Suh Robert D, Wallace Amanda B, Sheehan Ramon E, Heinze Stefan B, Goldin Jonathan G
Department of Radiological Sciences, UCLA Medical Center, 10833 Le Conte Ave, B2-168, Center for the Health Sciences, Los Angeles, CA 90095-1721, USA.
Radiology. 2003 Dec;229(3):821-9. doi: 10.1148/radiol.2293021756.
To assess whether percutaneous radiofrequency (RF) ablation of unresectable pulmonary malignancies is safe and technically feasible and to evaluate the usefulness of computed tomographic (CT) nodule densitometry as a tool for following up tumors after ablation.
Twelve patients (seven men and five women; mean age, 60.6 years) with unresectable disease (because of poor lung reserve or multifocality) underwent nodule CT densitometry and CT-guided percutaneous RF ablation of 19 lung tumors (six [32%] tumors were adenocarcinoma, one (5%) was large cell carcinoma, two (10%) were bronchoalveolar carcinoma, four (21%) were colorectal carcinoma, and six (32%) were sarcoma less than 50 cm2 in area (range, 0.25-35.00 cm2). No patients had symptoms of their disease before RF ablation. Follow-up CT densitometry was scheduled for 1, 3, 6, and 12 months after RF ablation. Lesions were evaluated for change in area and contrast enhancement at follow-up CT.
RF ablation was well tolerated by all patients. Intraprocedural complications included 12 cases of pneumothoraces (two patients required chest tube placement, while 10 were asymptomatic and required no further treatment), two cases of pleural effusion, and two cases of moderate pain (one case during and one case both during and after the procedure). Mean follow-up was 4(1/2) months (range, 1-12 months). In the eight patients with 3-month follow-up, lesion size increased in two and remained stable in six. Mean contrast enhancement, however, decreased from 46.8 HU (range, 19-107 HU) at baseline to 9.6 HU (range, 0-32 HU) at 1-2-month follow-up. In the one patient with 12-month CT densitometry follow-up, lesion enhancement was less than 50% of that at baseline, and lesion diameter remained stable.
These preliminary results show that percutaneous RF ablation is a safe and technically feasible management option for unresectable pulmonary malignancies. CT densitometry may have potential for future use as a noninvasive method of following up tumors after RF ablation.
评估经皮射频（RF）消融不可切除的肺恶性肿瘤是否安全且技术上可行，并评估计算机断层扫描（CT）结节密度测定作为消融后肿瘤随访工具的实用性。
12例（7例男性和5例女性；平均年龄60.6岁）因肺储备功能差或多灶性而不可切除疾病的患者接受了结节CT密度测定及CT引导下经皮RF消融19个肺肿瘤（6个[32%]肿瘤为腺癌，1个[5%]为大细胞癌，2个[10%]为细支气管肺泡癌，4个[21%]为结直肠癌，6个[32%]为面积小于50 cm²的肉瘤（范围为0.25 - 35.00 cm²）。在RF消融前，所有患者均无疾病症状。计划在RF消融后1、3、6和12个月进行随访CT密度测定。在随访CT中评估病变的面积变化和对比增强情况。
所有患者对RF消融耐受性良好。术中并发症包括12例气胸（2例患者需要放置胸腔引流管，10例无症状且无需进一步治疗），2例胸腔积液，以及2例中度疼痛（1例在术中，1例在术中及术后）。平均随访时间为4（1/2）个月（范围为1 - 12个月）。在8例进行3个月随访的患者中，2例病变大小增加，6例保持稳定。然而，平均对比增强从基线时的46.8 HU（范围为19 - 107 HU）降至1 - 2个月随访时的9. HU（范围为0 - HU）。在1例进行12个月CT密度测定随访的患者中，病变增强小于基线时的50%，且病变直径保持稳定。
这些初步结果表明，经皮RF消融是不可切除肺恶性肿瘤的一种安全且技术上可行的治疗选择。CT密度测定可能有潜力在未来用作RF消融后肿瘤随访的非侵入性方法。
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