Division of Thoracic Surgery, Cardiac Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
J Thorac Oncol. 2011 Dec;6(12):2044-51. doi: 10.1097/JTO.0b013e31822d538d.
About one-fifth of patients with resectable non-small cell lung cancer (NSCLC) are unsuitable for surgical treatment. Radiofrequency ablation offers an alternative minimally invasive option. We report the result of an intention-to-treat study with long-term follow-up.
From 2001 to 2009, we performed 80 percutaneous radiofrequency ablations of 59 stage I NSCLC in 57 inoperable patients. Two patients were treated for two separate lesions. The study group consisted of 45 males and 12 females, with mean age of 74 years (range, 40-88 years). All patients had pathological evidence of NSCLC, which was in stage IA in 44 cases and in stage IB in the other 15 cases. The mean size of the lesions was 2.6 cm (range, 1.1-5 cm). Fourteen lesions were retreated up to five times. The procedure was always performed under local anesthesia and conscious sedation. Most of the procedures were performed under computed tomography guidance, with nine under ultrasonography guidance.
In all cases, the procedure was technically successful. No mortality was recorded, and major morbidity consisted of four cases of pneumothorax requiring pleural drainage. At a mean follow-up of 47 months, the complete response rate was 59.3% (stage Ia 65.9%, stage Ib 40%, p = 0.01), with a mean local recurrence interval of 25.9 months. Median overall survival and cancer-specific survival were 33.4 and 41.4 months, respectively. Cancer-specific actuarial survival was 89% at 1 year, 59% at 3 years, and 40% at 5 years.
Radiofrequency ablation treatment of early-stage NSCLC seems to be a effective minimally invasive therapy even in the long-term period, particularly for stage Ia tumors.
约五分之一的可切除非小细胞肺癌（NSCLC）患者不适合手术治疗。射频消融术提供了一种微创的替代选择。我们报告了一项长期随访的意向治疗研究结果。
2001 年至 2009 年，我们对 57 名无法手术的患者中的 59 例 I 期 NSCLC 进行了 80 例经皮射频消融术。两名患者接受了两次单独的治疗。研究组包括 45 名男性和 12 名女性，平均年龄为 74 岁（范围，40-88 岁）。所有患者均有非小细胞肺癌的病理证据，其中 44 例为 IA 期，15 例为 IB 期。病变的平均大小为 2.6 厘米（范围，1.1-5 厘米）。14 个病灶最多进行了五次再治疗。该程序始终在局部麻醉和清醒镇静下进行。大多数程序在计算机断层扫描引导下进行，9 个在超声引导下进行。
在所有病例中，该程序均技术上成功。未记录到死亡率，主要并发症包括 4 例需要胸腔引流的气胸。在平均 47 个月的随访中，完全缓解率为 59.3%（IA 期为 65.9%，IB 期为 40%，p = 0.01），平均局部复发间隔为 25.9 个月。中位总生存期和癌症特异性生存期分别为 33.4 个月和 41.4 个月。癌症特异性生存 actuarial 率为 1 年时为 89%，3 年时为 59%，5 年时为 40%。
射频消融术治疗早期 NSCLC 似乎是一种有效的微创治疗方法，即使在长期内也是如此，特别是对于 IA 期肿瘤。
