Microwave Ablation Plus Chemotherapy Enhances PFS Without Added Toxicity in Advanced NSCLC

Microwave ablation plus chemotherapy significantly improves progression-free survival (PFS) in patients with advanced non–small cell lung cancer (NSCLC) without increasing toxicity, according to a study published in Thoracic Cancer.¹

Unlocking the Potential of Microwave Ablation in Advanced NSCLC

Lung cancer is the second-most diagnosed malignancy worldwide—only behind breast cancer—but it remains the leading cause of cancer-related mortality. NSCLC, in particular, accounts for about 85% of all lung cancer cases.² As a result, the researchers emphasized the urgent need for effective strategies in the prevention, early detection, and management of NSCLC.¹

The NSCLC therapeutic landscape varies by disease stage, with surgical resection offering the best chance of a cure in patients with early-stage disease. Meanwhile, those diagnosed at stages II to IV typically require multimodal approaches involving chemotherapy, radiotherapy, immunotherapy, and targeted therapies. Local ablative techniques, including radiofrequency ablation, cryoablation, and microwave ablation, are minimally invasive alternatives for patients who are not surgical candidates or for those who have limited responses to systemic therapies.

The researchers explained that microwave ablation uses non-ionizing electromagnetic waves to generate localized heat and induce tumor necrosis through cellular disruption. This treatment method has become an essential tool to treat various solid tumors, including those of the lungs, liver, kidneys, and bone metastases.³

Although microwave ablation is considered a promising modality for local tumor control, its combined use with chemotherapy in advanced NSCLC remains insufficiently studied.¹ To address this knowledge gap, the researchers conducted a systematic review and meta-analysis, which evaluated clinical outcomes related to the effect of microwave ablation combined with chemotherapy vs chemotherapy alone in patients with advanced NSCLC.

“Preliminary data suggest that this combination may enhance treatment efficacy by leveraging the local cytoreductive effect of ablation with the systemic reach of chemotherapy,” the authors wrote.

Enhanced PFS, Tolerable Safety Profile Observed With Microwave Ablation Plus Chemotherapy

The study’s primary outcome was PFS, with secondary outcomes including partial remission and adverse event rates. The researchers pooled HRs and risk ratios (RRs) with 95% CIs using random effects models. They also reconstructed individual patient data from Kaplan-Meier curves to perform a one-stage survival meta-analysis.

Using relevant search terms, the researchers performed a comprehensive literature search of MEDLINE, EMBASE, and the Cochrane Library to find eligible studies, spanning from each database’s inception to June 2025. Eligible studies included randomized controlled trials (RCTs) and observational studies comparing microwave ablation plus chemotherapy vs chemotherapy alone in patients with advanced NSCLC. They also searched for additional studies using the references of those previously included. From each included study, the researchers extracted study characteristics and patient demographics.

With this search strategy, they identified 467 results, of which 4 met the inclusion criteria for analysis. The 4 studies included 2 observational studies and 2 RCTs, encompassing 483 patients, 249 of whom received microwave ablation combined with chemotherapy and 234 of whom received chemotherapy alone. The number of patients in each study ranged from 49 to 293, with their ages ranging from 59 to 65 years. Regarding histological subtype, most patients had advanced pulmonary adenocarcinoma.

Compared with those receiving chemotherapy alone, patients across all studies receiving microwave ablation plus chemotherapy demonstrated a significant improvement in PFS (HR, 0.408; 95% CI, 0.24-0.49; P < .001; I² = 53.3%). The researchers noted that the robustness of the results was confirmed through a 2-stage meta-analysis and leave-one-out sensitivity analysis, both of which showed consistent benefit, regardless of study exclusion.

Regarding the secondary outcomes, the partial remission rate did not differ significantly between treatment groups (RR, 0.74; 95% CI, 0.37-1.50; P = 0.41; I² = 62.8%). The incidence of adverse events was also comparable between groups (RR, 1.08; 95% CI, 0.86-1.36; P = .49; I² = 56.8%).

Further Defining the Role of Microwave Ablation Through Additional Research

The researchers concluded by acknowledging several limitations, including methodological heterogeneity and the potential for residual confounding. Also, the lack of individual patient data prevented them from performing subgroup analyses, which they claimed could have provided deeper insights. Nonetheless, the researchers expressed confidence in their findings and used them to suggest areas for further research.

“While the results are promising, further high-quality randomized trials are needed to confirm these findings and better define the role of microwave ablation in this setting,” the authors concluded.

References

1. Onyeji PC, Kaur A, Consoli L, et al. Microwave ablation combined with chemotherapy versus chemotherapy alone in patients with advanced non-small cell lung cancer-systematic review and meta-analysis. Thorac Cancer. 2026;17(1):e70221. doi:10.1111/1759-7714.70221
2. Moussa AM, Ziv E, Solomon SB, Camacho JC. Microwave ablation in primary lung malignancies. Semin Intervent Radiol. 2019;36(4):326-333. doi:10.1055/s-0039-1700567
3. Gala KB, Shetty NS, Patel P, Kulkarni SS. Microwave ablation: how we do it? Indian J Radiol Imaging. 2020;30(2):206-213. doi:10.4103/ijri.IJRI_240_19