Microwave Ablation Combined With Chemotherapy Versus Chemotherapy Alone in Patients With Advanced Non‐Small Cell Lung Cancer—Systematic Review and Meta‐Analysis

Non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related mortality worldwide. Although chemotherapy remains a cornerstone in the treatment of advanced NSCLC, local ablative strategies such as microwave ablation (MWA) have emerged as promising adjunctive therapies. However, the survival benefits of combining MWA with chemotherapy remain uncertain. This meta-analysis aims to evaluate the efficacy and safety of microwave ablation combined with chemotherapy compared to chemotherapy alone in patients with advanced NSCLC. A comprehensive search was conducted in MEDLINE, EMBASE, and Cochrane Library through January 2025. Eligible studies included randomized controlled trials or observational studies comparing MWA associated with chemotherapy versus chemotherapy alone in patients with advanced NSCLC. The primary outcome was progression-free survival (PFS); secondary outcomes included partial remission (PR) rate and adverse events (AE). Hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI) were pooled using random-effects models. Individual patient data (IPD) were reconstructed from Kaplan-Meier curves to perform a one-stage survival meta-analysis. Four studies comprising 483 patients were included. MWA associated with chemotherapy significantly improved PFS (HR 0.408; 95% CI 0.24-0.49; p < 0.001; I² = 53.3%). No significant differences were found for PR (RR 0.74; 95% CI 0.37-1.50; p = 0.41) or AE (RR 1.08; 95% CI 0.86-1.36; p = 0.49). Sensitivity analyses confirmed the robustness of the findings. MWA combined with chemotherapy significantly improves PFS in advanced NSCLC without increasing toxicity.