Simon Caroline J, Dupuy Damian E, Iannitti David A, Lu David S K, Yu Nam C, Aswad Bassam I, Busuttil Ronald W, Lassman Charles
Department of Diagnostic Imaging, Brown Medical School, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA.
AJR Am J Roentgenol. 2006 Oct;187(4):W333-40. doi: 10.2214/AJR.05.0804.
Microwave ablation is emerging as a new treatment option for patients with unresectable hepatic malignancies. This two-center study shows the results of a phase 1 clinical trial of patients with known hepatic masses who underwent synchronous triple antenna microwave ablation before elective hepatic resection.
Intraoperative microwave ablation was performed before hepatic resection. Hepatic lesions were targeted using real-time intraoperative sonography with three microwave antennas positioned in a triangular configuration. Microwave ablation was performed at 45 W for 10 minutes. Hepatic resection was then completed in the standard fashion. Gross specimens were sectioned and measured to determine tumor and ablation sizes. Representative areas were stained with H and E stain and vital histochemical nicotinamide adenine dinucleotide (NADH) stain.
Ten patients with a mean age of 64 years (range, 48-79 years) were treated. Tumor histology included colorectal carcinoma metastases and hepatocellular carcinoma. The mean maximal tumor diameter was 4.4 cm (range, 2.0-5.7 cm). The mean maximal ablation diameter was 5.5 cm (range, 5.0-6.5 cm), while the average ablation zone volume was 50.8 cm3 (range, 30.3-65.5 cm3). Gross and microscopic examinations of areas after microwave ablation showed clear coagulation necrosis, even surrounding large hepatic vessels (> 3 mm in diameter). A marked thermallike effect was observed with maximal intensity closest to the antenna sites. NADH staining confirmed the uniform absence of viable tumor in the ablation zone.
This study shows the feasibility of using multiple microwave antennas simultaneously in the treatment of liver tumors intraoperatively. Additional percutaneous studies are currently under way to investigate the safety and efficacy in treating nonsurgical candidates.
微波消融正成为不可切除肝脏恶性肿瘤患者的一种新的治疗选择。这项双中心研究展示了一项1期临床试验的结果，该试验针对已知肝脏肿块的患者，在择期肝切除术前进行同步三天线微波消融。
在肝切除术前进行术中微波消融。使用实时术中超声定位肝脏病变，将三根微波天线呈三角形配置放置。以45瓦功率进行10分钟的微波消融。然后以标准方式完成肝切除。对大体标本进行切片和测量，以确定肿瘤和消融范围的大小。选取代表性区域进行苏木精-伊红（H&E）染色和重要的组织化学烟酰胺腺嘌呤二核苷酸（NADH）染色。
共治疗了10例患者，平均年龄64岁（范围48 - 79岁）。肿瘤组织学类型包括结直肠癌转移瘤和肝细胞癌。平均最大肿瘤直径为4.4厘米（范围2.0 - 5.7厘米）。平均最大消融直径为5.5厘米（范围5.0 - 6.5厘米），而平均消融区体积为50.8立方厘米（范围30.3 - 65.5立方厘米）。微波消融后区域的大体和显微镜检查显示有清晰的凝固性坏死，即使在大肝血管（直径>3毫米）周围也是如此。在最靠近天线部位观察到明显的类似热效应，强度最大。NADH染色证实消融区内均无存活肿瘤。
本研究表明术中同时使用多根微波天线治疗肝脏肿瘤是可行的。目前正在进行额外的经皮研究，以调查其在治疗非手术候选患者中的安全性和有效性。
