Department of Interventional Radiology, Institut Bergonié, Bordeaux, France.
Radiology. 2012 Aug;264(2):597-605. doi: 10.1148/radiol.12111303. Epub 2012 Jun 12.
To determine the efficacy and tolerance of ultrasonography (US)-guided percutaneous radiofrequency (RF) ablation with endocrine therapy in elderly patients with breast cancer who decline or are not candidates for surgery.
Internal ethics committee approval was obtained, and patients gave informed written consent. Women older than 70 years with breast carcinoma, who had undergone neoadjuvant endocrine therapy within the past 6 months, underwent US-guided RF ablation while under local anesthesia and sedation. Only tumors measuring 3 cm or smaller and situated at least 1 cm from the skin, nipple, and chest wall were selected. Multitine electrodes were used. Endocrine therapy was continued for a total of 5 years, and breast irradiation was not performed. Clinical follow-up included US, mammography, and dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging every 2 months for 6 months and then every 6 months until 5 years. Primary end points were RF ablation efficacy at 1 year on the basis of DCE MR imaging follow-up and procedural tolerance. The secondary end point was delayed local efficacy at the end of endocrine therapy (5 years) on the basis of DCE MR imaging follow-up.
Twenty-one women were treated from December 2004 to April 2010 (median age, 79 years; age range, 70-88 years). Efficacy was demonstrated at 1 year, with only one patient presenting with a local relapse. No general complications were noted. Skin burn occurred in four patients, with spontaneous healing after a maximum of 2 months. Ten patients were followed up for 5 years, with three additional patients presenting with cancer recurrence outside the ablation zone at 30, 48, and 60 months-including two with lobular carcinoma. Four patients died during the full follow-up, two of breast cancer-related causes and two of unrelated causes.
RF ablation in elderly patients with nonresected breast cancer is well tolerated and efficient at 1-year follow-up. The technique is not recommended for lobular carcinoma.
确定拒绝或不适合手术的老年乳腺癌患者在接受内分泌治疗的同时接受超声引导下经皮射频（RF）消融的疗效和耐受性。
本研究获得了内部伦理委员会的批准，患者也签署了知情同意书。70 岁以上的女性，在过去 6 个月内接受过新辅助内分泌治疗，在局部麻醉和镇静下接受超声引导下 RF 消融。仅选择直径不超过 3cm 且距离皮肤、乳头和胸壁至少 1cm 的肿瘤。使用多极针电极。内分泌治疗共进行 5 年，未行乳房照射。临床随访包括 US、乳房 X 线摄影术和动态对比增强（DCE）磁共振成像（MR），前 6 个月每 2 个月进行一次，此后每 6 个月进行一次，直到 5 年。主要终点是基于 DCE MR 成像随访的 1 年 RF 消融疗效和手术耐受性。次要终点是基于 DCE MR 成像随访的内分泌治疗结束时（5 年）的延迟局部疗效。
2004 年 12 月至 2010 年 4 月期间共治疗 21 例女性（中位年龄 79 岁；年龄范围 70-88 岁）。1 年时显示疗效，仅有 1 例患者局部复发。未观察到一般并发症。4 例患者出现皮肤烧伤，最长 2 个月后自行愈合。10 例患者随访 5 年，其中 3 例在消融区域外出现癌症复发，分别为 30、48 和 60 个月，包括 2 例为小叶癌。4 例患者在整个随访期间死亡，其中 2 例死于乳腺癌相关原因，2 例死于非相关原因。
对于未切除的老年乳腺癌患者，RF 消融具有良好的耐受性，在 1 年随访时疗效显著。该技术不推荐用于小叶癌。
