Department of Radiology, St Vincent's University Hospital, Dublin, Ireland.
J Thorac Imaging. 2011 Feb;26(1):18-26. doi: 10.1097/RTI.0b013e3181e48d5e.
The aim of this study was to evaluate the literature for articles assessing radiofrequency ablation (RFA) for pulmonary malignancy.
The "bottom-up" approach to evidence-based practice was applied by 2 reviewers to the retrieval and appraisal of original research articles published on pulmonary RFA between 2002 and 2009. Primary lung cancer and pulmonary metastases data were analyzed separately. The relationship between the percentage of local recurrence rate and lesion size, patient age, follow-up duration, and time to local recurrence was assessed using Spearman's rank correlation. Discrete time series were used to evaluate time trends.
Secondary evidence yielded 1 review of 26 observational studies. Primary evidence yielded 46 studies that seemed suitable for detailed appraisal. A total of 2905 ablations were performed in 1584 patients. Eight studies evaluated primary lung cancers alone, 11 evaluated pulmonary metastases alone, 25 evaluated both, and 2 did not specify the histology. Results revealed trends toward increasing use of conscious sedation over general anesthesia, increasing use of multitined probes, decreasing size of nodule selection, and use of positron emission tomography/computed tomography as the optimal follow-up tool. Mean morbidity was 24.6%. The most prevalent side effects included pneumothorax (28.3%), pleural effusions (14.8%), and pain (14.1%). Procedure-related mortality ranged from 0 to 5.6, with an overall procedure-related mortality rate of 0.21%. There were 282 (12.2%) local recurrences occurring at a mean of 13 months. The mean overall survival rate was 59.4%, and the cancer-specific survival rate was 82.6%.
This evidence-based practice review of pulmonary RFA shows it to be a promising treatment for pulmonary malignancy in carefully selected patient populations. Studies with higher levels of evidence, including case-control, prospective nonrandomized and randomized trials, that compare RFA with alternative contemporary local treatments are urgently needed.
本研究旨在评估评估射频消融（RFA）治疗肺部恶性肿瘤的文献。
采用循证实践的“自下而上”方法，由两名审查员检索和评估 2002 年至 2009 年间发表的关于肺 RFA 的原始研究文章。分别分析原发性肺癌和肺转移数据。使用 Spearman 等级相关评估局部复发率与病变大小、患者年龄、随访时间和局部复发时间之间的关系。使用离散时间序列评估时间趋势。
次要证据得出了 26 项观察性研究的综述。主要证据得出了 46 项似乎适合详细评估的研究。共对 1584 名患者的 2905 个消融部位进行了治疗。8 项研究单独评估原发性肺癌，11 项研究单独评估肺转移，25 项研究同时评估两者，2 项研究未具体说明组织学。结果显示，清醒镇静的使用率逐渐增加，多齿探针的使用率逐渐增加，结节选择的尺寸逐渐减小，正电子发射断层扫描/计算机断层扫描作为最佳随访工具的使用率逐渐增加。平均发病率为 24.6%。最常见的副作用包括气胸（28.3%）、胸腔积液（14.8%）和疼痛（14.1%）。与手术相关的死亡率范围为 0 至 5.6%，总手术相关死亡率为 0.21%。有 282 例（12.2%）局部复发发生在平均 13 个月。总的生存率为 59.4%，癌症特异性生存率为 82.6%。
本对肺 RFA 的循证实践综述表明，它是一种有前途的治疗方法，适用于精心挑选的患者人群中的肺部恶性肿瘤。迫切需要更高水平的证据研究，包括病例对照、前瞻性非随机和随机试验，将 RFA 与替代的当代局部治疗方法进行比较。
