Safety and efficacy of transbronchial radiofrequency ablation for stage IA peripheral lung cancer: a retrospective cohort study

Abstract

Background: Percutaneous radiofrequency ablation (RFA) is a commonly used treatment for inoperable early-stage lung cancer, though it carries a significant risk of complications. Transbronchial RFA has emerged as a promising alternative, but robust clinical evidence supporting its adoption remains scarce. This study aims to investigate the safety and efficacy of transbronchial RFA in treating early-stage peripheral lung cancer.

Methods: This retrospective cohort study included patients with early-stage (IA) peripheral lung cancer who underwent transbronchial RFA due to inoperability or refusal of surgery from August 2020 to December 2023. All patients underwent transbronchial RFA under the guidance of X-ray or cone-beam computed tomography (CBCT). The safety endpoint included the incidence of adverse events in the month after ablation. The efficacy endpoints involved the local control progression-free survival (LPFS), as well as the factors affecting therapeutic outcomes.

Results: A total of 46 patients with 51 tumors underwent 55 transbronchial RFA procedures. The mean age of patients was 67.7 years, and the mean lesion size was 16.4 mm. Adverse events and intervention-acquired adverse events were reported in 11.5% and 9.8% of participants. The local control analysis revealed 1-, 2-, and 3-year LPFS rates of 87.5%, 73.4%, and 69.8%, respectively. The efficacy predictor analysis revealed that transbronchial RFA guided by CBCT had significantly better LPFS compared to that of X-ray guidance (1- and 3-year LPFS rates: 97.2% vs. 55.4% and 79.3% vs. 36.9%, respectively).

Conclusions: Transbronchial RFA for peripheral lung cancer showed a favorable safety profile. The efficacy of transbronchial RFA was also evaluated, and it was found that CBCT-guided bronchial ablation had better outcomes. Future studies will require prospective randomized controlled trials to further confirm its efficacy.

Keywords: Radiofrequency ablation (RFA); bronchoscopy; lung cancer.

Figure 1

A case of prolonged hospitalization due to pneumothorax. (A) CT image at preoperative evaluation. (B) CT image at 24 h postoperatively. (C,D) X-ray images at 3 days, 4 days, showing right pneumothorax with thoracic close drainage. (E,F) CT images at 1 month, 12 months; the right pneumothorax disappeared and the solid lesion became smaller. CT, computed tomography.

Figure 2

A case of CBCT-guided transbronchial RFA. (A) The CBCT images obtained during the RFA procedure demonstrate the location of the target lesion prior to the procedure. (B) Interprocedural confirmation of the ablation catheter inside the target lesion. (C) The CBCT images were obtained prior to the withdrawal of the catheter in RFA ablation. It was confirmed that the ablation area had covered the entire lesion. (D-K) CT images acquired at preoperative evaluation, 24 hours, 1 month, 3 months, 6 months, 12 months, 24 months, 36 months. CBCT, cone-beam computed tomography; CT, computed tomography; RFA, radiofrequency ablation.

Figure 3

Kaplan-Meier survival curves of LPFS. (A) LPFS for stage IA patients. The intersection point of the dashed lines and the Kaplan-Meier curve was the median LPFS. The median LPFS was 41 months, and 1-, 2-, and 3-year LPFS rates were 87.5%, 73.4%, and 69.8%, respectively. (B) LPFS curves by image guidance: patients with CBCT guidance had significant longer LPFS than X-ray. The intersection points of the dashed lines and the Kaplan-Meier curves were the median LPFS (median LPFS: 41 vs. 31 months). CBCT, cone-beam computed tomography; LPFS, local control progression-free survival.