Fujiwara Jun, Nakamura Terukazu, Shiraishi Takumi, Mikami Kazuya, Takaha Natsuki, Ukimura Osamu, Kawauchi Akihiro, Miki Tsuneharu, Yamagami Takuji, Nishimura Tsunehiko
Department of Urology, Kyoto Prefectural University of Medicine.
Gan To Kagaku Ryoho. 2009 Nov;36(12):2117-20.
Radio-frequency ablation (RFA) has been successfully applied for local control of metastatic tumor. The aim of this study was to assess the effectiveness and safety of RFA to post-chemotherapeutic metastatic germ cell tumors (GCTs). As combined modality therapy, RFA was performed to 42 tumors in 19 patients of GCTs at our institution between November 2000 and December 2008. RFA was performed for 10 liver metastatic tumors (in 6 cases), 32 lung metastatic tumors (in 13 cases), and median age was 36 years old (range 20-53) and the median tumor size was 12 mm (range 2-40). We used Cool-tip RF system (straight electrode needle of the internal cooling type, Radionics, Palm Coast, USA) for RFA with ultrasound or CT fluorosent guidance under intravenous or local anesthesia. The therapeutic effect was assessed by the contrast-enhanced CT or MRI. When contrast enhancement was remained in the tumor, the treatment was repeated. The 28 evaluable lesions followed were with median 25 months in the term of the surveillance, and 9 tumors were treated by an additional session of RFA repeatedly. complete response (CR) was achieved in 12 out of 12 tumors (100%) with tumor maker normalization. On the other hand, 12 out of 16 tumors (75%) without marker normalization showed CR. All of the 24 tumors with tumor diameter of 30 mm or less achieved CR, and the tumor greater than 30 mm achieved no CR. Major complications included pneumothorax (n=9) and hemato-thoraxes (n=2), but no complications in surrounding organs. The chest drainage tube was required in 4 cases (36%). RFA might be an alternative therapeutic option of combined modality therapy as salvage therapy for post-chemotherapeutic metastatic germ cell tumors.
射频消融（RFA）已成功应用于转移性肿瘤的局部控制。本研究的目的是评估RFA对化疗后转移性生殖细胞肿瘤（GCT）的有效性和安全性。作为综合治疗方法，2000年11月至2008年12月期间，我们机构对19例GCT患者的42个肿瘤进行了RFA。对10个肝转移瘤（6例）、32个肺转移瘤（13例）进行了RFA，中位年龄为36岁（范围20 - 53岁），中位肿瘤大小为12 mm（范围2 - 40 mm）。我们使用Cool - tip射频系统（内部冷却型直电极针，美国棕榈海岸的Radionics公司），在静脉或局部麻醉下，通过超声或CT荧光透视引导进行RFA。通过增强CT或MRI评估治疗效果。当肿瘤内仍有造影剂增强时，重复治疗。对随后随访的28个可评估病变进行了中位25个月的监测，9个肿瘤重复进行了额外的RFA治疗。12个肿瘤中有12个（100%）肿瘤标志物正常化，达到完全缓解（CR）。另一方面，16个肿瘤中有12个（75%）肿瘤标志物未正常化，但也达到了CR。所有直径30 mm或更小的24个肿瘤均达到CR，大于30 mm的肿瘤未达到CR。主要并发症包括气胸（n = 9）和血胸（n = 2），但周围器官无并发症。4例（36%）需要放置胸腔引流管。RFA可能作为化疗后转移性生殖细胞肿瘤挽救治疗的一种综合治疗替代选择。
