Yevich Steven, Gaspar Natalie, Tselikas Lambros, Brugières Laurence, Pacquement Hélène, Schleiermacher Gudren, Tabone Marie-Dominique, Pearson Ernesto, Canale Sandra, Muret Jane, de Baere Thierry, Deschamps Frederic
Interventional Radiology Department, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France.
Pediatric and Teenage Oncology Department, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France.
Ann Surg Oncol. 2016 Apr;23(4):1380-6. doi: 10.1245/s10434-015-4988-z. Epub 2015 Nov 20.
The role of percutaneous thermal ablation as a minimally-invasive treatment has not been evaluated in children under 18 years of age with pulmonary osteosarcoma metastases.
This was a retrospective review of children treated with percutaneous thermal ablation for pulmonary osteosarcoma metastasis after prior surgical metastasectomy and chemotherapy. Selection criteria included number of pulmonary nodules <5 and nodule size smaller than 2 cm. Indications were discussed at multidisciplinary meetings. The goal was to achieve complete remission using percutaneous thermal ablation, thereby avoiding additional thoracotomies.
A total of 26 pulmonary nodules (mean size 6.7 mm, range 2-16 mm) were successfully treated by percutaneous computed tomography (CT)-guided thermal ablation in 11 children with osteosarcoma between the ages of 7 and 17 years (median 12.5). Patients denied post-procedure pain. Complications were limited to three pneumothoraxes (two minor, one major), and median hospitalization duration was 2.0 days. One patient died of rapidly progressive lumbar metastasis discovered 20 days post-ablation. Of the remaining 10 patients, local control at the ablation site was achieved, with median follow up of 16.7 months (range 4.1-41.8). Five patients remained in complete remission after median follow-up of 37.5 months, and five patients developed new metastases (one osseous, four pulmonary), of which two are in remission after subsequent treatment.
Percutaneous thermal ablation is a safe and effective minimally-invasive curative local treatment alternative for children with oligometastatic pulmonary osteosarcoma in whom surgical intervention is clinically contraindicated or unappealing.
经皮热消融作为一种微创治疗方法，在18岁以下肺骨肉瘤转移患儿中的作用尚未得到评估。
这是一项对先前接受过手术转移灶切除术和化疗后接受经皮热消融治疗肺骨肉瘤转移的患儿的回顾性研究。选择标准包括肺结节数量<5个且结节大小小于2厘米。在多学科会议上讨论了适应症。目标是通过经皮热消融实现完全缓解，从而避免额外的开胸手术。
在11名年龄在7至17岁（中位数12.5岁）的骨肉瘤患儿中，通过经皮计算机断层扫描（CT）引导的热消融成功治疗了总共26个肺结节（平均大小6.7毫米，范围2 - 16毫米）。患者术后否认疼痛。并发症仅限于3例气胸（2例轻度，1例重度），中位住院时间为2.0天。1例患者在消融后20天死于快速进展的腰椎转移。其余10例患者中，消融部位实现了局部控制，中位随访时间为16.7个月（范围4.1 - 41.8个月）。5例患者在中位随访37.5个月后仍处于完全缓解状态，5例患者出现了新的转移灶（骨转移1例，肺转移4例），其中2例在后续治疗后缓解。
对于临床禁忌手术干预或手术缺乏吸引力的寡转移性肺骨肉瘤患儿，经皮热消融是一种安全有效的微创根治性局部治疗选择。
