Lin Miao, Eiken Pat, Blackmon Shanda
Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
J Thorac Dis. 2020 Nov;12(11):7039-7047. doi: 10.21037/jtd-2019-cptn-08.
Lung ablation has been introduced into lung cancer treatment for about two decades. Currently, 3 main choices of thermal energy for lung ablation are radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation. As a mostly palliative, occasionally curative intent local treatment, the feasibility and safety of lung ablation have been validated in small size lung cancer treatment, especially in lung tumor ≤3 cm. Improved techniques and experience in recent years help render outcomes much better than before for lung cancer patients who are medically inoperable with early stage primary lung cancer, and patients with oligometastasis or local recurrence. For stage IA non-small cell lung cancer (NSCLC) patients underwent RFA, 1- and 2-year overall survival rate were reported as 86.3% and 69.8%. And 1- and 2-year local recurrence rate were reported as 68.9% and 59.8%. Limitations, including heat sink, skin burn, and inconsistent heat conduction, are observed in the first applied ablation technique, RFA. MWA and cryoablation are developed to overcome these limitations and achieve the goal of less morbidity. Generally, imaged guided thermal ablation has a good safety profile, with pneumothorax as the most common morbidity. This article will mainly discuss the current features and application of these ablation techniques in lung cancer treatment.
肺消融术引入肺癌治疗领域已有约二十年。目前，肺消融的3种主要热能选择是射频消融（RFA）、微波消融（MWA）和冷冻消融。作为一种主要用于姑息治疗、偶尔用于根治性治疗的局部治疗方法，肺消融术在小尺寸肺癌治疗中的可行性和安全性已得到验证，尤其是在肺肿瘤≤3 cm的患者中。近年来技术和经验的改进，使那些因医学原因无法进行手术的早期原发性肺癌患者、寡转移或局部复发患者的治疗效果比以前有了很大改善。对于接受RFA治疗的IA期非小细胞肺癌（NSCLC）患者，报告的1年和2年总生存率分别为86.3%和69.8%。报告的1年和2年局部复发率分别为68.9%和59.8%。在最初应用的消融技术RFA中观察到了一些局限性，包括热沉、皮肤烧伤和热传导不一致。MWA和冷冻消融的发展是为了克服这些局限性并实现降低发病率的目标。一般来说，影像引导下的热消融具有良好的安全性，气胸是最常见的并发症。本文将主要讨论这些消融技术在肺癌治疗中的当前特点和应用。
