Lung Ablation Outcomes for Inoperable Stage IA Non–Small Cell Lung Cancer

PURPOSE: To evaluate the effectiveness and safety outcomes of percutaneous cryoablation for Stage IA non-small cell lung cancer (NSCLC) in medically inoperable patients. MATERIALS AND METHODS: This retrospective study analyzed 176 consecutive patients who underwent percutaneous cryoablation for biopsy-proven Stage IA NSCLC at a single institution between July 2020 and July 2025. Inclusion criteria included tumor size ≤3 cm, medically inoperable disease or patient refusal of surgery, and an Eastern Cooperative Oncology Group (ECOG) performance status score of <2. Procedures were performed under computed tomography (CT) guidance with a standardized triple freeze-thaw protocol. Follow-up involved routine CT and positron emission tomography (PET) imaging at standardized intervals. Overall survival (OS) and local progression-free survival (LPFS) and adverse event rates were calculated using Kaplan-Meier and Cox proportional hazards models. RESULTS: Of the 170 patients with complete follow-up data, the 1-year and 3-year LPFS rates were 91.8% and 89.4%, respectively, whereas the overall local progression rate was 10.6%. OS rates were 100.0% at 1 year and 94.7% at 3 years. On multivariate analysis, only larger tumor size (Stage IA3 vs IA2) was a significant independent predictor of local progression (adjusted hazard ratio, 4.71; P = .001). Pneumothorax requiring intervention was the most common adverse event (17.6%), with no in-hospital deaths, air embolism, or massive pulmonary hemorrhage. CONCLUSIONS: Percutaneous cryoablation provides effective local control with a favorable safety profile in patients with medically inoperable Stage IA NSCLC particularly with tumor smaller than 2.0 cm. These results support further exploration of cryoablation as a primary treatment modality for this patient population.