Susa Michiro, Kikuta Kazutaka, Nakayama Robert, Nishimoto Kazumasa, Horiuchi Keisuke, Oguro Sota, Inoue Masanori, Yashiro Hideki, Nakatsuka Seishi, Nakamura Masaya, Matsumoto Morio, Chiba Kazuhiro, Morioka Hideo
Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, 160-8582, Japan.
Department of Orthopaedic Surgery, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan.
BMC Cancer. 2016 Oct 13;16(1):798. doi: 10.1186/s12885-016-2852-6.
Historically, local control of recurrent sarcomas has been limited to radiotherapy when surgical re-resection is not feasible. For metastatic carcinomas to the bone or soft tissue, radiotherapy and some interventional radiology treatment along with other systemic therapies have been widely advocated due to the possibility of disseminated disease. These techniques are effective in alleviating pain and achieving local control for some tumor types, but it has not been effective for prolonged local control of most tumors. Recently, cryoablation has been reported to have satisfactory results in lung and liver carcinoma treatment. In this study, we analyzed the clinical outcome of CT-guided cryoablation for malignant bone and soft tissue tumors to elucidate potential problems associated with this procedure.
Since 2011, 11 CT-guided cryoablations in 9 patients were performed for locally recurrent or metastatic bone and soft tissue tumors (7 males and 2 females) at our institute. The patients' average age was 74.8 years (range 61-86) and the median follow up period was 24.1 months (range 5-48). Histological diagnosis included renal cell carcinoma (n = 4), dedifferentiated liposarcoma (n = 2), myxofibrosarcoma (n = 2), chordoma (n = 1), hepatocellular carcinoma (n = 1), and thyroid carcinoma (n = 1). Cryoablation methods, clinical outcomes, complications, and oncological outcomes were analyzed.
There were 5 recurrent tumors and 6 metastatic tumors, and all cases had contraindication to either surgery, chemotherapy or radiotherapy. Two and 3 cycles of cryoablation were performed for bone and soft tissue tumors, respectively. The average length of the procedure was 101.1 min (range 63-187), and the average number of probes was 2.4 (range 2-3). Complications included 1 case of urinary retention in a patient with sacral chordoma who underwent prior carbon ion radiotherapy, 1 transient femoral nerve palsy, and 1 minor wound complication. At the final follow up, 4 patients showed no evidence of disease, 2 were alive with disease, and 3 died of disease.
Reports regarding CT-guided cryoablation for musculoskeletal tumors are rare and the clinical outcomes have not been extensively studied. In our case series, CT-guided cryoablation had analgesic efficacy and there were no cases of local recurrence post procedure during the follow-up period. Although collection of further data regarding use of this technique is necessary, our data suggest that cryoablation is a promising option in medically inoperable musculoskeletal tumors.
从历史上看，当手术再次切除不可行时，复发性肉瘤的局部控制仅限于放射治疗。对于骨或软组织的转移性癌，由于存在疾病播散的可能性，放射治疗和一些介入放射学治疗以及其他全身治疗已被广泛提倡。这些技术在缓解疼痛和实现某些肿瘤类型的局部控制方面是有效的，但对于大多数肿瘤的长期局部控制并不有效。最近，据报道冷冻消融在肺癌和肝癌治疗中取得了令人满意的结果。在本研究中，我们分析了CT引导下冷冻消融治疗恶性骨和软组织肿瘤的临床结果，以阐明与该手术相关的潜在问题。
自2011年以来，我们研究所对9例患者的11次CT引导下冷冻消融术用于局部复发或转移性骨和软组织肿瘤（7例男性和2例女性）。患者的平均年龄为74.8岁（范围61 - 86岁），中位随访期为24.1个月（范围5 - 48个月）。组织学诊断包括肾细胞癌（n = 4）、去分化脂肪肉瘤（n = 2）、黏液纤维肉瘤（n = 2）、脊索瘤（n = 1）肝细胞癌（n = 1）和甲状腺癌（n = 1）。分析了冷冻消融方法、临床结果、并发症和肿瘤学结果。
有5例复发性肿瘤和6例转移性肿瘤，所有病例均有手术、化疗或放疗的禁忌证。骨和软组织肿瘤分别进行了2个和3个周期的冷冻消融。手术的平均时长为101.1分钟（范围63 - 187分钟），平均探针数量为2.4个（范围2 - 3个）。并发症包括1例接受过碳离子放疗的骶骨脊索瘤患者出现尿潴留。1例短暂性股神经麻痹和1例轻微伤口并发症。在最后随访时，4例患者无疾病证据，2例带瘤生存，3例死于疾病。
关于CT引导下冷冻消融治疗肌肉骨骼肿瘤的报道很少，临床结果尚未得到广泛研究。在我们的病例系列中，CT引导下冷冻消融具有镇痛效果，随访期间术后无局部复发病例。尽管有必要收集关于该技术应用的更多数据，但我们的数据表明冷冻消融是医学上无法手术的肌肉骨骼肿瘤的一个有前景的选择。
