Granata Vincenza, Fusco Roberta, De Muzio Federica, Cutolo Carmen, Setola Sergio Venanzio, Simonetti Igino, Dell'Aversana Federica, Grassi Francesca, Bruno Federico, Belli Andrea, Patrone Renato, Pilone Vincenzo, Petrillo Antonella, Izzo Francesco
Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via Mariano Semmola, 80131 Naples, Italy.
Medical Oncology Division, Igea SpA, 80013 Naples, Italy.
J Clin Med. 2022 May 13;11(10):2766. doi: 10.3390/jcm11102766.
One of the major fields of application of ablation treatment is liver tumors. With respect to HCC, ablation treatments are considered as upfront treatments in patients with early-stage disease, while in colorectal liver metastases (CLM), they can be employed as an upfront treatment or in association with surgical resection. The main prognostic feature of ablation is the tumor size, since the goal of the treatment is the necrosis of all viable tumor tissue with an adequate tumor-free margin. Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most employed ablation techniques. Ablation therapies in HCC and liver metastases have presented a challenge to radiologists, who need to assess response to determine complication-related treatment. Complications, defined as any unexpected variation from a procedural course, and adverse events, defined as any actual or potential injury related to the treatment, could occur either during the procedure or afterwards. To date, RFA and MWA have shown no statistically significant differences in mortality rates or major or minor complications. To reduce the rate of major complications, patient selection and risk assessment are essential. To determine the right cost-benefit ratio for the ablation method to be used, it is necessary to identify patients at high risk of infections, coagulation disorders and previous abdominal surgery interventions. Based on risk assessment, during the procedure as part of surveillance, the radiologists should pay attention to several complications, such as vascular, biliary, mechanical and infectious. Multiphase CT is an imaging tool chosen in emergency settings. The radiologist should report technical success, treatment efficacy, and complications. The complications should be assessed according to well-defined classification systems, and these complications should be categorized consistently according to severity and time of occurrence.
消融治疗的主要应用领域之一是肝脏肿瘤。对于肝细胞癌（HCC），消融治疗被视为早期疾病患者的一线治疗方法，而在结直肠癌肝转移（CLM）中，它们可作为一线治疗或与手术切除联合使用。消融的主要预后特征是肿瘤大小，因为治疗的目标是使所有存活的肿瘤组织坏死并获得足够的无瘤切缘。射频消融（RFA）和微波消融（MWA）是最常用 的消融技术。HCC和肝转移瘤的消融治疗对放射科医生提出了挑战，他们需要评估治疗反应以确定与并发症相关的治疗方案。并发症定义为手术过程中任何意外的变化，不良事件定义为与治疗相关的任何实际或潜在损伤，可能发生在手术过程中或之后。迄今为止，RFA和MWA在死亡率或严重或轻微并发症方面均未显示出统计学上的显著差异。为了降低严重并发症的发生率，患者选择和风险评估至关重要。为了确定所使用消融方法的正确成本效益比，有必要识别出有感染、凝血障碍和既往腹部手术干预高风险的患者。基于风险评估，在手术过程中作为监测的一部分，放射科医生应注意几种并发症，如血管、胆道、机械性和感染性并发症。多期CT是紧急情况下选择的成像工具。放射科医生应报告技术成功率、治疗效果和并发症。应根据明确的分类系统评估并发症，并应根据严重程度和发生时间对这些并发症进行一致的分类。
