Safety and efficacy of thermal ablation for subpleural lung cancers

Abstract

Background: The study was conducted to assess the safety and efficacy of thermal ablation for the treatment of subpleural lung cancer. Methods: Eighty-nine patients with 101 subpleural lung cancers were identified between January 2012 and July 2018 in our database and included in this study. Tumors were classified as adhering to cervical, costal, diaphragmatic, and mediastinal pleurae. Lesions were categorized based on their relationship to the pleura: close to the pleura, causing pleural indentation, and involving the pleura. The complete ablation rate, local progression-free survival, complications, and associated factors were analyzed. Results: Subpleural lung cancers included lesions located under costal (n = 69), mediastinal (n = 17), cervical (n = 8), and diaphragmatic (n = 7) pleurae. The rate of complete ablation was 87.1% and the local progression-free survival rates at 3, 6, 12, and 24 months were 86%, 77%, 75%, and 64%, respectively. Tumor size was the most important factor influencing technique efficacy (P < 0.05), with a complete ablation rate of only 55.6% in lung cancers measuring > 30 mm. There were nine (10.11%) major complications, including one chest abscess, five cases of pneumothorax, and three cases of hemothorax. The occurrence of major complications was associated with increased levels of pain within 48 hours post-procedure (P < 0.05). Conclusion: Local thermal ablation is a safe and effective treatment for subpleural lung cancers. Tumor size was the most significant factor affecting technique efficacy. Post-procedure pain indicated the possibility of major complications.