Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery.
Interventional Radiology, Department of Radiology, St George Hospital, Kogarah, Sydney, New South Wales, Australia.
Ann Oncol. 2010 Oct;21(10):2017-2022. doi: 10.1093/annonc/mdq098. Epub 2010 Mar 24.
Image-guided percutaneous radiofrequency ablation (RFA) has been proposed as an efficacious local therapy for lung metastases in nonsurgical candidates. Reports of long-term outcome from this treatment have been limited.
A prospective open-labeled trial of RFA was initiated in November 2000 for treatment of lung metastases in nonsurgical candidates. RFA was carried out under fluoroscopic computed tomography. Treatment complications and survival parameters were analyzed.
Of 148 patients treated, 66 patients (46%) had a complete response, 38 patents (26%) had a partial response, 57 patients (39%) had stable disease and 23 patients (16%) had progressive disease. The median progression-free survival was 11 months [95% confidence interval (CI) 9-14]. The median overall survival and 3- and 5-year survivals were 51 months (95% CI 19-83) and 60% and 45%, respectively. Disease-free interval (P = 0.013) and response to treatment (P = 0.002) were independent predictors for overall survival. Complications occurred in up to 45% of patients, of which 45 patients (30%) required chest tube placement.
This analysis confirms that RFA of lung metastases may achieve long-term survival in nonsurgical candidates with an acceptable complication rate hence supporting its incorporation into the oncosurgical management of lung metastases for the purposes of cure, stabilization and disease prolongation.
影像引导经皮射频消融（RFA）已被提议作为非手术患者肺转移的有效局部治疗方法。关于这种治疗的长期结果的报告有限。
2000 年 11 月，我们启动了一项 RFA 的前瞻性开放性试验，用于治疗非手术患者的肺转移。RFA 在透视计算机断层扫描下进行。分析了治疗并发症和生存参数。
在接受治疗的 148 例患者中，66 例（46%）完全缓解，38 例（26%）部分缓解，57 例（39%）疾病稳定，23 例（16%）疾病进展。无进展生存期的中位数为 11 个月[95%置信区间（CI）9-14]。总生存期的中位数和 3 年、5 年生存率分别为 51 个月（95%CI 19-83）和 60%和 45%。无病间隔（P=0.013）和对治疗的反应（P=0.002）是总生存期的独立预测因素。多达 45%的患者出现并发症，其中 45 例（30%）需要放置胸腔引流管。
这项分析证实，RFA 治疗肺转移可能为非手术患者带来长期生存，并发症发生率可接受，因此支持将其纳入肺转移的肿瘤外科治疗，以达到治愈、稳定和延长疾病的目的。
