Department of Radiology, Churchill Hospital, Old Road, Oxford, OX3 7LJ, UK.
Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Clin Radiol. 2019 Jan;74(1):80.e19-80.e26. doi: 10.1016/j.crad.2018.09.014. Epub 2018 Nov 14.
To determine local control, safety, and survival following percutaneous computed tomography (CT)-guided high-power microwave ablation (MWA) in the treatment of primary lung malignancy at a single institution.
From July 2010 to June 2016, 52 patients (mean age 76.3 years, range 55-91 years) with 61 unresectable primary lung cancers of mean diameter 23.8 mm (range 26-55 mm) underwent MWA in 55 ablation sessions. Tumours were diagnosed at biopsy, or positron-emission tomography (PET) avidity (mean SUV max = 10.51) and interval growth. Statistical analysis was performed by Kaplan-Meier modelling and Cox and logistic regression.
Local tumour progression (LTP) was diagnosed in six lesions (10%). Median time to local recurrence was 3 months (range 2-14 months). There was a near 12-fold increased odds of local recurrence if the lesion size was >3 cm (95% confidence interval [CI]: 1.84-75.14; p=0.009). The median inpatient stay was 1 day, with no intra-procedural deaths and a 0% 30-day post-ablation mortality rate. Pneumothorax requiring drain was the most serious complication, occurring in 22% (n=12) of patients. Presence of severe emphysema and predicted forced expiratory volume in 1 second (FEV1) of <50% were found to predict future requirement of a drain (odds ratio [OR] 8.17, 95% CI: 1.62-41.37, p=0.01 and OR: 5.14, 95% CI: 1.28-20.68, p=0.02 respectively), when adjusted for age and gender. Tumour size >3 cm had a hazard ratio of 4.37 compared with tumour size ≤3 cm (95% CI: 1.45-13.17, p=0.009) of risk of cancer death at any time, by Cox regression.
MWA for primary lung malignancy is a safe and effective treatment for primary lung tumours with outcomes that may be comparable to stereotactic body radiation therapy.
在一家机构中，确定经皮 CT 引导下高功率微波消融（MWA）治疗原发性肺癌的局部控制、安全性和生存率。
从 2010 年 7 月至 2016 年 6 月，52 例（平均年龄 76.3 岁，范围 55-91 岁）61 个不可切除的原发性肺癌患者（平均直径 23.8mm，范围 26-55mm）在 55 次消融治疗中接受 MWA。肿瘤经活检或正电子发射断层扫描（PET）摄取（平均 SUVmax=10.51）和间隔生长诊断。通过 Kaplan-Meier 模型和 Cox 及 logistic 回归进行统计学分析。
6 个病变（10%）诊断为局部肿瘤进展（LTP）。局部复发的中位时间为 3 个月（范围 2-14 个月）。如果病变大小>3cm，局部复发的几率增加近 12 倍（95%置信区间[CI]：1.84-75.14；p=0.009）。中位住院时间为 1 天，无术中死亡，术后 30 天死亡率为 0%。需要引流的气胸是最严重的并发症，发生率为 22%（n=12）。存在严重肺气肿和预计 1 秒用力呼气量（FEV1）<50%被发现预测未来需要引流（比值比[OR]8.17，95%CI：1.62-41.37，p=0.01 和 OR：5.14，95%CI：1.28-20.68，p=0.02），在调整年龄和性别后。与肿瘤直径≤3cm 相比，肿瘤直径>3cm 的患者癌症死亡的风险比（HR）为 4.37（95%CI：1.45-13.17，p=0.009），通过 Cox 回归。
MWA 治疗原发性肺癌是一种安全有效的原发性肺癌治疗方法，其结果可能与立体定向体部放疗相当。
