Researchers optimistic about new therapy for lung cancer


Researchers optimistic about new therapy for lung cancer


An article in the July edition of The Lancet Oncology suggests that a common treatment for liver cancer - radiofrequency ablation - can also be used to treat lung cancer. A team of European and American researchers calls for randomized controlled trials in order to more robustly investigate this minimally invasive procedure for cancer treatment.

In both men and women, lung cancer causes the most cancer deaths, and 80% of these are non-small-cell lung cancer (NSCLC). The usual treatment strategy for early-stage NSCLC patients is surgery, but many patients are unable to withstand invasive procedures. Doctors and patients must consider limitations such as a lung function measurement that predicts likelihood of survival after surgery (pulmonary reserve), associated disease, and the general medical fitness of the patient. Further complications exist because of the high frequency of lung metastasis - when cancers elsewhere in body spread to the lungs. Sometimes surgery is optimal and has survival benefits, such as when the cancer has spread from the colon. However, often patients must be rejected for surgery and offered radiotherapy or chemotherapy procedures instead. For these patients, there is lower expected survival rate and unsatisfactory long-term outcomes.

One minimally invasive therapy that can break down solid tumors is called percutaneous image-guided radiofrequency ablation (RFA). Recent practice has demonstrated the ability of RFA to destroy large volumes of tumors in a controlled fashion, and the technique has become an effective substitute for surgery in liver cancer patients. An advantage of RFA is that the procedure focuses on the target tumor and takes about an hour - it is more gentle on the body compared to surgery. In addition, tests of lung function indicate that RFA does not damage healthy lung tissue, and RFA does not reduce patients' quality of life. Testing the feasibility, safety, and efficacy of RFA in treating lung tumors, Professor Riccardo Lencioni (Division of Diagnostic and Interventional Radiology, Cisanello University Hospital, Pisa, Italy) and colleagues conducted a prospective, multi-center trial called the RAPTURE study.

The RAPTURE study consisted of 106 patients with 183 malignant lung tumors that were verified by biopsy. The tumors were all 3.5 cm or smaller in diameter. Doctors diagnosed 33 of the patients with NSCLC, 53 of the patients with metastatic lung cancer derived from the colon, and 20 patients with metastatic lung cancer that spread from other parts of the body. The patients - not suitable for surgery, chemotherapy, or radiotherapy - received RFA and two years of follow up.

Results are summarized below:

  • 75 of 85 (88%) assessable patients had a confirmed complete response of tumors that lasted at least one year.
  • Overall survival rates were:
    • 70% at 1 year and 48% at 2 years in NSCLC patients
    • 89% at 1 year and 66% at 2 years in those with lung cancer metastasized from colon cancer
  • Cancer-specific survival rates were:
    • 92% at 1 year and 73% at 2 years in NSCLC patients
    • 91% at 1 year and 68% at 2 years in those with lung cancer metastasized from colon cancer
The 2-year overall survival for the 13 patients with stage I NSCLC was 75%, and the 2-year cancer-specific survival for these patients was 92%. There was a 99% rate of correctly placed ablation devices, and no patients died due to any of the 137 ablation placements. There were 27 cases of pneumothorax and 4 of pleural effusion that required drainage. No significant declines in lung function were noted.

In the authors own words: "Our study shows that radiofrequency ablation can be completed successfully in high percentage of patients with small lung tumours...The safety profile of the procedure was also acceptable, with no mortality or life-threatening complications associated with it...A randomised controlled trial comparing radiofrequency ablation versus standard treatment options is now warranted to prove the clinical benefit of this approach."

Response to radiofrequency ablation of pulmonary tumours: a prospective, intention-to-treat, multicentre clinical trial (the RAPTURE study)

Riccardo Lencioni, Laura Crocetti, Roberto Cioni, Robert Suh, Derek Glenn, Daniele Regge, Thomas Helmberger, Alice R Gillams, Andrea Frilling, Marcello Ambrogi, Carlo Bartolozzi, Alfredo Mussi

The Lancet Oncology .

DOI:10.1016/S1470-2045(08)70155-4

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Section Issues On Medicine: Disease