非结直肠癌肺转移瘤的消融治疗：激光诱导间质热疗（LITT）、射频消融（RFA）和微波消融（MWA）后肿瘤反应的回顾性分析。
Ablation therapy of non-colorectal cancer lung metastases: retrospective analysis of tumour response post-laser-induced interstitial thermotherapy (LITT), radiofrequency ablation (RFA) and microwave ablation (MWA).
机构信息
a Institute for Diagnostic and Interventional Radiology , Johann Wolfgang Goethe ? University Hospital , Frankfurt am Main , Germany.
b Department of Diagnostic and Interventional Radiology, Cairo University Hospital , Cairo , Egypt.
出版信息
Int J Hyperthermia. 2017 Nov;33(7):820-829. doi: 10.1080/02656736.2017.1306656. Epub 2017 Apr 3.
PURPOSE
To retrospectively compare the local tumour response and survival rates in patients with non-colorectal cancer lung metastases post-ablation therapy using laser-induced thermotherapy (LITT), radiofrequency ablation (RFA) and microwave ablation (MWA).
MATERIAL AND METHODS
Retrospective analysis of 175 computed tomography (CT)-guided ablation sessions performed on 109 patients (43 males and 66 females, mean age: 56.6 years). Seventeen patients with 22 lesions underwent LITT treatment (tumour size: 1.2-4.8 cm), 29 patients with 49 lesions underwent RFA (tumour size: 0.8-4.5 cm) and 63 patients with 104 lesions underwent MWA treatment (tumour size: 0.6-5 cm). CT scans were performed 24-h post-therapy and on follow-up at 3, 6, 12, 18 and 24 months.
RESULTS
The overall-survival rates at 1-, 2-, 3- and 4-year were 93.8, 56.3, 50.0 and 31.3% for patients treated with LITT; 81.5, 50.0, 45.5 and 24.2% for patients treated with RFA and 97.6, 79.9, 62.3 and 45.4% for patients treated with MWA, respectively. The mean survival time was 34.14 months for MWA, 34.79 months for RFA and 35.32 months for LITT. In paired comparison, a significant difference could be detected between MWA versus RFA (p = 0.032). The progression-free survival showed a median of 23.49 ± 0.62 months for MWA,19.88 ± 2.17 months for LITT and 16.66 ± 0.66 months for RFA (p = 0.048). The lowest recurrence rate was detected in lesions ablated with MWA (7.7%; 8 of 104 lesions) followed by RFA (20.4%; 10 of 49 lesions) and LITT (27.3%; 6 of 22 lesions) p value of 0.012. Pneumothorax was detected in 22.16% of MWA ablations, 22.73% of LITT ablations and 14.23% of RFA ablations.
CONCLUSION
LITT, RFA and MWA may provide an effective therapeutic option for non-colorectal cancer lung metastases with an advantage for MWA regarding local tumour control and progression-free survival rate.
目的
回顾性比较激光诱导热疗（LITT）、射频消融（RFA）和微波消融（MWA）治疗非结直肠癌肺转移患者的局部肿瘤反应和生存率。
材料与方法
对 109 例患者（43 名男性和 66 名女性，平均年龄：56.6 岁）的 175 次 CT 引导消融治疗进行回顾性分析。17 例 22 个病灶接受 LITT 治疗（肿瘤大小：1.2-4.8cm），29 例 49 个病灶接受 RFA 治疗（肿瘤大小：0.8-4.5cm），63 例 104 个病灶接受 MWA 治疗（肿瘤大小：0.6-5cm）。治疗后 24 小时及随访 3、6、12、18 和 24 个月进行 CT 扫描。
结果
接受 LITT 治疗的患者 1、2、3 和 4 年的总生存率分别为 93.8%、56.3%、50.0%和 31.3%；接受 RFA 治疗的患者分别为 81.5%、50.0%、45.5%和 24.2%；接受 MWA 治疗的患者分别为 97.6%、79.9%、62.3%和 45.4%。MWA 的平均生存时间为 34.14 个月，RFA 为 34.79 个月，LITT 为 35.32 个月。在配对比较中，MWA 与 RFA 之间存在显著差异（p=0.032）。无进展生存率显示 MWA 为 23.49±0.62 个月，LITT 为 19.88±2.17 个月，RFA 为 16.66±0.66 个月（p=0.048）。MWA 消融的病变复发率最低（7.7%，104 个病变中有 8 个），其次是 RFA（20.4%，49 个病变中有 10 个）和 LITT（27.3%，22 个病变中有 6 个）（p 值为 0.012）。MWA 消融术、LITT 消融术和 RFA 消融术的气胸发生率分别为 22.16%、22.73%和 14.23%。
结论
LITT、RFA 和 MWA 可为非结直肠癌肺转移提供有效的治疗选择，MWA 在局部肿瘤控制和无进展生存率方面具有优势。
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