Chen Tianming, Jin Jiewen, Chen Shilin
Department of Thoracic Surgery, Jiangsu Cancer Hospital Affiliated to Nanjing Medicinal University, Nanjing 210009, China.
Department of Cancer Surgery, Yifu Hospital Affiliated to Nanjing Medicinal University, Nanjing 210009, China.
J Thorac Dis. 2017 Dec;9(12):5131-5142. doi: 10.21037/jtd.2017.11.11.
To enhance our understanding of the feasibility, effectiveness, safety and quality of life (QoL) of radiofrequency ablation (RFA) for inoperable patients with pulmonary tumors.
The data of 88 patients with pulmonary tumors undergoing RFA were collected. Proof of malignancy was obtained by biopsy in all patients. Diagnoses included non-small cell lung cancer (NSCLC) in 74 patients and pulmonary metastases in 14 patients. Patients underwent computed tomography (CT)-guided RFA according to standard protocol and had a 2-year follow-up. Results assessment included feasibility (correct placement of the ablation probe into all targeted tumors), effectiveness (overall survival rate and local control rate), safety (treatment-related complication and changes in pulmonary function) and QoL.
One hundred and thirty-four RFAs were successfully conducted in 88 patients with 96 nodules. Correct placement of ablation probe into targeted tumors with completion of the planned treatment protocol was feasible in all 88 (100%) patients and no procedure-related deaths occurred. Major complication rate was 4.5% (4/88), which consisted of symptomatic pneumothorax (2/88) and high fever (2/88). No significant worsening of pulmonary function was observed. Tumors shrank obviously at 6 months after RFA with a statistically significance (P<0.001).The overall survival rate in 6 months, 1 year and 2 years were 100%, 95.5% and 70.5%, respectively while the local control rate in 6 months, 1 year and 2 years were 92.1%, 87.5% and 51.1% respectively. There was no significant difference of overall survival rate and local control rate between NSCLC and metastatic carcinoma. No significant worsening of QoL was observed.
CT-guided RFA is a feasible, effective and safe therapy for inoperable patients with pulmonary tumors. However, RFA could not obviously improve the QoL in the patients with pulmonary tumors. More prospective studies comparing RFA with standard non-surgical treatment options were needed.
为了增强我们对射频消融术（RFA）治疗无法手术的肺肿瘤患者的可行性、有效性、安全性及生活质量（QoL）的理解。
收集88例接受RFA治疗的肺肿瘤患者的数据。所有患者均通过活检获得恶性肿瘤证据。诊断包括74例非小细胞肺癌（NSCLC）和14例肺转移瘤。患者按照标准方案接受计算机断层扫描（CT）引导下的RFA治疗，并进行了2年的随访。结果评估包括可行性（将消融探针正确置入所有目标肿瘤）、有效性（总生存率和局部控制率）、安全性（治疗相关并发症和肺功能变化）及生活质量。
88例患者的96个结节成功进行了134次RFA。在所有88例（100%）患者中，将消融探针正确置入目标肿瘤并完成计划治疗方案是可行的，且未发生与手术相关的死亡。主要并发症发生率为4.5%（4/88），包括症状性气胸（2/88）和高热（2/88）。未观察到肺功能明显恶化。RFA术后6个月肿瘤明显缩小，差异有统计学意义（P<0.001）。6个月、1年和2年的总生存率分别为100%、95.5%和70.5%，而6个月、1年和2年的局部控制率分别为92.1%、87.5%和51.1%。NSCLC和转移癌之间的总生存率和局部控制率无显著差异。未观察到生活质量明显恶化。
CT引导下的RFA是治疗无法手术的肺肿瘤患者的一种可行、有效且安全的治疗方法。然而，RFA并不能明显改善肺肿瘤患者的生活质量。需要更多比较RFA与标准非手术治疗方案的前瞻性研究。
