Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
Department of Pulmonology, Luigi Vanvitelli University, Naples, Italy.
Med Oncol. 2020 Mar 12;37(4):25. doi: 10.1007/s12032-020-01352-2.
Hepatocellular carcinoma (HCC) is a frequent tumor that may be treated with radiofrequency thermal ablation (RFA). RFA has been used with success also in treatment of pulmonary metastases from a wide range of primitive tumors, especially colorectal. Previous studies have shown that RFA con be used in treating HCC pulmonary metastases. Purpose of our study was a retrospective evaluation of overall survival and complication rates of percutaneous CT-guided radiofrequency ablation of pulmonary metastases from hepatocellular carcinoma (HCC). Data were collected from 40 CT-guided ablation sessions performed on 42 lesions in 26 patients (16 M and 10 F; mean age 62.5 years) with pulmonary metastases from HCC (size range 0.3-4 cm, mean diameter 1.4 ± 0.98 cm) from February 2012 to December 2017. All patients, as in advanced stage of illness (stage C), were treated according to Barcelona Clinic Liver Cancer (BCLC) criteria, with Sorafenib. They had no active HCC foci in the liver and no more than three metastases in the lung. Patients did not discontinue medical therapy with Sorafenib and pulmonary relapses were treated up to three times. In two patients two lesions were treated during the same procedure. Each lesion was ablated under CT guidance. Follow-up contrast-enhanced CT at 1, 3, 6, 12-month and every 6 months after treatment were reviewed. A total of 42 metastatic lung lesions from HCC in 26 patients (57% male, 43% female) were treated with CT-guided radiofrequency thermal ablation procedures. Immediate radiofrequency ablation-related complications (subtle pneumothorax) were observed in 9 of 40 procedures (22.5%). Only one patient developed a pneumothorax requiring drainage tube insertion (2.5%). No other major complications occurred. Moreover, no significant worsening of pulmonary function was observed. In all patients the overall survival rates were 88.5% at 1 year, 69.8% at 3 years and 26.2% at 5 years. Our retrospective assessment confirmed that percutaneous CT-guided radiofrequency thermal ablation in 23 patients with pulmonary metastases from HCC represents an effective and safe alternative treatment option in patients not considerable as potential candidates to surgery.
肝细胞癌（HCC）是一种常见的肿瘤，可以采用射频热消融（RFA）治疗。RFA 已成功用于治疗来自多种原始肿瘤的肺转移瘤，尤其是结直肠癌。先前的研究表明，RFA 可用于治疗 HCC 肺转移瘤。本研究的目的是回顾性评估经皮 CT 引导射频消融治疗肝细胞癌（HCC）肺转移瘤的总生存率和并发症发生率。数据来自 2012 年 2 月至 2017 年 12 月期间对 26 例患者的 42 个病灶（23 例男性，10 例女性；平均年龄 62.5 岁）进行的 40 次 CT 引导消融术，这些患者均患有 HCC 肺转移瘤（大小范围 0.3-4cm，平均直径 1.4±0.98cm）。所有患者均处于疾病晚期（C 期），根据巴塞罗那临床肝癌（BCLC）标准进行治疗，使用索拉非尼。他们的肝脏中没有活动性 HCC 病灶，肺部转移灶不超过 3 个。患者未停止使用索拉非尼的药物治疗，肺复发时最多接受 3 次治疗。在两名患者中，同一程序中治疗了两个病灶。每个病灶均在 CT 引导下进行消融。治疗后 1、3、6、12 个月和治疗后每 6 个月进行增强 CT 随访。26 例患者（57%为男性，43%为女性）的 42 个 HCC 肺转移瘤采用 CT 引导射频热消融治疗。40 次治疗中有 9 次（22.5%）出现即刻与射频消融相关的并发症（轻微气胸）。仅 1 例患者出现需要引流管插入的气胸（2.5%）。没有发生其他严重并发症。此外，没有观察到明显的肺功能恶化。在所有患者中，1 年总生存率为 88.5%，3 年生存率为 69.8%，5 年生存率为 26.2%。我们的回顾性评估证实，对 23 例 HCC 肺转移瘤患者进行经皮 CT 引导射频热消融是一种有效且安全的替代治疗选择，对于不能考虑手术的患者是一种潜在的治疗方法。
