Comparative study of bronchoscopic and CT-guided percutaneous microwave ablation for inoperable non-small cell lung cancer.

Background: Patients with inoperable stage I non-small cell lung cancer (NSCLC) have limited treatment options. Microwave ablation (MWA) offers a promising alternative. This study aims to compare the clinical efficacy and safety of computed tomography (CT)-guided percutaneous transthoracic microwave ablation (PTMA) and bronchoscopic transbronchial microwave ablation (BTMA). Methods: A total of 126 patients with stage I NSCLC who were not candidates for surgery underwent PTMA or BTMA. Outcomes evaluated included complete ablation rate, local control rate (LCR), progression-free survival (PFS), technical success, procedure-related complications, and lesion size changes. Subgroup analyses were conducted based on age, nodule size, and nodule density. Results: The 6-month complete ablation rates were similar in the BTMA and PTMA groups (96.7% vs. 95.5%, P>0.99). At 12 months, LCR and PFS were also comparable (LCR: 95.0% vs. 95.5%; PFS: 91.7% vs. 90.9%; log-rank P=0.62). Subgroup analysis indicated a trend toward lower PFS in patients with larger nodules in both the PTMA group (P=0.03) and BTMA group (P=0.03). Technical success rates were high in both groups (97.0% for PTMA and 93.3% for BTMA). The PTMA group had a significantly higher incidence of chest pain (66.7% vs. 10.0%, P<0.001) and pneumothorax requiring thoracentesis (18.8% vs. 3.3%, P=0.006), while other complications showed no significant difference. Conclusions: Both PTMA and BTMA are effective treatment options for inoperable stage I NSCLC. BTMA offers similar efficacy with fewer complications and may be preferable in selected patients.