热消融治疗非小细胞肺癌肾上腺转移瘤的 5 年单中心经验
Thermal Ablation in the Management of Adrenal Metastasis Originating from Non-small Cell Lung Cancer: A 5-year Single-center Experience.
机构信息
First Pediatric Clinic, National and Kapodistrian University of Athens, Agia Sofia Children's Hospital, Athens 11527, Greece.
Department of Medical Imaging and Interventional Radiology, Sotiria General Hospital for Chest Diseases, Athens 11527, Greece.
出版信息
Chin Med J (Engl). 2017 Sep 5;130(17):2027-2032. doi: 10.4103/0366-6999.210496.
BACKGROUND
Treatment of adrenal metastasis from lung carcinoma may prolong survival in the selected patients. However, not all patients can undergo surgery; thus, minimally invasive ablation procedures such as radiofrequency ablation (RFA) and microwave ablation (MWA) have gained acceptance as alternative treatment methods. This study summarized a 5-year single-center experience regarding the evaluation of safety and efficacy of computed tomography (CT)-guided thermal ablation in the management of adrenal metastasis originating from non-small cell lung cancer (NSCLC).
METHODS
The data of NSCLC patients ablated for adrenal metastasis at the Department of Diagnostic Imaging and Interventional Radiology, General Hospital Sotiria, were retrospectively analyzed. Patients were divided into two groups: RFA group and MWA group according to the therapeutic approaches. Preprocedural blood tests included measurement of international normalized ratio, partial thromboplastin time, and platelet enumeration. A dual-phase contrast-enhanced spiral CT was performed immediately after the procedure to assess the immediate response after ablation and to screen for related complications. Follow-up was performed with CT or magnetic resonance imaging at 1, 3, 6 months and 1 year after ablation and every 6 months thereafter.
RESULTS
A total of 99 ablation sessions in 71 patients with adrenal metastasis originating from NSCLC were included in the final analysis. Self-limited, postablation syndrome occurred in 16/99 (16.1%) of ablation sessions. All procedures were technically successful. Immediate postablation imaging showed no contrast enhancement of the ablated tumor in all patients. Follow-up imaging at 3 months revealed local tumor progression in 8 (22.8%) patients of the RFA group and 7 (19.4%) patients of MWA group, all of them underwent a second session successfully. The 1-year assessment revealed local recurrence of the ablated tumor in six patients (17.1%) of RFA group and seven patients (19.4%) of MWA group. Among these 71 patients, those with tumor size >3.5 cm had a higher local recurrence rate (65.2%, 15/23) than those with tumors ≤3.5 cm (16.7%, 8/48; P = 0.012). There was no significant difference in the median survival time between RFA (14.0 months) and MWA (14.6 months) groups (P > 0.05).
CONCLUSIONS
RFA and MWA showed comparable efficacy and safety in adrenal metastasis treatment.
背景
治疗肺癌肾上腺转移可以延长部分患者的生存期。然而，并非所有患者都可以接受手术治疗；因此，射频消融（RFA）和微波消融（MWA）等微创消融术已作为替代治疗方法得到认可。本研究总结了索蒂里亚综合医院放射诊断与介入放射科 5 年的单中心经验，评估 CT 引导下热消融治疗非小细胞肺癌（NSCLC）肾上腺转移的安全性和有效性。
方法
回顾性分析了在索蒂里亚综合医院放射诊断与介入放射科接受肾上腺转移 RFA 和 MWA 治疗的 NSCLC 患者的数据。根据治疗方法，将患者分为 RFA 组和 MWA 组。术前检查包括国际标准化比值、部分凝血活酶时间和血小板计数。术后立即行双期增强螺旋 CT 检查，评估消融后的即刻反应并筛查相关并发症。消融后 1、3、6 个月和 1 年以及此后每 6 个月行 CT 或磁共振成像随访。
结果
共有 71 例 NSCLC 肾上腺转移患者的 99 次消融治疗纳入最终分析。16/99（16.1%）次消融治疗出现自限性、消融后综合征。所有手术均成功完成。即刻消融后影像学检查显示所有患者的消融肿瘤均无造影增强。3 个月随访时，RFA 组 8 例（22.8%）和 MWA 组 7 例（19.4%）患者局部肿瘤进展，均再次成功消融。1 年评估时，RFA 组 6 例（17.1%）和 MWA 组 7 例（19.4%）患者消融肿瘤局部复发。在这 71 例患者中，肿瘤直径>3.5cm 的患者局部复发率（65.2%，15/23）高于肿瘤直径≤3.5cm 的患者（16.7%，8/48；P=0.012）。RFA 组（14.0 个月）和 MWA 组（14.6 个月）的中位生存时间无显著差异（P>0.05）。
结论
RFA 和 MWA 治疗肾上腺转移的疗效和安全性相当。
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