Video-assisted radiofrequency ablation for pleural disseminated non-small cell lung cancer

BMC Surgery

Qun Wang²  Hao Wang²  Hong Fan²  Wei Jiang²  Ming Zhong¹  Yaxing Shen² 

[1] Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China;Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

关键词: Thoracoscopy/VATS;    Lung cancer surgery;    Ablative therapy;   

Others  :  866922
DOI  :  10.1186/1471-2482-13-19

 received in 2012-07-28, accepted in 2013-06-10,  发布年份 2013

【 摘 要 】

Background

Clinically, some patients would have false-negative results in the diagnosis of non-small cell lung cancer (NSCLC) with pleural dissemination, losing their chances of prolonged survival from surgery. Hence, this study aimed to clarify the benefit of radiofrequency ablation (RFA) for NSCLC with malignant pleural dissemination that is detected during thoracoscopic lobectomy.

Methods

From July 2006, we started the application of RFA in combination with talc pleurodesis (R-TP) for pleural disseminated NSCLCs diagnosed by thoracoscopy. Patients who underwent TP alone (from December 30, 2005 to June 30, 2006) were retrospectively evaluated in compared with R-TP (from July 1, 2006 to June 30, 2008). Clinical features were collected and compared to identify the difference in clinical outcomes between R-TP and TP alone. After discharge (three months after surgery), tumor response to treatment was assessed, and follow-up results were recorded to determine the perioperative and mid-time survival difference between the two groups.

Results

In our study, the two groups were comparable in age, sex, performance status (PS) score, tumor location, and histological diagnosis. The incidence rate of intraoperative pleural dissemination was 5.98%, as diagnosed by video-assisted thoracoscopy. All the surgeries were completed without conversion to open thoracotomy. Except for the longer operation duration in the R-TP group (p < 0.001), there was no significant difference between the two groups in terms of surgical features. Postoperatively, no mortality occurred in either group during hospital stay; however, two patients from the R-TP group developed complications (9.52%). The complete and partial remission rates in the R-TP group were 80% and 10%, respectively, and the stabilization rate was 10%. After the three-year follow-up, the overall survival (OS) rates of the R-TP and TP groups were 14.29% and 0%, respectively. The median survival and median tumor progression-free survival (PFS) periods were longer in the R-TP group than in the TP group (OS: 19 months versus 12.5 months, p = 0.045; PFS: 9.5 months versus 5.5 months, p = 0.028).

Conclusions

The introduction of RFA to TP offered survival benefits to pleural disseminated NSCLC patients, making it a potential alternative palliative treatment for local tumor. However, multicenter randomized controlled trials are required to confirm these findings.

