Background: Although surgery remains the standard of care for early stage non-small cell lung cancer, as many as 30% of these patients are considered nonoperative because of co-existing medical morbidities. Early results with the use of ablative techniques alone or in combination with radiation in the treatment of early stage non-small cell lung cancer appear promising. Radiofrequency ablation with external beam radiation has been used for stage I lung cancer and has shown local control rates of greater than 90% at 2 years. Patients with poor pulmonary reserve, however, may not even be candidates for external beam irradiation. The use of HDR brachytherapy as an adjunct to radiofrequency ablation and an alternative to conventional radiotherapy may provide the opportunity for greater tissue sparing than that accomplished with conformal radiotherapy.

Methods: 17 medically inoperable patients with biopsy proven stage I non-small cell lung cancer were treated with radiofrequency ablation followed by single fraction HDR brachytherapy. Brachytherapy catheters were inserted immediately after radiofrequency ablation, and one fraction of HDR brachytherapy was delivered on the same day. Doses of brachytherapy ranged from 14.4 Gy to 20 Gy (median 18 Gy). Patients were followed clinically and radiographically to determine tumor control and toxicity profile.

Results: Median follow-up time was 22 months. The procedure was generally well tolerated. Five of the seventeen patients required a chest tube post-treatment, and one patient developed an empyema. There were no deaths within one month of treatment. Of the seventeen patients, three patients have recurred locally. Each of the patients with local recurrences was originally treated for T2 disease. In total, three of seven cases with T2N0 disease experienced local recurrences, whereas all nine patients with T1 disease were controlled locally. Two of the three local failures were treated with a second radiofrequency ablation.

Conclusions: This combination approach was relatively well tolerated and provided good short term local control, particularly for T1N0 patients.