Division of Thoracic Surgery, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Ann Thorac Surg. 2012 Mar;93(3):921-7; discussion 927-88. doi: 10.1016/j.athoracsur.2011.11.043. Epub 2012 Jan 31.
This study characterizes the management of locoregional recurrence (LRR) in patients with high-risk stage I non-small cell lung cancer (NSCLC) treated with lung radiofrequency ablation (RFA).
Consecutive patients with biopsy-proven stage I NSCLC underwent computed tomography-guided lung RFA from December 2003 to 2010. All patients were deemed medically inoperable or refused an operation. RFA was performed with curative intent.
Fifty-five ablations were performed in 45 patients (age, 51 to 89 years) with stage I NSCLC. At a median follow-up of 32 months, LRR occurred in 21 (38%) within a mean of 12±10 (range, 1-44) months from RFA. Recurrence was observed locally in the tumor bed in 18 (33%), in regional nodes in 4 (7%), and distant in 2 (4%). The mean maximal tumor diameter was 2.3±1.3 (range, 0.7 to 4.5) cm. In tumors exceeding 3 cm, 10 (80%) were associated with LRR. Recurrent lesions were treated with repeat RFA (5), radiotherapy (8), chemoradiotherapy (5), and chemotherapy (2). Local control was achieved by repeat RFA in 2 of 5 (40%) or by radiotherapy in 8 lesions (100%), with 2 regional nodal failures (median follow-up, 40±13 months). Overall survival among patients who did or did not experience LRR was similar (32% to 35%). Repeat RFA was not associated with any significant complications or procedure-related 30-day mortality.
Lung RFA is associated with increased rates of local failure in tumors exceeding 3 cm and in contact with larger segmental vessels. Patients with local failure can be promptly salvaged with SBRT or repeat RFA, without detriment to overall survival.
本研究描述了经 CT 引导下射频消融术（RFA）治疗的高危Ⅰ期非小细胞肺癌（NSCLC）患者局部区域复发（LRR）的管理情况。
连续纳入 2003 年 12 月至 2010 年期间经活检证实的Ⅰ期 NSCLC 患者，所有患者均因医学原因不能手术或拒绝手术，RFA 治疗目的为根治性。
45 例患者（年龄 51-89 岁）共行 55 次 RFA 术，Ⅰ期 NSCLC。中位随访 32 个月，RFA 后 12±10（1-44）个月内 21 例（38%）发生 LRR。复发部位包括肿瘤床局部 18 例（33%）、区域淋巴结 4 例（7%）和远处 2 例（4%）。最大肿瘤直径的平均值为 2.3±1.3（0.7-4.5）cm。肿瘤直径＞3cm 的患者中，10 例（80%）发生 LRR。局部复发患者分别接受重复 RFA（5 例）、放疗（8 例）、放化疗（5 例）和化疗（2 例）。5 例局部复发中，重复 RFA 后 2 例（40%）和 8 例（100%）接受放疗的患者局部控制，2 例区域淋巴结失败（中位随访 40±13 个月）。发生 LRR 与未发生 LRR 的患者总生存率相似（32%与 35%）。重复 RFA 未增加任何并发症或与 30 天死亡率相关的手术风险。
肿瘤直径＞3cm 且毗邻较大节段血管的患者，RFA 后 LRR 发生率增加。局部复发患者可及时采用 SBRT 或重复 RFA 挽救，不影响总生存率。
