Comparison of Survival after Sublobar Resections and Ablative Therapies for Stage I Non−Small Cell Lung Cancer

BACKGROUND: Lobectomy is the standard therapy for patients with stage I non−small cell lung cancer (NSCLC). Recently, sublobar resections (SLR), radiofrequency ablation (RFA), and percutaneous cryablation therapy (PCT) for high-risk patients unfit for standard resection have been reported. This study compares all 3 modalities in stage I NSCLC. STUDY DESIGN: Patients with biopsied stage I NSCLC determined by PET/CT deemed medically unfit for standard resection were reviewed by a tumor board according to American College of Surgeons Oncology Group/NIH inoperability criteria before being offered SLR, RFA, or PCT under anesthesia. Patients were followed with CT scans alternating with PET scans. The primary end points were overall survival, cancer-specific survival, and cancer-free survival. Kaplan-Meier analysis and log-rank tests were used. RESULTS: Sixty-four patients underwent SLR (n = 25; 11 men, 13 women; median age 66 years, range 49 to 85 years), RFA (n = 12; 8 men, 4 women; median age 74 years, range 62 to 83 years), and PCT (n = 27; 16 men, 11 women; median age 74 years; range 59 to 88 years). The probability of 3-year survival for the SLR, RFA, and PCT groups was 87.1%, 87.5%, and 77%, respectively (p > 0.05). The 3-year cancer-specific and cancer-free survival for SLR, RFA, and PCT groups was 90.6% and 60.8% versus 87.5% and 50% versus 90.2% and 45.6%, respectively. CONCLUSIONS: This experience suggests comparable survival after sublobar resections and ablative therapies at 3 years. Ablative therapies appear to be a reasonable alternative in high-risk patients not fit for surgery. However, larger randomized studies with longer follow-up are needed to make recommendations for therapy.