Padda Sukhmani, Kothary Nishita, Donington Jessica, Cannon Walter, Loo Billy W, Kee Stephen, Wakelee Heather
Department of Medicine, Stanford University, Stanford, CA, USA.
Clin Lung Cancer. 2008 Mar;9(2):122-6. doi: 10.3816/CLC.2008.n.019.
Two cases of complications secondary to the use of microwave ablation (MWA) in non-small-cell lung cancer (NSCLC) are discussed herein. The first case involves a 62-year-old man with stage IB NSCLC who declined surgery and pursued MWA. Within 7 months, he had residual disease at the MWA treatment site, and surgery was performed. The patient was found to have pleural and chest wall involvement, making complete resection impossible. The second case involves an 86-year-old woman with a second local recurrence of NSCLC and previous treatment including surgery and chemoradiation therapy. She was initially a surgical candidate but declined surgery and pursued MWA. Within 6 months, she had residual disease at the MWA treatment site. A second MWA was performed, and she developed a large cavitary abscess at the MWA site and had subsequent clinical decline. Less invasive ablation therapies and stereotactic radiosurgery are being developed for patients with inoperable lung cancer. Because these modalities have recently been developed, trials that clearly show efficacy and survival benefit are yet to be completed. Ablation procedures can result in complications, including residual disease and cavitary lesions susceptible to infection. These cases highlight the caution that should still be observed when recommending lung ablation strategies and the importance of selecting appropriate patients.
本文讨论了两例非小细胞肺癌（NSCLC）患者使用微波消融（MWA）后出现的并发症。第一例患者为一名62岁的IB期NSCLC男性，拒绝手术而选择MWA。7个月内，他在MWA治疗部位出现残留病灶，随后接受了手术。术中发现患者存在胸膜和胸壁受累，无法进行完整切除。第二例患者是一名86岁的女性，NSCLC出现第二次局部复发，既往接受过手术及放化疗。她最初符合手术指征，但拒绝手术而选择MWA。6个月内，她在MWA治疗部位出现残留病灶。进行了第二次MWA后，她在MWA部位出现了一个大的空洞性脓肿，随后病情临床恶化。目前正在为无法手术的肺癌患者开发侵入性较小的消融治疗和立体定向放射外科治疗。由于这些治疗方式是最近才开发出来的，尚未完成能明确显示疗效和生存获益的试验。消融手术可能导致并发症，包括残留病灶和易感染的空洞性病变。这些病例凸显了在推荐肺部消融策略时仍应谨慎的必要性，以及选择合适患者的重要性。
