Division of Abdominal Imaging and Cross-Sectional Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angles, California.
Division of Abdominal Imaging and Cross-Sectional Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angles, California.
J Vasc Interv Radiol. 2021 May;32(5):729-738. doi: 10.1016/j.jvir.2021.01.270. Epub 2021 Feb 16.
To assess the safety, feasibility, and efficacy of percutaneous thermal ablation (TA) in the treatment of metastatic gynecologic (GYN) tumors.
A study cohort of 42 consecutive women (mean age, 59. years; range, 25-78 years) with metastatic GYN tumors (119 metastatic tumors) treated with radiofrequency (n = 47 tumors), microwave (n = 47 tumors), or cryogenic (n = 30 tumors) ablation from over 2,800 ablations performed from January 2001 to January 2019 was identified. The primary GYN neoplasms consisted of ovarian (27 patients; 77 tumors; mean tumor diameter [MTD], 2.50 cm), uterine (7 patients; 26 tumors; MTD, 1.89 cm), endometrial (5 patients; 10 tumors; MTD, 2.8 cm), vaginal (2 patients; 5 tumors; MTD, 2.40 cm), and cervical (1 patient; 1 tumor; MTD, 1.90 cm) cancers. In order of descending frequency, metastatic tumors treated by TA were located in the liver or liver capsule (74%), lungs (13%), and peritoneal implants (9%). Single tumors were also treated in the kidneys, rectus muscle, perirectal soft tissue (2.5%), and retroperitoneal lymph nodes (1.6%). All efficacy parameters of TA and definitions of major and minor adverse events are categorized by the latest Society of Interventional Radiology reporting standards.
The median follow-up of treated patients was 10 months. After the initial ablation, 95.6% of the patients achieved a complete tumor response confirmed by contrast-enhanced magnetic resonance imaging or computed tomography. On surveillance imaging, 8.5% of the ablated tumors developed local progression over a median follow-up period of 4.1 months. Five of 8 tumors with local recurrence underwent repeated treatment over a mean follow-up period of 18 months, and 4 of 5 tumors achieved complete eradication after 1 additional treatment session that resulted in a secondary efficacy of 80%. The overall technique efficacy of TA was 96.2% over a median follow-up period of 10 months.
TA was safe and effective for the local control of metastatic GYN tumors in the lungs, abdomen, and pelvis, with an overall survival rate of 37.5 months and a local progression-free survival rate of 16.5 months, with only 4.8% of treated patients experiencing a major adverse event.
评估经皮热消融（TA）治疗妇科转移性肿瘤的安全性、可行性和疗效。
从 2001 年 1 月至 2019 年 1 月期间进行的 2800 多次消融治疗中，确定了 42 例连续患有妇科转移性肿瘤（119 个转移性肿瘤）的女性（平均年龄 59 岁；年龄范围 25-78 岁）的研究队列，她们接受了射频（n=47 个肿瘤）、微波（n=47 个肿瘤）或冷冻（n=30 个肿瘤）消融治疗。原发性妇科肿瘤包括卵巢（27 例患者；77 个肿瘤；平均肿瘤直径 [MTD]，2.50 厘米）、子宫（7 例患者；26 个肿瘤；MTD，1.89 厘米）、子宫内膜（5 例患者；10 个肿瘤；MTD，2.8 厘米）、阴道（2 例患者；5 个肿瘤；MTD，2.40 厘米）和宫颈（1 例患者；1 个肿瘤；MTD，1.90 厘米）癌。按降序排列，TA 治疗的转移性肿瘤分别位于肝脏或肝包膜（74%）、肺部（13%）和腹膜种植（9%）。肾脏、直肌、直肠周围软组织（2.5%）和腹膜后淋巴结（1.6%）也单独治疗单个肿瘤。TA 的所有疗效参数和主要和次要不良事件的定义均按最新的介入放射学学会报告标准进行分类。
治疗患者的中位随访时间为 10 个月。在初始消融后，95.6%的患者通过增强磁共振成像或计算机断层扫描确认完全肿瘤反应。在监测影像上，8.5%的消融肿瘤在中位随访 4.1 个月后出现局部进展。8 个局部复发肿瘤中有 5 个在平均随访 18 个月后接受了重复治疗，5 个肿瘤中有 4 个在第 1 次额外治疗后完全消除，这导致二次疗效为 80%。TA 的总体技术疗效为中位随访 10 个月时的 96.2%。
TA 治疗肺部、腹部和骨盆的妇科转移性肿瘤是安全有效的，总生存率为 37.5 个月，局部无进展生存率为 16.5 个月，仅有 4.8%的治疗患者发生重大不良事件。
