Morphological Appearance of Radiofrequency Ablated Stage I NSCLC in Medically Inoperable Patients as Related to Recurrence: Results from the ACOSOG Z4033 (Alliance Trial)

Tuesday, Dec. 1 3:20PM - 3:30PM Location: S405AB

Lillian Xiong, MD, Providence, RI (Presenter) Nothing to Disclose
Erica S. Alexander, BS, Providence, RI (Abstract Co-Author) Nothing to Disclose
Shauna Hillman, MS, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Angelina D. Tan, BS,BA, Rochester, MN (Abstract Co-Author) Nothing to Disclose
Grayson L. Baird, MS, Providence, RI (Abstract Co-Author) Nothing to Disclose
Hiran Fernando, MD, Boston, MA (Abstract Co-Author) Consultant, CSA Medical, Inc Research Consultant, Galil Medical Ltd Research Grant, Deep Breeze Ltd
Damian E. Dupuy, MD, Providence, RI (Abstract Co-Author) Research Grant, NeuWave Medical Inc Board of Directors, BSD Medical Corporation Stockholder, BSD Medical Corporation Speaker, Educational Symposia

This study evaluates tumor and ablation zone morphology as related to recurrence in medically inoperable patients with stage I NSCLC undergoing CT-guided RFA in a prospective multi-center trial.


This prospective, multicenter group trial was approved by each institutional review board. 54 patients from 16 US sites were enrolled, of these, 50 patients (23 Men, 27 Women; mean age 75.3±7.5 years) met eligibility requirements. Patients were followed using CT; evidence of CT recurrence and pre- and post-ablation imaging characteristics were recorded. Characteristics evaluated included tumor/ablation zone shape (round, ovoid, bilobed, irregular), size, borders (smooth, speculated, lobulated), distance to large vessels/airway and distance to pleura.


A difference was observed for months to recurrence between those with ablation zones greater than 3cm and less than 3cm (p=.0023). The median time of recurrence for those with ablation zones less than 3cm was 8.16 months, while the median recurrence time for those with zones greater than 3cm could not be determined. Recurrence free probability was 30% for those with ablation zones less than 3cm and 75% for those with zones greater than 3cm.No significant differences were found between those with and without recurrence for age (p=.47), performance score (p=.43), histology (p=.34), baseline tumor SUV (p=.91), tumor size (p=.59), peak power (p=.92), peak current (p=.63), max temp (p=.65), total time (p=.28), shape (p=.30), cavitation (p=.29), sphericity (p=.45), distance from tumor edge to large vessel (p=.62), and distance to pleura (p=.25).


Of those morphological characteristics considered, size of ablation zone appears to be most predictive of recurrence-free survival for those patients treated with RFA for early stage lung cancers.


Post-radiofrequency ablation zones greater than 3-cm were significantly less likely to be associated with recurrent disease, in a multi-institutional prospective study of 50 stage I NSCLC patients.

Honored Educators

Presenters or authors on this event have been recognized as RSNA Honored Educators for participating in multiple qualifying educational activities. Honored Educators are invested in furthering the profession of radiology by delivering high-quality educational content in their field of study. Learn how you can become an honored educator by visiting the website at: https://www.rsna.org/Honored-Educator-Award/

Damian E. Dupuy, MD - 2012 Honored Educator