Wang M, Pan Y W, Zhou Z G, Cui Y, Du K P, Li S
Department of Radiology, the First Hospital Affiliated to Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Zhong Liu Za Zhi. 2017 May 23;39(5):395-399. doi: 10.3760/cma.j.issn.0253-3766.2017.05.015.
To evaluate the feasibility and short-term effect of CT guided cryoablation for malignant chest wall or pleural involvement. To follow up 22 patients with chest wall or pleural involvement of various malignancies who underwent cryoablation from January 2012 to January 2015 by conducting postoperative 1-, 3- and 6-month enhanced CT, MRI or PET-CT examinations, respectively, evaluate local curative effect, and observe their progression-free survival (PFS), postoperative pain remission and complications after the cryoablation. A total of 22 patients with 27 lesions received 26 times of argon-helium cryoablation. According to the coverage situation of immediate postoperative ice balls on the lesions, they were divided into a complete coverage group (Group A with 18 patients) and a partial coverage group (Group B with 4 patients). 1 month later, 15 patients' tumors were completely ablated, and 3 had residue and thus received the second cryoablation in Group A, while all patients' tumors had residue in Group B. 3 months later, 17 patients' tumors were completely ablated, and 1 had residue and thus received another cryoablation in Group A, while all patients' residual tumors enlarged in different extent in group B. 6 months later, all lesions were ablated in group A while all patients' residual tumors enlarged in group B. For the 22 patients, their preoperative, and postoperative 1-week, 1-month, 3-month, and 6-month VAS scores were 4.95±0.57, 1.45±0.35, 1.45±0.35, 1.64±1.71, and 2.00±2.35, respectively. The differences in the preoperative, postoperative 1-week, and postoperative 1-month scores are significant statistically (<0.05), and the difference in the postoperative 1-month and 6-month scores is also with statistical significance (=0.03). For all patients, their post-operative 1-week, 1-month, 3-monte and 6-month pain remission rates are 90.9%(20/22), 90.9%(20/22), 86.4% (19/22)and 81.8%(18/22), respectively. With a median follow-up of 13.5 months, the median PFS is 7 months. The adverse effect after argon-helium cryoablation involved transitory worsened pain (16 cases), pleural effusion (5 cases, including 3 underwent closed drainage), fever (5 cases), and hemoptysis (3 cases). CT guided argon-helium cryoablation is a safe and effective method to treat malignant chest wall or pleural involvement.
评估CT引导下冷冻消融术治疗恶性胸壁或胸膜受累的可行性及短期疗效。对2012年1月至2015年1月期间接受冷冻消融术的22例各种恶性肿瘤胸壁或胸膜受累患者进行术后1个月、3个月和6个月的增强CT、MRI或PET-CT检查，评估局部疗效，观察其无进展生存期（PFS）、术后疼痛缓解情况及冷冻消融术后并发症。22例患者共27个病灶接受了26次氩氦冷冻消融术。根据术后即刻冰球对病灶的覆盖情况，将其分为完全覆盖组（A组18例）和部分覆盖组（B组4例）。1个月后，A组15例患者肿瘤完全消融，3例有残留并接受了第二次冷冻消融，而B组所有患者肿瘤均有残留。3个月后，A组17例患者肿瘤完全消融，1例有残留并接受了再次冷冻消融，而B组所有患者残留肿瘤均有不同程度增大。6个月后，A组所有病灶均消融，而B组所有患者残留肿瘤均增大。22例患者术前及术后1周、1个月、3个月和6个月的视觉模拟评分（VAS）分别为4.95±0.57、1.45±0.35、1.45±0.35、1.64±1.71和2.00±2.35。术前、术后1周和术后1个月评分差异有统计学意义（<0.05），术后1个月和6个月评分差异也有统计学意义（=0.03）。所有患者术后1周、1个月、3个月和6个月的疼痛缓解率分别为90.9%（20/22）、90.9%（20/22）、86.4%（19/22）和81.8%（18/22）。中位随访13.5个月，中位PFS为7个月。氩氦冷冻消融术后的不良反应包括短暂性疼痛加重（16例）、胸腔积液（5例，其中3例行闭式引流）、发热（5例）和咯血（3例）。CT引导下氩氦冷冻消融术是治疗恶性胸壁或胸膜受累的一种安全有效的方法。
