Bronchoscopic pulsed electric field ablation for locally advanced and metastatic NSCLC: A six-patient real-world experience from a rural community hospital.

Abstract

e23399 Background: ALIYA pulsed electric field (PEF) ablation is a bronchoscopic, non-thermal local therapy designed to induce immunogenic tumor cell death while preserving stromal architecture. Real-world data from rural or non-tertiary settings remain limited. We describe feasibility, safety, and early outcomes following bronchoscopic ALIYA PEF in locally advanced or metastatic NSCLC treated in a rural community oncology program at Guthrie Clinic Sayre PA. Methods: We retrospectively reviewed all patients with NSCLC who underwent bronchoscopic ALIYA PEF between 03/2025 and 07/2025. Clinical characteristics, procedural details, treatment sequencing, radiographic response (RECIST v1.1), and adverse events (CTCAE v5.0) were abstracted from the medical record. Results: Six patients (median age 66.5 years; range 42–70) underwent PEF without procedural interruption or acute complications. Histology was adenocarcinoma in four patients and squamous cell carcinoma in two. PEF was performed upfront prior to chemoradiation/systemic therapy (n = 2) or at locoregional/metastatic recurrence (n = 4). Two patients underwent PEF during active immunotherapy, and 5/6 received immunotherapy during their treatment course. No pneumothorax, arrhythmia, hemodynamic instability, airway compromise, or PEF-related grade ≥3 toxicity occurred within 30 days. All patients initiated or continued systemic therapy without delay attributable to PEF. The best RECIST response was PR in 2 patients, SD in 1, and PD in 3. In-field control was maintained in 5/6 patients (83%), with one in-field recurrence and predominantly distant progression. Median time to progression (TTP; from PEF to first radiographic or clinical progression) was 7.5 months. At a median follow-up of 11.2 months (range 4.4–19), all patients were alive and receiving systemic therapy at last follow-up. No immune-related adverse events were clinically attributed to PEF. Conclusions: Bronchoscopic ALIYA PEF was technically feasible and well tolerated in a rural community oncology program, with no PEF-related grade ≥3 toxicity or systemic therapy delays. In-field control was maintained in most patients. These results support prospective evaluation of PEF as an adjunct to standard chemoradiation and immunotherapy strategies in NSCLC.