【 授权许可】

   
2013 Shen et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Yamamoto K, Ohsumi A, Kojima F, Imanishi N, Matsuoka K, Ueda M, Miyamoto Y: Long-term survival after video-assisted thoracic surgery lobectomy for primary lung cancer. Ann Thorac Surg 2010, 89:353-359.
• [2]Morgensztern D, Waqar S, Subramanian J, Trinkaus K, Govindan R: Prognostic impact of malignant pleural effusion at presentation in patients with metastatic non-small-cell lung cancer. J Thorac Oncol 2012, 7:1485-1489.
• [3]Sawabata N, Matsumura A, Motohiro A, Osaka Y, Gennga K, Fukai S, Mori T: Malignant minor pleural effusion detected on thoracotomy for patients with non-small cell lung cancer: is tumor resection beneficial for prognosis? Ann Thorac Surg 2002, 73:412-415.
• [4]Basso SM, Mazza F, Marzano B, Santeufemia DA, Chiara GB, Lumachi F: Improved quality of life in patients with malignant pleural effusion following video assisted thoracoscopic talc pleurodesis. Preliminary results. Anticancer Res 2012, 32:5131-5134.
• [5]Dupuy DE, Zagoria RJ, Akerley W, Mayo-Smith WW, Kavanagh PV, Safran H: Percutaneous radiofrequency ablation of malignancies in the lung. Am J Roentgenol 2000, 174:57-59.
• [6]Crabtree T, Puri V, Timmerman R, Fernando H, Bradley J, Decker PA, Paulus R, Putnum JB Jr, Dupuy DE, Meyers B: Treatment of stage I lung cancer in high-risk and inoperable patients: comparison of prospective clinical trials using stereotactic body radiotherapy (RTOG 0236), sublobar resection (ACOSOG Z4032), and radiofrequency ablation (ACOSOG Z4033). J Thorac Cardiovasc Surg 2013, 145:692-699.
• [7]Lanuti M, Sharma A, Willers H, Digumarthy SR, Mathisen DJ, Shepard JA: Radiofrequency ablation for stage I non-small cell lung cancer: management of locoregional recurrence. Ann Thorac Surg 2012, 93:921-927.
• [8]Zemlyak A, Moore WH, Bilfinger TV: Comparison of survival after sublobar resections and ablative therapies for stage I non-small cell lung cancer. J Am Coll Surg 2010, 211:68-72.
• [9]Ambrogi MC, Fanucchi O, Cioni R, Dini P, De Liperi A, Cappelli C, Davini F, Bartolozzi C, Mussi A: Long-term results of radiofrequency ablation treatment of stage I non-small cell lung cancer: a prospective intention-to-treat study. J Thorac Oncol 2011, 6:2044-2051.
• [10]Paul S, Altorki NK, Sheng S, Lee PC, Harpole DH, Onaitis MW, Stiles BM, Port JL, D’Amico TA: Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg 2010, 139:366-378.
• [11]Chansky K, Sculier JP, Crowley JJ, Giroux D, Van Meerbeeck J, Goldstraw P: The International Association for the Study of Lung Cancer Staging Project: prognostic factors and pathologic TNM stage in surgically managed non-small cell lung cancer. J Thorac Oncol 2009, 4:792-801.
• [12]Watanabe S, Asamura H, Suzuki K, Tsuchiya R: Problems in diagnosis and surgical management of clinical N1 non-small cell lung cancer. Ann Thorac Surg 2005, 79:1682-1685.
• [13]Simon CJ, Dupuy DE, DiPetrillo TA, Safran HP, Grieco CA, Ng T, Mayo-Smith WW: Pulmonary radiofrequency ablation: long-term safety and efficacy in 153 patients. Radiology 2007, 243:268-275.
• [14]Lencioni R, Crocetti L, Cioni R, Suh R, Glenn D, Regge D, Helmberger T, Gillams AR, Frilling A, Ambrogi M, Bartolozzi C, Mussi A: Response to radiofrequency ablation of pulmonary tumours: a prospective, intention-to-treat, multicentre clinical trial (the RAPTURE study). Lancet Oncol 2008, 9:621-628.
• [15]Zhu JC, Yan TD, Morris DL: A systematic review of radiofrequency ablation for lung tumors. Ann Surg Oncol 2008, 15:1765-74.
• [16]Kim SR, Han HJ, Park SJ, Min KH, Lee MH, Chung CR, Kim MH, Jin GY, Lee YC: Comparison between surgery and radiofrequency ablation for stage I non-small cell lung cancer. Eur J Radiol 2012, 81:395-399.
• [17]Schneider T, Reuss D, Warth A, Schnabel PA, von Deimling A, Herth FJ, Dienemann H, Hoffmann H: The efficacy of bipolar and multipolar radiofrequency ablation of lung neoplasms-results of an ablate and resect study. Eur J Cardiothorac Surg 2011, 39:968-973.
• [18]Huang L, Han Y, Zhao J, Wang X, Cheng Q, Li X, Xu H, Gao K: Is radiofrequency thermal ablation a safe and effective procedure in the treatment of pulmonary malignancies? Eur J Cardiothorac Surg 2011, 39:348-351.
• [19]Donington J, Ferguson M, Mazzone P, Handy J Jr, Schuchert M, Fernando H, Loo B Jr, Lanuti M, de Hoyos A, Detterbeck F, Pennathur A, Howington J, Landreneau R, Silvestri G: American College of Chest Physicians and Society of Thoracic Surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer. Chest 2012, 142:1620-1635.
• [20]Goldberg SN, Gazelle GS, Compton CC, Mueller PR, McLoud TC: Radio-frequency tissue ablation of VX2 tumor nodules in the rabbit lung. Acad Radiol 1996, 3:929-935.
• [21]Haasbeek CJ, Senan S, Smit EF, Paul MA, Slotman BJ, Lagerwaard FJ: Critical review of nonsurgical treatment options for stage I non-small cell lung cancer. Oncologist 2008, 13:309-319.