Macchi et al. (2017), Med Oncol, Italy [2] Prospective multicentre randomized trial (LUMIRA) (level of evidence: 1b)
| 52 patients with stage IV NSCLC, randomized into 2 groups: RFA (n = 28) MWA (n = 24) Mean tumour diameter (cm) ± SD: 1.90 ± 0.89 Ablation power: 40 W
| Tumour size: day of ablation, 6-month postablation, 12-month postablation Contrast enhancement at 12 months
| RFA group: significant reduction in tumour size between 6 and 12 months (P = 0.0014) MWA group: significant reduction in tumour size between 6 and 12 months (P = 0.0003) and between pretherapy and 12 months (P = 0.0215) 25% in RFA group 6.25% in MWA group (no statistical analysis performed)
| Apparent disparity in contrast enhancement at the tumour site at 12 months may be in favour of reduced tumour recurrence with MWA treatment Unclear determination of tumour size compared with ablation zone and/or tumour recurrence Unclear TNM staging
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| | Overall local recurrence rate Local recurrence rate in early- versus late-stage groups Local recurrence rate (≤3 cm) versus larger tumour size (>3 cm)
| 15.9% (18/113) at median follow-up 18 months Early-stage group: 2/35 (5.7%), advanced-stage group: 16/78 (20.5%), P = 0.047 Size <3 cm: 3/56 (5.4%), size >3 cm: 15/57 (15%), P = 0.002
| A larger study that shows the curative effect of MWA in patients with primary lung cancer who are unsuitable for surgical treatment Recurrence rate more likely in advanced-stage disease and larger tumour size Study used RECIST criteria which are not validated for use postablation
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Zheng et al. (2016), J Vasc Interv Radiol, China [4] Retrospective single-centre cohort study (level of evidence: 2b)
| | | | MWA is an effective treatment for lung tumours in a large patient cohort with a long duration of follow-up Analysis on a per-patient rather than per-lesion basis Heterogeneous tumour type and previous treatments
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Healey et al. (2017), J Vasc Interv Radiol, USA [5] Retrospective single-centre cohort study (level of evidence: 2b)
| | | 80% (86/108) at median follow-up 14.1 months 62.1 months (95% CI, 28.9, upper bound of CI not reached; range 0.2–96.6 months) Estimated at 22%, 36% and 44% at 1, 2 and 3 years, respectively
| Demonstrates the efficacy of MWA for the treatment of single lung malignancy in a larger data set with longer term follow-up Use of multiple devices by multiple operators at varied power settings over a long-time period may underestimate the rates of local control that can be achieved with newer, higher power devices Heterogeneous tumour type and previous treatments
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Dupuy et al. (2015), Cancer, USA [6] Prospective multicentre trial (ALLIANCE) (level of evidence: 2b)
| | | | Represents the first cooperative group analysis of NSCLC RFA with a single device with strict enrolment criteria Close imaging surveillance can easily identify recurrence, and repeat local therapy with either repeat thermal ablation or SBRT can be performed
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Lencioni et al. (2008), Lancet Oncol, Italy [7] Prospective multicentre trial (RAPTURE) (level of evidence: 2b)
| 106 patients undergoing RFA for lung malignancy between July 2001 and December 2005 Primary NSCLC (n = 33) Secondary metastasis (n = 73) where n is the number of patients Mean tumour diameter (cm): 1.7 ± 1.3
| | | This trial presents seminal evidence for RFA in primary lung cancer RECIST criteria used which are not validated for use post-ablation to determine treatment response Insufficient length of follow-up period to detect late tumour recurrences Heterogeneous patient population
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Bi et al. (2016), Int J Radiat Oncol, USA [8] Systematic review (level of evidence: 2a)
| | | 1 year (%): 77 (95% CI: 70–85) 2 years (%): 48 (95% CI: 37–58) 3 years (%): 55 (95% CI: 47–62) 5 years (%): 42 (95% CI: 30–54)
| This systematic review showed that SBRT provided superior 1-, 2-, 3- and 5-year local tumour control over RFA Very limited number of RFA trials, mainly observational studies with short follow-up time Definitions of local progression were not always consistent across the studies
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