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Radiofrequency ablation versus surgical resection for the treatment of oligometastatic lung disease - 23/12/20

Doi : 10.1016/j.diii.2020.09.006 
L. Tselikas a, b, c, , L. Garzelli a, O. Mercier b, c, d, e, A. Auperin f, L. Lamrani e, F. Deschamps a, S. Yevich a, g, C. Roux a, S. Mussot c, d, e, A. Delpla a, F. Varin h, A. Hakime a, C. Teriitehau a, C. Le Péchoux c, i, P. Pradère c, d, C. Caramella c, j, B. Besse b, c, k, E. Fadel b, c, d, e, T. de Baere a, b, c
a Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France 
b University of Paris-Saclay, 91190 Saint-Aubin, France 
c Institut d’Oncologie thoracique, 94805 Villejuif, France 
d Department of Thoracic and Vascular Surgery, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France 
e Research and Innovation Unit, INSERM U999, DHU Torino, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France 
f Biostatistics and Epidemiology Unit, Gustave-Roussy INSERM 1018, 94805 Villejuif, France 
g Interventional Radiology, MD-Anderson, 77030 Houston, TX, USA 
h Department of Anesthesiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France 
i Department of Radiation Therapy, Gustave-Roussy Cancer Campus, 94805 Villejuif, France 
j Radiology Department, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France 
k Department of Cancer Medicine, Gustave-Roussy Cancer Campus, 94805 Villejuif, France 

Corresponding author at: Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France.Interventional Radiology, Gustave-Roussy Cancer CampusVillejuif94805France

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Highlights

No differences in efficacy are found between radiofrequency ablation and surgery for oligometastatic lung disease.
Local recurrence risk is higher for tumours>2 cm treated by radiofrequency ablation compared to those treated by surgery.
Hospital stay is significantly shorter after radiofrequency ablation of oligometastatic lung disease than after surgery.

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Abstract

Purpose

The purpose of this study was to compare efficacy and tolerance between radiofrequency ablation (RFA) and surgery for the treatment of oligometastatic lung disease.

Materials and methods

This retrospective study reviewed patients treated in two institutions for up to 5 pulmonary metastases with a maximal diameter of 4cm and without associated pleural involvement or thoracic lymphadenopathy. Patient demographics, tumor characteristics, treatment outcome, and length of hospital stay were compared between the two groups. Efficacy endpoints were overall survival (OS), progression-free survival (PFS) and pulmonary or local tumor progression rates.

Results

Among 204 patients identified, 78 patients (42 men, 36 women; mean age, 53.3±14.9 [SD]; age range: 15–81 years) were treated surgically, while 126 patients (59 men, 67 women; mean age, 62.2±10.8 [SD]; age range: 33–80 years) were treated by RFA. In the RFA cohort, patients were significantly older (P<0.0001), with more extra-thoracic localisation (P=0.015) and bilateral tumour burden (P=0.0014). In comparison between surgery and RFA cohorts, respectively, the 1- and 3-year OS were 94.8 and 67.2% vs. 94 and 72.1% (P=0.46), the 1- and 3-year PFS were 49.4% and 26.1% vs. 38.9% and 14.8% (P=0.12), the pulmonary progression rates were 39.1% and 56% vs. 41.2% and 65.3% (P>0.99), and the local tumour progression rates were 5.4% and 10.6% vs. 4.8% and 18.6% (P=0.07). Tumour size>2cm was associated with a significantly higher local tumor progression in the RFA group (P=0.010). Hospitalisation stay was significantly shorter in the RFA group (median of 3 days; IQR=2 days; range: 2–12 days) than in the surgery group (median of 9 days; IQR=2 days; range: 6–21 days) (P<0.01).

Conclusion

RFA should be considered a minimally-invasive alternative with similar OS and PFS to surgery in the treatment of solitary or multiple lung metastases measuring less than 4cm in diameter without associated pleural involvement or thoracic lymphadenopathy.

Le texte complet de cet article est disponible en PDF.

Keywords : Lung neoplasms, Radiofrequency ablation (RFA), Percutaneous treatment, Treatment outcome

Abbreviations : CI, CT, IQR, OS, PET, PFS, PFT, RFA, 18FDG-PET


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© 2020  Soci showét showé françaises de radiologie. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 102 - N° 1

P. 19-26 - janvier 2021 Retour au numéro
Article précédent Article précédent
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