Minimally invasive techniques for medically inoperable stage 1 non small cell lung cancer: Radiotherapy is still the gold standard

摘要

We read with great interest, and some concern, the recent article by Liu and Steinke, entitled 'High-powered percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: A preliminary study'. This article retrospectively studied in 15 patients the feasibility and outcomes of treatment of medically inoperable stage 1 non-small cell lung cancer (NSCLC) with microwave ablation (MWA). The publication of this article raises a number of issues, several of which we would like to highlight.The authors state that this study was conducted due to a need for minimally invasive alternatives to surgery for this patient population. However, an obvious omission in this article is the lack of any mention of the well-established treatment option of external beam radiotherapy.Currently, radiotherapy is the standard of care for medically inoperable stage 1 NSCLC patients, with level II evidence supporting its use. Phase II studies using the modern hypofractionated technique of stereotactic body radiotherapy (SBRT) have demonstrated results that are similar to surgery, with 85-90% local control at 3 years. This compares with a 31% local failure rate at 1 year using MWA in this report.