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. 2019 Jul;18(1):659-666.
doi: 10.3892/ol.2019.10375. Epub 2019 May 20.

Usefulness of percutaneous microwave ablation for large non-small cell lung cancer: A preliminary report

Claudio Pusceddu  1 , Luca Melis  1 , Barbara Sotgia  1 , Daniela Guerzoni  2 , Alberto Porcu  3 , Alessandro Fancellu  3
Affiliations

Usefulness of percutaneous microwave ablation for large non-small cell lung cancer: A preliminary report

Claudio Pusceddu et al. Oncol Lett. 2019 Jul.

Abstract

The role of microwave ablation (MWA) in patients with non-small cell lung cancer (NSCLC) remains ill-defined. This retrospective study evaluated the oncological outcomes of CT-guided MWA in patients with large NSCLC. Kaplan-Meier analysis was used to evaluate overall survival (OS) and cancer-specific survival (CSS). The log-rank test was used to compare survival between patients with an NSCLC size greater or smaller than 4 cm. The likelihood of local tumor progression (LTP) was analyzed using a multivariable regression model. A total of 53 patients with 65 tumors were analyzed. The mean tumor size was 5.0±1.8 cm. At the 1-month CT scan, complete tumor ablation was observed in 44.6% of cases. In 18.5% of cases a redo-MWA session was carried out, while in 4.6%, a third MWA was necessary to obtain complete tumor necrosis. The mean follow-up was 28.1±20.6 months with a median duration of 21.5 months. The 1-year, 2-year, 3-year and 5-year OS rates were 78.2, 48.3, 34.8 and 18.3%, respectively. The median CSS was 25 months (95% CI 15.5-34.5). The 1-year, 2-year, 3-year and 5-year CSS rates were 84.3, 53.7, 42.1 and 30.0%, respectively. OS in patients with tumor size ≥4 cm was significantly lower when compared with those having smaller tumors (P=0.03). LTP was observed in 19 patients (35.8%). Incomplete tumor ablation [odds ratio (OR) 6.57; P<0.05] and tumor size ≥4 cm (OR 0.18; P<0.05) were significant independent predictors of LTP. In conclusion, CT-guided MWA may represent a useful tool in the multimodality treatment of patients with large advanced NSCLC.

Keywords: CT-guided ablation; microwave ablation; multimodality cancer treatment; non-small cell lung cancer; non-surgical treatment; percutaneous treatment.

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Figures

Figure 1.
Figure 1.
Complete MWA of adenocarcinoma measuring 3.7 cm in major diameter of the left lung in a 71-year-old woman. (A) Basal contrast-enhanced CT scan. (B) MWA by insertion of one antenna with an output power of 60 W for 10 min. (C) CT control 24 h after the procedure. (D) Follow-up CT scan at 1 month, showing a tumor size reduction without any evidence of enhancement. MWA, microwave ablation.
Figure 2.
Figure 2.
MWA of a large adenocarcinoma of the left lung in a 78-year old woman. (A) Chest x-ray demonstrating a 14×10 cm mass in the upper lobe of the left lung. (B) CT-guided MWA using two antennae with multiple insertions. (C) CT scan after MWA treatment showing a large area of cavitation, suggestive of tumor necrosis. (D) Pre-treatment transversal and coronal (E) CT scan showing a large mass in the upper left lobe, in close proximity to large mediastinal vessels and parietal pleura. (F) Transversal and coronal (G) CT scan after 1 month showing extensive necrosis with residual contrast-enhancement. The patient succumbed 7 months after the treatment. MWA, microwave ablation.
Figure 3.
Figure 3.
MWA of squamous cell carcinoma (4×5 cm) of the left lung located in close proximity to the descending aorta in a 67-year-old man. (A) Basal unenhanced CT scan and (B) contrast-enhanced CT scan. (C) MWA by insertion of an antenna with output power of 70 W for 10 min with patient in prone position. (D) MWA by insertion of a second antennae with an output power of 70 W for 10 min with the patient in a prone position. (E) Follow-up CT scan at 10 months showing a tumor size reduction (1.8 cm) with subtle enhancement. MWA, microwave ablation.
Figure 4.
Figure 4.
Overall survival after MWA for non-small-cell lung cancer. MWA, microwave ablation.
Figure 5.
Figure 5.
CSS after MWA for non-small-cell lung cancer. MWA, microwave ablation. CSS, cancer-specific survival.
Figure 6.
Figure 6.
Overall survival after MWA for non-small-cell lung cancer in relation to tumor size. P=0.03 (log rank test). MWA, microwave ablation.
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