Five-Year Survival and Durable Local Control After Image-Guided Thermal Ablation for Stage IA Non-Small Cell Lung Cancer

Purpose To evaluate five-year overall survival, cancer-specific survival, local tumor progression-free survival, local recurrence, and durable local control after repeat ablation in patients with Stage IA non-small cell lung cancer treated with image-guided thermal ablation. Materials and Methods This HIPAA-compliant, institutional review board-approved retrospective cohort study included 85 patients with Stage IA non-small cell lung cancer treated with image-guided thermal ablation between 2011 and 2018. Patients had a single target tumor: 16 T1a, 45 T1b, and 24 T1c tumors. Outcomes included technical success, five-year overall survival (OS), cancer-specific survival (CSS), local tumor progression-free survival (LTPFS), local recurrence, durable local control (no further local recurrence after repeat ablation during follow-up), and adverse events. Kaplan-Meier analysis estimated survival outcomes. Results Median follow-up was 55.6 months. Ablation modalities included microwave ablation in 41 patients, cryoablation in 37, and radiofrequency ablation in 7. Technical success was 100%. Grade 2 or higher adverse events within 90 days occurred in 8 patients (9.4%), all pneumothoraces requiring chest tubes. Five-year OS was 68.2%, 77.4%, and 68.2%; CSS was 100%, 87.2%, and 100%; and LTPFS was 100%, 77.8%, and 100% for T1a, T1b, and T1c tumors, respectively. Overall five-year LTPFS was 92.6%. Local recurrence occurred in 8 patients (9.4%). Six underwent repeat ablation without subsequent recurrence, yielding durable local control in 97.6%. Conclusion Image-guided thermal ablation provided favorable five-year survival and high durable local control for Stage IA non-small cell lung cancer, supporting ablation as a repeatable and effective treatment option.