Hasegawa Takaaki, Sato Yozo, Kuroda Hiroaki, Chatani Shohei, Murata Shinichi, Yamaura Hidekazu, Kato Mina, Onaya Hiroaki, Inaba Yoshitaka
Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, Japan.
Department of Thoracic Surgery, Aichi Cancer Center, Japan.
Interv Radiol (Higashimatsuyama). 2020 Jun 10;5(2):94-102. doi: 10.22575/interventionalradiology.2020-0003. eCollection 2020 Jun 30.
To evaluate the outcomes of radiofrequency ablation (RFA) on lung tumors < 1 cm in maximum diameter.
Twenty-eight patients (12 male, 16 female; median age, 59 years; mean age, 58 ± 16 years; range, 16-78 years) who underwent RFA for lung tumors < 1 cm in diameter between November 2009 and September 2018 were included in this study. Thirty-five tumors (median size, 8.4 mm; mean size, 7.7 ± 1.9 mm; range, 3.6-9.9 mm) were treated with 33 sessions of RFA. Technique efficacy and safety were subsequently evaluated. Initial and secondary technique efficacy were defined as complete ablation without residual tumor or local tumor progression after initial and repeat RFA, respectively. Safety was evaluated according to the Common Terminology Criteria for Adverse Events, version 5.0.
Residual tumor remained for 1 tumor (3%, 1/35) and local tumor progression was found in 2 tumors (6%, 2/35). Initial technique efficacy rate was therefore 91% (32/35). The remaining 3 tumors were treated by repeat RFA (secondary technique efficacy rate: 100%, 35/35). Initial technique efficacy rate was significantly lower for tumors treated with starting energy ≥ 20 W (P = 0.02) and showing a quick increase in tissue impedance (P = 0.01). There were 4 grade 2 adverse events (12%, 4/33) comprising pneumothorax requiring chest tube placement, and 14 grade 1 adverse events comprising self-limiting pneumothorax (36%, 12/33) and pulmonary parenchymal hemorrhage (6%, 2/33).
To achieve good outcomes for lung tumors < 1 cm, radiofrequency energy should be started at < 20 W. Application of manual mode ablation might be considered when delivery of power cannot be continued due to a quick increase in tissue impedance.
评估射频消融（RFA）治疗最大直径<1 cm的肺肿瘤的疗效。
本研究纳入了2009年11月至2018年9月期间接受RFA治疗直径<1 cm肺肿瘤的28例患者（男性12例，女性16例；年龄中位数59岁；平均年龄58±16岁；范围16 - 78岁）。对35个肿瘤（大小中位数8.4 mm；平均大小7.7±1.9 mm；范围3.6 - 9.9 mm）进行了33次RFA治疗。随后评估技术疗效和安全性。初始技术疗效定义为初次RFA后无残留肿瘤或局部肿瘤进展的完全消融，二次技术疗效定义为重复RFA后无残留肿瘤或局部肿瘤进展的完全消融。根据《不良事件通用术语标准》第5.0版评估安全性。
1个肿瘤（3%，1/35）残留肿瘤，2个肿瘤（6%，2/35）出现局部肿瘤进展。因此，初始技术有效率为91%（32/35）。其余3个肿瘤通过重复RFA治疗（二次技术有效率：100%，35/35）。起始能量≥20 W治疗的肿瘤（P = 0.02）以及组织阻抗迅速增加的肿瘤（P = 0.01）的初始技术有效率显著较低。有4例2级不良事件（12%，4/33），包括需要放置胸管的气胸，以及14例1级不良事件，包括自限性气胸（36%，12/33）和肺实质出血（6%，2/33）。
为使直径<1 cm的肺肿瘤获得良好疗效，射频能量应从<20 W开始。当由于组织阻抗迅速增加而无法持续输送能量时，可考虑应用手动模式消融。
