Abbas Ghulam, Schuchert Matthew J, Pennathur Arjun, Gilbert Sebastien, Luketich James D
Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
Thorac Surg Clin. 2007 May;17(2):261-71. doi: 10.1016/j.thorsurg.2007.03.007.
RFA and SRS have been demonstrated to be safe with reasonable efficacy in the treatment of small lung tumors. It is unclear which option is the most effective in the treatment of NSCLC, with both RFA and SRS demonstrating similar early response and progression rates. RFA can be performed in one treatment session, whereas it now seems that SRS is more effective if larger doses of radiation over two to three fractions are performed. RFA is not recommended for centrally based tumors. There are also some tumors (eg, small apical tumors, posteriorly positioned tumors close to the diaphragm, and tumors close to the scapula) where it may be difficult percutaneously to position an active electrode. Such patients are more optimally treated with SRS. In certain circumstances, a combined approach may be beneficial (RFA and SRS). At this point in time, MWA is the least well developed modality. Although treatment times and heat-sink effect may be less compared with RFA, larger trials are needed to understand better the impact of this factor on effectiveness and safety. The heat-sink effect may be protective, minimizing the necrosis of large blood vessels and the risk of subsequent fatal hemoptysis. Future studies need to address long-term outcomes using standardized assessments of treatment response between centers. Comparisons between different RFA systems and ablation modalities need to be undertaken to delineate the optimal use of these strategies in the treatment of early stage lung cancer. Until long-term data with these ablative techniques become available, surgical resection should be performed when clinically possible.
射频消融（RFA）和立体定向放射治疗（SRS）已被证明在治疗小肺肿瘤方面是安全的，且疗效合理。目前尚不清楚哪种方法在治疗非小细胞肺癌（NSCLC）方面最有效，RFA和SRS的早期反应率和进展率相似。RFA可在一次治疗中完成，而现在看来，如果分两到三次给予更大剂量的辐射，则SRS更有效。不建议对中央型肿瘤进行RFA。也有一些肿瘤（例如小尖部肿瘤、靠近膈肌的后部肿瘤以及靠近肩胛骨处的肿瘤），经皮放置活性电极可能会比较困难。此类患者采用SRS治疗更为理想。在某些情况下，联合治疗方法（RFA和SRS）可能有益。目前，微波消融（MWA）是发展最不完善的治疗方式。尽管与RFA相比，治疗时间和热沉效应可能较小，但仍需要更大规模试验以更好地了解该因素对有效性和安全性的影响。热沉效应可能具有保护作用，可将大血管坏死及随后致命性咯血的风险降至最低。未来研究需要通过各中心间标准化的治疗反应评估来探讨长期疗效。需要对不同的RFA系统和消融方式进行比较，以明确这些策略在早期肺癌治疗中的最佳应用。在获得这些消融技术的长期数据之前，临床可行时应进行手术切除。
