Iguchi T, Hiraki T, Gobara H, Fujiwara H, Sakurai J, Matsui Y, Mitsuhashi T, Toyooka S, Kanazawa S
Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku, Okayama 700-8558, Japan.
Center for Innovative Clinical Medicine, Okayama University Medical School, 2-5-1 Shikata-cho, kita-ku, Okayama 700-8558, Japan.
Diagn Interv Imaging. 2017 Jul-Aug;98(7-8):535-541. doi: 10.1016/j.diii.2017.01.008. Epub 2017 Feb 22.
To retrospectively evaluate the feasibility, safety, and efficacy of radiofrequency ablation (RFA) of lung tumors located near the diaphragm.
A total of 26 patients (15 men, 11 women; mean age, 61.5 years±13.0 [SD]) with a total of 29 lung tumors near the diaphragm (i.e., distance<10mm) were included. Mean tumor diameter was 11.0mm±5.3 (SD) (range, 2-23mm). Efficacy of RFA, number of adverse events and number of adverse events with a grade≥3, based on the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0, were compared between patients with lung tumors near the diaphragm and a control group of patients with more distally located lung tumors (i.e., distance≥10mm).
RFA was technically feasible for all tumors near the diaphragm. Four grade 3 adverse events (1 pneumothorax requiring pleurodesis and 3 phrenic nerve injuries) were observed. No grade≥4 adverse events were reported. The median follow-up period for tumors near the diaphragm was 18.3 months. Local progression was observed 3.3 months after RFA in 1 tumor. The technique efficacy rates were 96.2% at 1 year and 96.2% at 2 years and were not different, from those observed in control subjects (186 tumors; P=0.839). Shoulder pain (P<0.001) and grade 1 pleural effusion (P<0.001) were more frequently observed in patients with lung tumor near the diaphragm. The rates of grade≥3 adverse events did not significantly differ between tumors near the diaphragm (4/26 sessions) and the controls (7/133 sessions) (P=0.083).
RFA is a feasible and effective therapeutic option for lung tumors located near the diaphragm. However, it conveys a higher rate of shoulder pain and asymptomatic pleural effusion by comparison with more distant lung tumors.
回顾性评估射频消融（RFA）治疗靠近膈肌的肺部肿瘤的可行性、安全性和有效性。
共纳入26例患者（15例男性，11例女性；平均年龄61.5岁±13.0[标准差]），其共有29个靠近膈肌的肺部肿瘤（即距离<10mm）。平均肿瘤直径为11.0mm±5.3（标准差）（范围2 - 23mm）。根据美国国立癌症研究所不良事件通用术语标准第4.0版，比较靠近膈肌的肺部肿瘤患者与肺部肿瘤位置更远（即距离≥10mm）的对照组患者的RFA疗效、不良事件数量及≥3级不良事件数量。
对于所有靠近膈肌的肿瘤，RFA在技术上是可行的。观察到4例3级不良事件（1例需要胸膜固定术的气胸和3例膈神经损伤）。未报告≥4级不良事件。靠近膈肌的肿瘤的中位随访期为18.3个月。1个肿瘤在RFA后3.3个月出现局部进展。1年时技术有效率为96.2%，2年时为96.2%，与对照组（186个肿瘤）观察到的有效率无差异（P = 0.839）。靠近膈肌的肺部肿瘤患者更常出现肩痛（P<0.001）和1级胸腔积液（P<0.001）。靠近膈肌的肿瘤（4/26次治疗）与对照组（7/133次治疗）之间≥3级不良事件的发生率无显著差异（P = 0.083）。
RFA是治疗靠近膈肌的肺部肿瘤的一种可行且有效的治疗选择。然而，与位置更远的肺部肿瘤相比，它导致肩痛和无症状胸腔积液的发生率更高。
