Pennathur Arjun, Luketich James D, Abbas Ghulam, Chen Mang, Fernando Hiran C, Gooding William E, Schuchert Matthew J, Gilbert Sebastien, Christie Neil A, Landreneau Rodney J
Heart, Lung, and Esophageal Surgery Institute, Pittsburgh, Pa, USA.
J Thorac Cardiovasc Surg. 2007 Oct;134(4):857-64. doi: 10.1016/j.jtcvs.2007.04.060. Epub 2007 Aug 29.
Surgical resection is the standard of care for stage I non-small cell lung cancer. The objective of this study was to evaluate computed tomography-guided radiofrequency ablation as an alternative treatment option for high-risk patients with stage I non-small lung cancer.
Patients with medically inoperable stage I non-small lung cancer were offered radiofrequency ablation. Thoracic surgeons evaluated and performed radiofrequency ablation under computed tomographic scanning guidance. Response was assessed by means of computed tomographic and positron emission tomographic scanning. Time to progression and survival were monitored every 3 months.
Nineteen patients underwent radiofrequency ablation over a 3-year period. There were 8 men and 11 women with a median age of 78 years (range, 68-88 years). Radiofrequency ablation resulted in pneumothorax requiring a pigtail catheter in 12 (63%) patients. An initial complete response was observed in 2 (10.5%) patients, a partial response in 10 (53%) patients, and stable disease in 5 (26%) patients. Early progression occurred in 2 (10.5%) patients. During follow-up, local progression occurred in 8 (42%) nodules, and the median time to progression was 27 months. There were no procedure-related mortalities, and 6 deaths occurred during follow-up. The mean follow-up in the remaining patients was 29 months (range, 9-52 months). The probability of survival at 1 year was estimated to be 95% (95% confidence interval, 0.85-1.0). The median survival was not reached.
Our experience indicates that radiofrequency ablation is safe in high-risk patients with stage I non-small lung cancer, with reasonable results in patients who are not fit for surgical intervention.
手术切除是Ⅰ期非小细胞肺癌的标准治疗方法。本研究的目的是评估计算机断层扫描引导下的射频消融作为Ⅰ期非小肺癌高危患者的替代治疗选择。
为患有医学上无法手术的Ⅰ期非小肺癌患者提供射频消融治疗。胸外科医生在计算机断层扫描引导下进行评估并实施射频消融。通过计算机断层扫描和正电子发射断层扫描评估反应情况。每3个月监测疾病进展时间和生存率。
在3年期间，19例患者接受了射频消融治疗。其中男性8例，女性11例，中位年龄为78岁（范围68 - 88岁）。射频消融导致12例（63%）患者出现气胸，需要置入猪尾导管。2例（10.5%）患者出现初始完全缓解，10例（53%）患者出现部分缓解，5例（26%）患者病情稳定。2例（10.5%）患者出现早期进展。在随访期间，8个（42%）结节出现局部进展，进展的中位时间为27个月。无手术相关死亡，随访期间有6例死亡。其余患者的平均随访时间为29个月（范围9 - 52个月）。1年生存率估计为95%（95%置信区间，0.85 - 1.0）。未达到中位生存期。
我们的经验表明，射频消融对于Ⅰ期非小肺癌高危患者是安全的，对于不适合手术干预的患者有合理的治疗效果。
