Improving Quality of Life for Lung Cancer Patients
Abstract: Thermal-based therapies are among the most promising novel treatments for solid, soft tissue tumors including non-small cell lung cancer and metastatic disease to the chest.
From Clinical Update, Summer 2007
Lung cancer remains the leading cause of cancer death in the United States. In 2007, surgical resection remains the best chance for cure, with five-year survival approaching 70 percent for T1N0 non-small cell lung cancer (NSCLC).
However, secondary to advanced disease or co-morbid conditions, many individuals with newly diagnosed NSCLC are not candidates for surgery. This cohort is typically offered radiation and/or chemotherapy which provide very limited chance for long-term survival. Thus, oncology research has strived to increase the patient population who can receive surgical management and improve non-operative lung cancer care and develop new forms.
Among the more promising novel treatments for solid, soft tissue tumors, including NSCLC and metastatic disease to the chest, are thermal-based therapies. These treatments, which destroy tissue by either freezing (cryoablation) or heating (radiofrequency, microwave, laser), have benefited from recent technical advancements and are evolving into a highly effective, minimally invasive management choice for localized neoplastic disease.
Wake Forest University Baptist Medical Center offers each of these technologies, and the appropriate choice of thermal therapy varies based on many factors such as tumor location, size and adjacent anatomy. In the lung, we tend to rely on radiofrequency ablation (RFA) which achieves tumor ablation by the use of directed alternating current creating local ionic agitation, frictional heat, and ultimately irreversible cellular damage. Interventional radiologists or surgeons perform the procedure under image guidance, typically utilizing computed tomography.
The procedure involves placement of a needle electrode with an insulated shaft and an “active” uninsulated tip into the tumor. Easier on the patient and with less toxicity than surgery and radiation therapy, these therapies are typically completed during one encounter on an outpatient basis with a favorable toxicity profile when compared with surgery and radiation therapy. RFA can be repeated as needed to manage recurrent disease.
RFA is approved by the Food and Drug Administration for the treatment of soft tissue tumors. It has been used as a single line therapy and in combination with other treatments for many types of cancer throughout the body. As it is relatively new, how it should best be incorporated into the various arms of oncology remains to be determined.
The Comprehensive Cancer Center at Wake Forest Baptist is taking a dynamic role in this investigation. In addition to active RFA programs addressing renal and hepatic neoplastic disease, the group will soon initiate a study to assess the benefit of treating non-operative stage 1a and select 1b NSCLC with a combination of RFA and external beam radiation.
While the criteria for the clinical use of RFA are not defined absolutely, most operators select patients on the basis of lesion size and number, and goal of the treatment. Early research has shown that the long-term success of pulmonary RFA alone drops off quickly for tumors much greater than 3 – 4 centimeters. If pain control is the objective, i.e. for neoplastic lesions involving the chest wall, then larger lesions can be logically addressed.
Chemotherapy and radiation remain the standard of care for the management of non-operative NSCLC. In the near future these traditional therapies may be routinely augmented, or occasionally replaced, with thermal-based therapies as more results emerge from long-term investigations.
The common goal must ultimately be to prolong and improve the quality of life of oncology patients. For well-selected patients, thermal-based therapies can do both.