SIR 2024
Interventional Oncology
Ericson John V. Torralba, BSc
Medical Student
Wright State University Boonshoft School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Garrett Fisher, BS (he/him/his)
Medical Student
Wright State University BSOM
Financial relationships: Full list of relationships is listed on the CME information page.
Reid M. Fursmidt, MSc (he/him/his)
Medical Student
Wright State University Boonshoft School of Medicine
Disclosure information not submitted.
Michael Gilbert, BS
Medical Student
Wright State University BSOM
Disclosure information not submitted.
Emily Boldman, PA
Interventional Radiology Physician Assistant
Dayton VA Medical Center
Disclosure information not submitted.
Brendan Boyer, PA
Interventional Radiology Physician Assistant
Dayton VA Medical Center
Disclosure information not submitted.
Perry Nystrom, MD
Associate Professor, Internal Medicine/Critical Care & Pulmonology
Dayton VA Medical Center
Disclosure information not submitted.
Albert Malcom, MD
Assistant Professor, Internal Medicine/Hematology & Oncology
Dayton VA Medical Center
Disclosure information not submitted.
John Mathis, MD, MSc
Chief of Radiology, Veteran Service Representative
Dayton VA Medical Center
Disclosure information not submitted.
Robert Short, MD, PhD
Section Chief, Interventional Radiology, Associate Professor, Surgery and Biomedical Engineering
Dayton VA Medical Center, Wright State University
Financial relationships: Full list of relationships is listed on the CME information page.
We describe a midterm comparison of microwave ablation (MWA), stereotactic body radiation therapy (SBRT), and surgical resection as primary therapy for early-stage non-small cell lung cancer (NSCLC) in a US veteran population.
Materials and Methods:
Retrospective, single-institution, review of pulmonary nodules from 6/2016 to 9/2023 was conducted, identifying 490 patients. Only patients undergoing MWA, SBRT, or resection of Stage IA NSCLC were included in the study. MWA was performed by a single operator using 2.45 GHz, gas-cooled system (NeuWave/Ethicon, Madison, WI). Resection composed of either lobectomy, sublobar/wedge resection, or pneumonectomy. Lesion characteristics, patient demographics, and adverse events were examined. Local tumor progression free survival (LT-PFS) (progression within treatment zone), NSCLC progression free survival (PFS) and overall survival (OS) by were analyzed with Kaplan-Meier, Cox regression and log rank test (SAS, Cary, NC).
Results:
Treatment of stage IA NSCLC occurred in 178 patients (MWA n=60, SBRT n=30, Resection n=88) with a mean tumor size of 18 mm + 0.9 mmm; 100 adeno, 69 squamous cell, and 9 unspecified carcinomas. For the MWA group, technical success was 100% with one prolonged air-leak that resolved at 20 days. All cause 90-day mortality for the MWA group was 1.6% n=1. Patients in the resection group underwent lobectomy n=50, segmentectomy n=37, or pneumonectomy n=1. All cause 90-day mortality for the resection group was 6.81%, n=6. Chest tube placement accompanied MWA n=22 (36.6%) and resection n=88 (100%). If admitted, the average total length of ICU stay was longer for the resection group compared to the MWA group (4.1 vs 1.0 days, p<0.001) All cause 90-day mortality for the SBRT group was 3.33% n=1. Median length of follow-up was 46.4, 39.9, and 43.5 months for MWA, resection and SBRT, respectively. Estimated LT-PFS median survival time was >62.1, >78.9, and >89.8 months for MWA, resection, and SBRT, respectively. Median PFS was estimated at 45.9, 45.8, and 36.2 months while Median OS was estimated at 54.2, >73.8, and 46.7 months for MWA, resection and SBRT respectively. For LT-PFS, PFS, and OS, no statistically significant difference was found between the three treatment groups (log rank p=0.223, 0.522, 0.599, respectively). Cox regression analysis did not reveal contributing variables to LT-PFS, PFS, or OS.
Conclusion:
MWA appears safe, effective, and non-inferior when compared to resection and SBRT as a primary therapy for early NSCLC. Further study is warranted in comparative prospective trials.