A National Cancer Database Analysis of Radiofrequency Ablation versus Stereotactic Body Radiotherapy in Early-Stage Non–Small Cell Lung Cancer
Figure: Log-rank analysis of the propensity score adjusted Kaplan-Meier survival curves comparing treatment types and stratified by propensity score. The number of patients at risk is listed below each time interval. P value for the log-rank test is included. RFA = RF ablation.
The results of this study shows that RF ablation and SBRT have similar OS for stage 1 NSCLC, in accordance to recent systematic review and other prospective studies as mentioned by the authors. Nonetheless, the rate of unplanned 30-day readmission was significantly higher in patients submitted to RF ablation. This could be explained by the presence of significantly more comorbidities in the RF ablation group (P = 0.001), but it is also likely related to the more invasive nature of percutaneous ablation compared to SBRT. Major limitations of the study were the significant sample size discrepancy between two groups, limited accuracy of data from NCDB and lack of information regarding technical procedure specifications and rate of local tumor control. However, this study provides a good insight of “real world” practice and how thermal ablation has been incorporated in the management of inoperable stage 1 NSCLC. It also paves the way for newer thermal ablative technologies such as microwave, which has the potential to improve local control by direct energy propagation, associated with less complication rates given the lower device profile.
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Ricardo Yamada, MD
Department of Radiology
Division of Vascular and Interventional Radiology
Medical University of South Carolina