June 17, 2008 -- A device that zaps tumors ups survival in patients with small, inoperable lung cancers, an international clinical trial suggests.
The technique is called radiofrequency ablation or RFA. Riccardo Lencioni, MD, Robert Suh, MD, and colleagues used RFA to zap 183 lung tumors in 106 patients rejected for surgery and considered unfit for radiation or chemotherapy.
Despite the frail condition of these patients, RFA got rid of the tumors in all but one patient. More importantly, overall survival was 70% at one year and 48% at two years for patients with primary lung cancer, and 89%-92% at one year and 64%-66% at two years for patients with other cancers that had spread to the lung.
None of the patients suffered worse lung function after undergoing RFA.
"We are offering a procedure to patients who traditionally would have very few options," Suh tells WebMD. "It is a safe procedure with a link to promising long-term survival."
It's a "very provocative study," says Edgardo S. Santos, MD, assistant professor of medicine at the University of Miami Sylvester Comprehensive Cancer Center. Santos was not involved in the Lencioni study.
"I was impressed with the complete response rates they were able to find," Santos tells WebMD. "And the survival at two years, 75% -- even for stage I lung cancer, that is great for patients rejected for surgery. So certainly the question now will be how can we move this kind of treatment into the management of lung cancer for patients."
Surgery remains the best treatment for lung cancer. But lung surgery means removal of parts of the lung. And even when the cancer is caught relatively early, some people -- such as those with lung disease -- can't afford to lose any more lung.
RFA isn't for every tumor. It can only be used in relatively small tumors. Lencioni, Suh, and colleagues treated only tumors 3.5 centimeters (about 1 3/8 inches) in diameter or smaller; the average tumor was 1.75 centimeters. This means that study patients had stage I or stage II lung cancer.
"What percentage of patients with non-small-cell lung cancer could qualify for this? If we look at those with stage I and II, that's about 15.7% of these cancers," Suh says. "Previously, patients in this group who cannot have surgery had little or nothing else to be offered. They would not qualify for outside beam radiation, because it causes too much lung damage, and chemotherapy has not been shown to be beneficial in this group."
The RFA device looks like a long needle with a handle on the end. Guided by CT scanning, a doctor inserts the needle into the lung and hits a switch that deploys tiny tines into the tumor. When the device is activated, it induces intense heat in and around the tumor, causing it to burn away.
RFA already is approved by the FDA for use in metastatic liver tumors and for general use in soft tissues, but it is not specifically approved for treating lung tumors.
Suh serves as a consultant to one maker of RFA devices, but not to the manufacturer of the device used in the study.