Microwave Ablation for Early-Stage Non-Small Cell Lung Cancer: Don't Put the Cart Before the Stereotactic Horse.

We read with interest the systematic review and meta-analysis by Laeseke et al.[ [1] Laeseke P. Ng C. Ferko N. Naghi A. Wright G.W.J. Zhang Y. Laidlaw A. Kalsekar I. Laxmanan B. Ghosh S.K. Zhou M. Szapary P. Pritchett M. Stereotactic body radiation therapy and thermal ablation for treatment of NSCLC: A systematic literature review and meta-analysis. Lung Cancer. 2023; 182: 107259 Abstract Full Text Full Text PDF Scopus (0) Google Scholar ] They report that patients with early-stage non-small cell lung cancer (NSCLC) had comparable outcomes after stereotactic body radiation therapy (SBRT) or microwave ablation (MWA), and that these outcomes were better than radiofrequency ablation (RFA). This article is of great interest, as prospective cooperative group clinical trials have shown that SBRT achieves excellent outcomes with 5-year local control rates greater than 90-95% in early-stage NSCLC.[ 2 Timmerman R.D. Hu C. Michalski J.M. Bradley J.C. Galvin J. Johnstone D.W. Choy H. Long-term Results of Stereotactic Body Radiation Therapy in Medically Inoperable Stage I Non-Small Cell Lung Cancer. JAMA Oncology. 2018; 4: 1287 Crossref PubMed Scopus (133) Google Scholar , 3 Videtic G.M. Paulus R. Singh A.K. Chang J.Y. Parker W. Olivier K.R. Timmerman R.D. Komaki R.R. Urbanic J.J. Stephans K.L. Yom S.S. Robinson C.G. Belani C.P. Iyengar P. Ajlouni M.I. Gopaul D.D. Gomez Suescun J.B. McGarry R.C. Choy H. Bradley J.D. Long-term Follow-up on NRG Oncology RTOG 0915 (NCCTG N0927): A Randomized Phase 2 Study Comparing 2 Stereotactic Body Radiation Therapy Schedules for Medically Inoperable Patients With Stage I Peripheral Non-Small Cell Lung Cancer. International Journal of Radiation Oncology, Biology, Physics. 2019; 103: 1077-1084 Abstract Full Text Full Text PDF PubMed Scopus (156) Google Scholar ] As a result, SBRT is the well-established standard of care for inoperable early-stage NSCLC, as supported by clinical guidelines from the National Comprehensive Cancer Network (NCCN), the American Society for Radiation Oncology (ASTRO),[ [4] Videtic G.M.M. Donington J. Giuliani M. Heinzerling J. Karas T.Z. Kelsey C.R. Lally B.E. Latzka K. Lo S.S. Moghanaki D. Movsas B. Rimner A. Roach M. Rodrigues G. Shirvani S.M. Simone C.B. Timmerman R. Daly M.E. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive Summary of an ASTRO Evidence-Based Guideline. Practical Radiation Oncology. 2017; 7: 295-301 Abstract Full Text Full Text PDF PubMed Scopus (305) Google Scholar ] and the American Society of Clinical Oncology (ASCO).[ [5] Schneider B.J. Daly M.E. Kennedy E.B. Antonoff M.B. Broderick S. Feldman J. Jolly S. Meyers B. Rocco G. Rusthoven C. Slotman B.J. Sterman D.H. Stiles B.M. Stereotactic Body Radiotherapy for Early-Stage Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Endorsement of the American Society for Radiation Oncology Evidence-Based Guideline. Journal of Clinical Oncology. 2018; 36: 710-719 Crossref PubMed Scopus (108) Google Scholar ]