Ablation of Stage I–II Non–Small Cell Lung Cancer in Patients With Interstitial Lung Disease: A Multicenter Retrospective Study

Background: Treatment options for patients with interstitial lung disease (ILD) who develop stage I-II non-small cell lung cancer (NSCLC) are severely limited, since surgical resection, radiation, and systemic therapy are associated with significant morbidity and mortality. Objective: The aim of this study was to evaluate the safety and efficacy of percutaneous ablation of stage I-II NSCLC in patients with ILD. Methods: This retrospective study included patients with ILD and stage I-II NSCLC treated with percutaneous ablation in three health systems between October 2004 and February 2023. A single thoracic radiologist at each site reviewed preprocedural chest CT examinations for presence and type of ILD according to 2018 American Thoracic Society Criteria, blinded to clinical outcomes. The primary outcome was 90-day major (grade ≥3) adverse events, based on Common Terminology Criteria for Adverse Events version 5.0. Secondary outcomes were hospital length of stay (HLOS), local control, and overall survival. Results: The study included 33 patients (19 male, 14 female; median age, 78 years; 16 with Eastern Cooperative Oncology Group performance status ≤1) with ILD who underwent 42 percutaneous ablation sessions (21 cryoablations, 11 radiofrequency ablations, 10 microwave ablations) of 43 NSCLC (median tumor size 1.6±2.5 cm [range, 0.7-5.4 cm], 37 stage I). Extent of lung fibrosis was ≤20% in 24 patients; 17 patients had imaging findings of definite or probable usual interstitial pneumonia. The 90-day major adverse event rate was 14% (6/42), including one grade-4 event. No acute ILD exacerbation or death occurred within 90 days. Median HLOS was 1 day (IQR, 0-2 days). Median imaging follow-up for local control was 17 months (IQR, 11-32 months). Median imaging or clinical follow-up for overall survival was 16 months (IQR, 6-26 months). Local control and overall survival were 78% and 77% at 1 year, and 73% and 46% at 2 years, respectively. Conclusion: Percutaneous ablation appears to be a safe and effective treatment option for stage I-II NSCLC in the setting of ILD following multidisciplinary selection. Clinical Impact: Patients with ILD and stage I-II NSCLC should be considered for percutaneous ablation since they are frequently ineligible for surgical resection, radiation, and systemic therapy.