Radiofrequency ablation of thoracic lesions: Part 2, initial clinical experience - Technical and multidisciplinary considerations in 30 patients
Radiofrequency ablation of thoracic lesions: Part 2, initial clinical experience - Technical and multidisciplinary considerations in 30 patients
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DOI：
10.2214/ajr.184.2.01840381
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发表时间：
2005-02-01
影响因子：
5
通讯作者：
Sugarbaker, DJ
中科院分区：
文献类型：
--
作者：
vanSonnenberg, E;Shankar, S;Sugarbaker, DJ
目标。我们研究的目的是报告我们对接受经皮成像引导的胸椎病变射频消融的患者的初步经验，并强调胸椎肿瘤消融的技术和多学科问题以及辅助手术。材料和方法。我们的队列包括30例患者，他们有原发性（18例）和继发性（11例）肺肿瘤、间皮瘤（1例）和5例继发性侵蚀、疼痛的肋骨，他们接受了总共36个病灶的消融（1例患者进行了两次消融）。患者或因医疗合并症或疾病程度而选择非手术治疗，或已用尽化疗和放疗方案，或拒绝手术或手术失败。经肿瘤学家、胸外科医生和介入放射科医生一致同意，患者接受射频消融治疗。在阻抗控制下使用阵列式电极治疗29例胸部肿瘤和邻近肋骨转移瘤（n = 5）。两名患者使用了冷尖端射频探针。除1例患者外，其余患者均采用CT引导和全身麻醉。1例患者采用超声引导和静脉清醒镇静。疼痛（n = 11）和肿瘤治愈或控制（n = 19）是手术的主要指征。射频消融的辅助手术包括盐水窗或水窗（n = 3）；经骨和经软骨路线的建立（n = 4）；肋间和椎旁神经阻滞（n = 15）；并使用术中导管（n = 1），针（n = 1）或鞘（n = 3）治疗气胸。随访2 ~ 26个月。所有的消融在技术上都是成功的。手术期间无死亡发生。根据短期随访成像（CT、PET、MRI）， 30个病变中26个肿瘤坏死大于90%。在11例接受消融术治疗疼痛的患者中，4例完全缓解，7例部分缓解。1例患者出现局部皮肤烧伤，4例患者在消融后4天出现自限性咯血，1例患者出现短暂性心房颤动，1例患者出现声音嘶哑，2例患者拔管后短暂重新插管。发生气胸8例；一名患者接受了胸管置入。4例患者因肿瘤胸外扩散而在消融术后1年内死亡。射频消融术对多种胸椎肿瘤的治疗是安全的，对疼痛控制和肿瘤杀伤有很高的疗效。消融的效果可通过CT、MRI或PET进行评估。各种技术问题将胸部肿瘤消融与标准腹部消融区分开来。许多其他胸椎介入放射学手术都有利于辅助射频消融。多学科方法为患者护理提供了宝贵的专业知识。
OBJECTIVE. The purpose of our study was to report our initial experience with patients who underwent percutaneous imaging-guided radiofrequency ablation of thoracic lesions, and to emphasize technical and multidisciplinary issues and adjunctive procedures specific to thoracic tumor ablation.MATERIALS AND METHODS. Our cohort consisted of 30 patients with a spectrum of primary (n = 18) and secondary (n = 11) lung tumors, mesothelioma (n = 1), and five secondarily eroded, painful ribs who underwent ablation of 36 total lesions (one patient had two ablations). Patients either were nonsurgical candidates because of medical comorbidities or extent of disease, or had exhausted chemotherapy and radiation therapy options, or had refused surgery or undergone unsuccessful surgery. Patients were treated with radiofrequency ablation after agreement among oncologists, thoracic surgeons, and interventional radiologists. An array-style electrode under impedance control was used to treat 29 thoracic tumors and the adjacent rib metastases (n = 5). A cool-tip radiofrequency probe was used for two patients. CT guidance and general anesthetic were used for all but one patient. Sonographic guidance and IV conscious sedation were used in one patient. Pain (n = 11) and tumor cure or control (n = 19) were the primary indications for the procedures. Adjunctive procedures to the radiofrequency ablations included the creation of saline or water windows (n = 3); establishment of transosseous and transchondral routes (n = 4); use of intercostal and paravertebral nerve blocks (n = 15); and use of an intraprocedural catheter (n = 1), needle (n = 1), or sheath (n = 3) for treatment of pneumothoraces. Follow-up was from 2 to 26 months.RESULTS. All ablations were technically successful. No periprocedural mortality occurred. Necrosis of tumor was greater than 90% in 26 of 30 lesions based on short-term follow-up imaging (CT, PET, MRI). In the 11 patients who underwent ablation for pain, relief was complete in four and partial in the other seven. One patient developed a local skin burn, four patients had self-limited hemoptysis up to 4 days after ablation, one had transient aytial fibrillation, one developed hoarseness, and two patients were transiently reintubated after extubation. Eight pneumothoraces developed; one patient underwent placement of a chest tube. Four patients died within 1 year of ablation from extrathoracic spread of tumor.CONCLUSION. Radiofrequency ablation for a variety of thoracic tumors can be performed safely and with a high degree of efficacy for pain control and tumor killing. The effect of ablation can be assessed with CT, MRI, or PET. Various technical issues differentiate thoracic tumor ablation from standard abdominal ablations. Numerous other thoracic interventional radiology procedures are beneficial to assist the radiofrequency ablation. A multidisciplinary approach offers valuable expertise for patient care.