Delpla Alexandre, de Baere Thierry, Varin Eloi, Deschamps Frederic, Roux Charles, Tselikas Lambros
Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy, 94800 Villejuif, France.
Cancers (Basel). 2021 Feb 22;13(4):908. doi: 10.3390/cancers13040908.
: Consensus guidelines of the European Society for Medical Oncology (ESMO) (2016) provided recommendations for the management of lung metastases. Thermal ablation appears as a tool in the management of these secondary pulmonary lesions, in the same manner as surgical resection or stereotactic ablative radiotherapy (SABR). : Indications, technical considerations, oncological outcomes such as survival (OS) or local control (LC), prognostic factors and complications of thermal ablation in colorectal cancer lung metastases were reviewed and put into perspective with results of surgery and SABR. : LC rates varied from 62 to 91%, with size of the metastasis (<2 cm), proximity to the bronchi or vessels, and size of ablation margins (>5 mm) as predictive factors of LC. Median OS varied between 33 and 68 months. Pulmonary free disease interval <12 months, positive carcinoembryonic antigen, absence of neoadjuvant chemotherapy and uncontrolled extra-pulmonary metastases were poor prognostic factors for OS. While chest drainage for less than 48 h was required in 13 to 47% of treatments, major complications were rare. : Thermal ablation of a selected subpopulation of patients with colorectal cancer lung metastases is safe and can provide excellent LC and delay systemic chemotherapy.
欧洲医学肿瘤学会（ESMO）（2016年）的共识指南为肺转移瘤的管理提供了建议。热消融与手术切除或立体定向消融放疗（SABR）一样，成为这些继发性肺部病变管理中的一种手段。回顾了结直肠癌肺转移瘤热消融的适应症、技术考量、生存（OS）或局部控制（LC）等肿瘤学结局、预后因素及并发症，并与手术和SABR的结果进行对比分析。LC率在62%至91%之间，转移瘤大小（<2 cm）、与支气管或血管的距离以及消融边缘大小（>5 mm）是LC的预测因素。中位OS在33至68个月之间。肺无瘤间期<12个月、癌胚抗原阳性、未进行新辅助化疗以及无法控制的肺外转移是OS的不良预后因素。虽然13%至47%的治疗需要胸腔引流少于48小时，但严重并发症很少见。对部分结直肠癌肺转移瘤患者进行热消融是安全的，并且可以提供良好的LC并延迟全身化疗。
