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Monday, September 7, 2020

Ablation Therapy for Advanced Stage Non-Small Cell Lung Cancer: A National Cancer Database Study


Clinical question: 

In patients with clinical stage IIIB or stage IV non-small cell lung cancer (NSCLC), is overall survival (OS) prolonged in patients who undergo ablation therapy (AT) compared to patients who do not receive AT?

Take away point: 

In patients with advanced stage NSCLC, AT as the sole therapy other than chemotherapy may be associated with prolonged overall survival.

Reference: 

Halsey, Kasey et al. (2020). “Ablation Therapy for Advanced Stage Non-Small Cell Lung Cancer: A National Cancer Database Study.” Journal of Vascular and Interventional Radiology 31 (8): 1210-1215.

Click here for abstract

Study design: 

Retrospective review

Funding source: 

National Natural Science Foundation of China grant

Setting: 

Multi-center, at cancer-accredited medical centers, utilizing the National Cancer Database (NCDB).





Summary:

Ablative Therapy (AT) is progressively utilized in the treatment of inoperable and early-stage NSCLC due to well-demonstrated prolonged survival rates, however little data exists on the efficacy AT in the treatment of late-stage NSCLC. Here, the authors retrospectively reviewed overall survival among patients with stage IIIB or stage IV NSCLC who were treated with AT as the only treatment aside from chemotherapy compared to patients who did not undergo AT.

Patients who underwent any other treatment modality for NSCLC were excluded. This resulted in a total of 140,819 patients (mean age of 69 years, 54.7% male) that were included in the study, of which 249 received AT. OS between these two cohorts was then calculated from the time of diagnosis to the time of death.

The median OS for all included patients was 5.0 months. Using a multivariate cox regression the cohort receiving AT had longer OS, however this was not a statistically significant difference. Propensity matching based on demographic and clinicopathologic characteristics was performed which resulted in a statistically significant OS of 5.9 months in the AT group compared to 4.7 months in the control group.

Additional propensity matching for tumors less than or equal to 3 cm resulting in statistically significant OS of 14.0 months in the AT group compared to 4.7 months in the control group.

Commentary:

Results of this retrospective review with propensity matched groups suggests that AT prolongs OS in patients with stage IIIB or IV NSCLC compared to AT, especially when pre-treatment tumor size is 3 cm or less.

As the efficacy of AT in early stage NSCLC is well-established (2-year survival rates exceeding 90%), this important data also suggests that AT is efficacious in more advanced stages of NSCLC. Importantly, AT can offer a treatment option for patients with late stage NSCLC especially in those who are poor surgical candidate or for those whom palliative care is indicated. The increase in OS in patients who underwent AT with tumor sizes of 3 cm or less is consistent with existing literature supporting excellent outcomes in smaller NSCL tumor sizes.

Limitations in the data presented here include relatively small AT cohort size compared to total included patient size, lack of details of cause-specific mortality, possibility for selection bias in that those who received AT in the setting of advanced stage NSCLC may be patients more clinically favorable for the procedure, and lack of detail regarding the specific ablation techniques performed.


Post Author:
Demetrios Geanon
MD Candidate, Class of 2021
Rush University Medical Center

David M. Tabriz, MD
Assistant Professor
Rush University Medical Center

@DrDaveTabriz

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