Wood Bradford J, Abraham Jame, Hvizda Julia L, Alexander H Richard, Fojo Tito
Special Procedures, Department of Diagnostic Radiology, Clinical Center, National Institutes of Health Clinical Center, Bethesda, Maryland, USA.
Cancer. 2003 Feb 1;97(3):554-60. doi: 10.1002/cncr.11084.
The current study was performed to analyze the feasibility, safety, imaging appearance, and short-term efficacy of image-guided percutaneous radiofrequency ablation (RFA) of primary and metastatic adrenal neoplasms including adrenocortical carcinoma.
The procedure was performed using 36 treatment spheres on 15 adrenocortical carcinoma primary or metastatic tumors in eight patients over 27 months. Tumors ranged from 15 to 90 mm in greatest dimension with a mean of 43 mm. All patients had unresectable tumors or were poor candidates for surgery. Mean follow-up was 10.3 months.
All patients were discharged or were free of procedure-related medical care 6-48 hours after the procedures without major complications. All treatments resulted in presumptive coagulation necrosis by imaging criteria, which manifested as loss of previous contrast enhancement in ablated tissue. Eight of 15 (53%) posttreatment thermal lesions lost enhancement and stopped growing on latest follow-up computed tomographic scan. Three of 15 (20%) demonstrated interval growth and four did not change in size. Of these four lesions, two showed contrast enhancement. For smaller tumors with a mean greatest dimension less than or equal to 5 cm, 8 of 12 (67%) tumors were completely ablated, as defined by decreasing size and complete loss of contrast enhancement. Three of 15 (20 %) tumors and related thermal lesions were found to have disappeared nearly completely on imaging.
Percutaneous, image-guided RFA is a safe and well tolerated procedure for the treatment of unresectable primary or metastatic adrenocortical carcinoma. The procedure is effective for the short-term local control of small adrenal tumors, and is most effective for tumors less than 5 cm. The survival rate for patients with adrenocortical carcinoma improves when radical excision is performed in selected patients. Aggressive local disease control may potentially influence survival as well. However, further study is required to evaluate survival impact, document long-term efficacy, and to determine if RFA can obviate repeated surgical intervention in specific clinical scenarios.
本研究旨在分析影像引导下经皮射频消融（RFA）治疗包括肾上腺皮质癌在内的原发性和转移性肾上腺肿瘤的可行性、安全性、影像学表现及短期疗效。
在27个月内，对8例患者的15个原发性或转移性肾上腺皮质癌肿瘤使用36个治疗球进行该手术。肿瘤最大直径为15至90毫米，平均为43毫米。所有患者均为不可切除肿瘤或手术不佳候选者。平均随访时间为10.3个月。
所有患者在术后6 - 48小时出院或无需进行与手术相关的医疗护理，无重大并发症。所有治疗通过影像学标准均导致推测性凝固性坏死，表现为消融组织中先前的对比增强消失。15个治疗后热损伤中有8个（53%）在最新的随访计算机断层扫描中失去增强且停止生长。15个中有3个（20%）显示有间隔期生长，4个大小未改变。在这4个病变中，2个显示有对比增强。对于平均最大直径小于或等于5厘米的较小肿瘤，12个中有8个（67%）肿瘤完全消融，定义为大小减小和对比增强完全消失。15个肿瘤中有3个（20%）及相关热损伤在影像学上几乎完全消失。
影像引导下经皮RFA是治疗不可切除的原发性或转移性肾上腺皮质癌的一种安全且耐受性良好的手术。该手术对小肾上腺肿瘤的短期局部控制有效，对小于5厘米的肿瘤最有效。对选定患者进行根治性切除时，肾上腺皮质癌患者的生存率会提高。积极的局部疾病控制也可能潜在地影响生存率。然而，需要进一步研究来评估对生存的影响、记录长期疗效，并确定RFA是否能避免在特定临床情况下的重复手术干预。
