Radiofrequency ablation for the treatment of non-small cell lung cancer in marginal surgical candidates
Radiofrequency ablation for the treatment of non-small cell lung cancer in marginal surgical candidates
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DOI：
10.1016/j.jtcvs.2004.10.019
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发表时间：
2005-03-01
影响因子：
6
通讯作者：
Luketich, JD
中科院分区：
文献类型：
--
作者：
Fernando, HC;De Hoyos, A;Luketich, JD
目的：非手术或拒绝手术的非小细胞肺癌患者的治疗选择有限。射频消融术对这些患者来说是一种潜在的侵入性较小的选择。本文报告了射频消融治疗周围型、原发性非小细胞肺癌的初步经验。中位年龄为75岁(58-86岁)。癌分期I期9例，II期2例，III期3例，IV期4例。IV期患者包括3例在既往肝叶切除术后复发，I期同时发生肝转移的患者也接受了射频消融治疗。肿瘤平均直径2.8CIN(1.2~4.5 cm)，2例行小切口射频消融，16例行CT引导下经皮消融。应用计算机断层扫描和正电子发射断层扫描评估消融结节的复发和放射学反应。结果：开放射频消融术后1例死于肺炎。中位住院天数为2.5天。7例(38.9%)患者因手术相关的胸膜前病变需要胸管或猪尾导尿管。平均随访14个月，15名患者(83.3%)存活。局部进展8个(38.1%)。平均和中位无进展间隔分别为16.8个月和18个月。对于I期癌症，平均无进展间隔为17.6个月。结论：本研究证实了射频消融治疗周围型小非小细胞肺癌的可行性。局部控制与放射治疗相当，如果不是更好的话。对于高危非小细胞肺癌患者，胸科医生应继续评估射频消融术是否是一种非侵入性治疗方法。
Objective: Treatment options for patients with non-small cell lung cancer who are not surgical candidates or who refuse operation are limited. Radiofrequency ablation represents a potential less invasive option for these patients. Our initial experience with radiofrequency ablation for peripheral, primary non-small cell lung cancer is reported.Methods: We treated 21 tumors in 18 patients. Median age was 75 (range 58-86) years. Cancer stages were I (n = 9), II (n = 2), III (n = 3), and IV (n = 4). Patients with stage IV disease included 3 with recurrence after previous lobectornies and I with a synchronous liver metastasis also treated with radiofrequency ablation. Median tumor diameter was 2.8 cin (range 1.2-4.5 cm), Radiofrequency ablation was delivered by minithoracotomy in 2 cases and by a computed tomography-guided percutaneous approach in 16 patients. Computed tomographic and positron emission tornographic scans were used to evaluate recurrence and radiographic response in ablated nodules.Results: One postoperative death occurred from pneumonia after open radiofrequency ablation. Median hospital stay was 2.5 days. A chest tube or pigtail catheter was required in 7 patients (38.9%) for procedure- related preurnothoraces. At a median follow-up of 14 months, 15 patients (83.3%) were alive. Local progression occurred in 8 nodules (38.1%). Mean and median progression-free intervals were 16.8 and 18 months, respectively. For stage I cancers, rnean progression-free interval was 17.6 months. Median progression-free interval was not reached.Conclusion: This study demonstrates the feasibility of radiofrequency ablation for small, peripheral non-small cell lung cancer tumors. Local control is comparable to, if not better than, that provided by radiotherapy. Radiofrequency ablation should continue to be evaluated by thoracic surgeons as a noninvasive therapy for the high-risk patient with non-small cell lung cancer.