery were treated, and Dr. Dupuy said that criterion covers a majority of lung cancer patients because generally lung cancer patients are often too old or who have other smoking-related conditions such as heart disease or chronic obstructive pulmonary disease that make them unlikely to survive surgery. "But RFA can even be done in very old patients," he said. One of the patients was 92 years old when he underwent RFA for a lung tumor. "We had to repeat the procedure a year later — when the patient was 93 — and now he is 95 and still leading a very active life," Dr. Dupuy said.
Of the local control patients, 62% were still alive at 21 months after surgery, and "at five years, more than half of the patients are still alive."
Bradford J. Wood, MD, a senior clinical investigator at the National Institutes of Health clinical center in Bethesda, Maryland, told Medscape that "we are on the edge of an explosion of image-guided noninvasive treatments and Dupuy's study is an exciting example of one of these treatments."
Dr. Wood, who was not involved in the study, said that RFA has already demonstrated impressive results for treatment of liver cancer and kidney cancers, but lung cancer is a new area for this technology. He noted that because lung cancer accounts for 56% of all cancer deaths, any new treatment has the potential for a huge public health impact. "It is really nice to have another treatment option since so many patients are not good candidates for surgery," he said.
RFA may be most useful in lung cancer when used as adjuvant therapy with chemotherapy or standard radiation therapy, Dr. Wood said. Dr. Dupuy echoed this observation, noting that RFA is effective for debulking large tumors that can then be treated with chemotherapy or radiation therapy.
Dr. Dupuy received grant support from Valley Lab, Vivant Medical, and Boston Scientific.
RSNA 90th Scientific Assembly and Annual Meeting: Abstract SSKO5-07. Presented Dec. 1, 2004.
medscape.com |
