Radiofrequency ablation for treatment of medically inoperable stage I non-small cell lung cancer
Radiofrequency ablation for treatment of medically inoperable stage I non-small cell lung cancer
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DOI：
10.1016/j.jtcvs.2008.08.034
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发表时间：
2009-01-01
影响因子：
6
通讯作者：
Shepard, Jo-Anne O.
中科院分区：
文献类型：
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作者：
Lanuti, Michael;Sharma, Amita;Shepard, Jo-Anne O.
目的：本研究评估射频消融治疗医学上不能手术的早期肺癌的长期效果。方法：连续31例经活检证实的非小细胞肺癌患者在4.5年的时间里接受了38次ct引导射频消融术治疗。所有患者都经过仔细挑选，并被多学科团队认为医学上不适合切除。射频消融以治疗为目的，使用单个或簇冷尖端电极。患者住院观察23小时。结果：所有病例均完成治疗，无30天死亡率。在31.5%（12/38）的治疗后，通过计算机断层扫描、正电子发射断层扫描或两者均证实局部复发。2例患者因气胸相关技术故障成功退诊；3例接受放疗，病情稳定。38例肿瘤平均最大直径为2.0±1.0 cm（范围0.8 ~ 4.4 cm）。中位随访17 +/- 11个月后，74%的患者（23/31）存活。3例患者死于转移性疾病；5人死于肺炎，治疗不及时。2年和4年生存率分别为78%和47%。中位总生存期为30个月。气胸（13%）、肺炎（16%）和胸腔积液（21%）是最常见的并发症。结论：在精心挑选的不能手术的早期肺癌患者中，射频消融术产生了令人鼓舞的中期结果，没有明显的肺功能丧失。局部肿瘤进展似乎与大于3cm的肺肿瘤有关。计算机断层扫描和正电子发射断层扫描需要进一步验证，以早期识别射频消融后局部肿瘤的进展。
Objective: This study evaluated long-term results of radiofrequency ablation for medically inoperable early-stage lung cancer.Methods: Thirty-one consecutive patients with biopsy-proven non-small cell lung cancer underwent 38 treatments of computed tomographically guided radiofrequency ablation in a 4.5-year period. All patients were carefully selected and deemed medically ineligible for resection by a multidisciplinary team. Radiofrequency ablation was performed with curative intent with a single or cluster cool-tip electrode. Patients were hospitalized for 23-hour observation.Results: Treatment was complete in all cases, with no 30-day mortality. Local recurrence was confirmed radiographically by computed tomography, positron emission tomography, or both after 31.5% of treatments (12/38). Two patients were successfully retreated for technical failures related to pneumothorax; 3 underwent radiotherapy with stable disease. Mean maximal diameter of 38 tumors treated was 2.0 +/- 1.0 cm ( range 0.8-4.4 cm). After median follow-up of 17 +/- 11 months, 74% of patients (23/31) were alive. Three patients died of metastatic disease; 5 died of pneumonia remote from treatment. The 2- and 4-year survivals were 78% and 47%, respectively. Median overall survival was 30 months. Pneumothorax (13%), pneumonia (16%), and pleural effusion (21%), were the most common complications.Conclusions: Radiofrequency ablation of medically inoperable early-stage lung cancer in carefully selected patients yields encouraging midterm results without significant loss of pulmonary function. Local tumor progression appears related to lung tumors larger than 3 cm. Computed tomography and positron emission tomography need further validation for the early identification of local tumor progression following radiofrequency ablation.