Clinical Center for Tumor Therapy, Second Affiliated Hospital of Chongqing Medical University, 74 Linjiang Rd, Chongqing 400010, China.
Radiology. 2010 Jun;255(3):967-78. doi: 10.1148/radiol.10090374.
To evaluate the long-term follow-up results of ultrasonographically (US)-guided high-intensity focused ultrasound ablation in patients with primary bone malignancy.
The study was approved by the ethics committee. Each patient or parent (if patient was younger than 18 years), signed an informed consent form before being selected and treated. From December 1997 to November 2004, 80 patients with a primary bone malignancy-60 with stage IIb disease and 20 with stage III disease (Enneking staging system)-were treated with US-guided high-intensity focused ultrasound ablation. High-intensity focused ultrasound ablation combined with chemotherapy was performed in 62 patients with osteosarcoma, one patient with periosteal osteosarcoma, and three patients with Ewing sarcoma. The remaining 14 patients had chondrosarcoma, giant cell bone cancer, periosteal sarcoma, or an unknown malignancy and were treated with high-intensity focused ultrasound ablation only. Magnetic resonance (MR) imaging or computed tomography (CT), and single photon emission computed tomography (SPECT) were used to assess tumor response. Cumulative survival rates were calculated by using the Kaplan-Meier method. Adverse effects were recorded.
High-intensity focused ultrasound ablation guided by real-time US was performed. Follow-up images demonstrated completely ablated malignant bone tumors in 69 patients and greater than 50% tumor ablation in the remaining 11 patients. Overall survival rates at 1, 2, 3, 4, and 5 years were 89.8%, 72.3%, 60.5%, 50.5%, and 50.5%, respectively. Survival rates at 1, 2, 3, 4, and 5 years were 93.3%, 82.4%, 75.0%, 63.7%, and 63.7%, respectively, in the patients with stage IIb cancer and 79.2%, 42.2%, 21.1%, 15.8%, and 15.8%, respectively, in those with stage III disease. Among the patients with stage IIb disease, long-term survival rates were substantially improved in the 30 patients who received the full treatment-that is, complete high-intensity focused ultrasound and full cycles of chemotherapy-compared with the survival rates for the 24 patients who did not finish the chemotherapy cycles and the six patients who underwent partial ablation only. Only five (7%) of the 69 patients who underwent complete ablation had local cancer recurrence during the follow-up period. Forty adverse events were recorded, with 14 patients requiring surgical intervention.
US-guided high-intensity focused ultrasound ablation of malignant bone tumors is feasible and effective and eventually may be a component of limb-sparing techniques for patients with these cancers.
评估超声引导高强度聚焦超声消融术治疗原发性骨恶性肿瘤的长期随访结果。
本研究经伦理委员会批准。每位患者或家长（如果患者小于 18 岁）在选择和治疗前均签署了知情同意书。从 1997 年 12 月至 2004 年 11 月，80 例原发性骨恶性肿瘤患者-60 例 IIb 期疾病和 20 例 III 期疾病（Enneking 分期系统）接受了超声引导高强度聚焦超声消融术治疗。62 例骨肉瘤患者、1 例骨膜骨肉瘤患者和 3 例尤文肉瘤患者接受了高强度聚焦超声消融术联合化疗。其余 14 例患者患有软骨肉瘤、巨细胞瘤、骨旁肉瘤或不明恶性肿瘤，仅接受高强度聚焦超声消融术治疗。磁共振（MR）成像或计算机断层扫描（CT）和单光子发射计算机断层扫描（SPECT）用于评估肿瘤反应。采用 Kaplan-Meier 法计算累积生存率。记录不良反应。
采用实时超声引导高强度聚焦超声消融术。随访图像显示，69 例恶性骨肿瘤完全消融，11 例患者肿瘤消融大于 50%。总生存率在 1、2、3、4 和 5 年分别为 89.8%、72.3%、60.5%、50.5%和 50.5%。IIb 期患者的生存率在 1、2、3、4 和 5 年分别为 93.3%、82.4%、75.0%、63.7%和 63.7%，III 期患者分别为 79.2%、42.2%、21.1%、15.8%和 15.8%。在 IIb 期患者中，接受完整治疗（即完全高强度聚焦超声和完整化疗周期）的 30 例患者的长期生存率显著提高，与未完成化疗周期的 24 例患者和仅行部分消融的 6 例患者的生存率相比。在随访期间，69 例完全消融的患者中仅有 5 例（7%）出现局部癌症复发。记录了 40 起不良事件，14 名患者需要手术干预。
超声引导高强度聚焦超声消融术治疗恶性骨肿瘤是可行且有效的，最终可能成为这些癌症保肢技术的组成部分。
