SIR 2024
Interventional Oncology
Erica S. Alexander, MD (she/her/hers)
Assistant Attending
Memorial Sloan Kettering Cancer Center
Financial relationships: Full list of relationships is listed on the CME information page.
Nadia N. Petre, MD
Senior Research Scientist
Memorial Sloan Kettering Cancer Center
Disclosure information not submitted.
Ken Zhao, MD
Assistant Attending
Memorial Sloan Kettering Cancer Center
Disclosure information not submitted.
Vlasios S. Sotirchos, MD
Assistant Attending
Memorial Sloan Kettering Cancer Center
Financial relationships: Full list of relationships is listed on the CME information page.
Constantinos T. Sofocleous, MD PhD
Professor IR
Weill Cornell Medical College Memorial Sloan-Kettering Cancer Center
Financial relationships: Full list of relationships is listed on the CME information page.
Samagra Jain, B. S. Chemical Engineering
Medical Student
Baylor College of Medicine
Disclosure information not submitted.
Stephen B. Solomon, MD
Section Chief
Memorial Sloan Kettering Cancer Center
Disclosure information not submitted.
Etay Ziv, MD PhD
Associate Attending
Memorial Sloan Kettering Cancer Center
Disclosure information not submitted.
To evaluate the safety and efficacy of microwave ablation (MWA) in the treatment of liver metastases (LM) secondary to non-small cell lung cancer (NSCLC).
Materials and Methods:
Retrospective study of all patients with NSCLC who underwent MWA of LM with intent for liver disease control from 3/2015 to 7/2022. Twenty-three patients (13 women; mean age at first ablation 66.6 years ± 7.6), with 32 LM, treated in 27 MWA sessions. Patients were treated with Neuwave MWA (Ethicon, Raritan, NJ) and/or Emprint MWA (Medtronic, Minneapolis, MN) systems.
Local tumor progression-free survival (LTPFS) and overall survival (OS) were estimated using Kaplan–Meier method. Post-operative complications were recorded and graded according to Common Terminology Criteria for Adverse Events (CTCAE) v5.0.
Results:
All patients had biopsy-proven adenocarcinoma (actionable mutations included: EGFR [7 patients] ALK [4]; BRAF [3]; KRAS [3]; RET [2]; MET [1]; NOS [3]). The median number of tumors treated in a single session was 1 (range 1-2). The largest dimension of the index tumor was 1.96± 0.75 cm (mean ± SD) (range, 1-4). The median number of ablation probes used were 1 (range, 1-3), with a median of 2 activations (range, 1-5), and with average ablation time of 11.98 (range, 2-38) minutes. All 30 sessions were technically successful.
Complete ablation was achieved in 14/32 tumors (44%); median length of follow-up was 37.67 (IQR:20.5-54.49) months. Median LTPFS was 16.33 (95%CI: 7.87-44.1) months. Median OS was 31.7 (95%CI: 11.13-65.83) months. Age (HR:1.18, 95%CI:1.09-1.28, p< 0.001), gender (female vs male, HR:0.33 0.11-1, p=0.05) and synchronous presence of untreated lung metastases (HR:12.75, 95%CI: 1.59-101.933, p=0.016) were significant predictors of OS. There was a trend of decreased OS in patients exhibiting EGFR mutations (median OS: 15 [95%CI: 3-43.2] months) compared to EGFR-negative patients (median OS: 31.7 [95%CI: 11.13-NR] months), p=0.09.
Complications within 30 days of treatment occurred in 12/27 sessions (44.4%). Most (10/27; 37.0%) were CTCAE grade 1-2 complications, including fatigue, transient shortness of breath, mild pain, or fever which was self-limited. Severe complications (CTCAE grade ³3) occurred in 2/27 sessions (7.4%) and included pulmonary embolus and severe abdominal pain limiting ADLs and mobility.
Conclusion:
Percutaneous MWA is a safe and effective treatment for LM secondary to NSCLC, with best survival benefits seen in younger patients, female patients, and those without synchronous untreated lung tumors.