Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China.
Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute; Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China.
J Cancer Res Ther. 2023 Feb;19(1):64-70. doi: 10.4103/jcrt.jcrt_2093_22.
BACKGROUND: Microwave ablation (MWA) of lung tumors is a technique that is dependent on the ablationist's level of expertise. The selection of the optimum puncture path and determination of appropriate ablative parameters is the key to the success and safe of the procedure. The objective of this study was to describe the clinical use of a novel three-dimensional visualization ablation planning system (3D-VAPS) for aided MWA of stage I non-small cell lung cancer (NSCLC). METHODS: This was a single-arm, single-center, retrospective study. From May 2020 to July 2022, 113 consented patients with stage I NSCLC received MWA treatment in 120 MWA sessions. The 3D-VAPS was used to determine that: (1) the overlap between the gross tumor region and simulated ablation; (2) the proper posture and appropriate puncture site on the surface of the body; (3) the puncture path; and (4) presetting preliminarily ablative parameters. Patients were monitored with contrast-enhanced CT scans at 1, 3, and 6 months, as well as every 6 months following that. The primary endpoints were technical success and a complete ablation rate. Local progression-free survival (LPFS), overall survival (OS), and comorbidities were secondary study objectives. RESULTS: The mean diameter of tumors was 1.9 ± 0.4 cm (range 0.9-2.5 cm). The mean duration was 5.34 ± 1.28 min (range 3.0-10.0 min). The mean power output was 42.58 ± 4.23 (range 30.0-50.0W). The median follow-up time was 19.0 months (6.0-26.0 months). The technical success rate was 100%. Three-month after the procedure, the complete ablation rate was 97.35%. 6, 9, 12, and 24 months LPFS rates were 100%, 98.23%, 98.23%, and 96.46%, respectively. One-year and 2-year OS rates were 100% and 100%. There were no patients who died both during the procedure and after the MWA of 30 days. The complications after MWA included pneumothorax (38.33%), pleural effusion (26.67%), intrapulmonary hemorrhage (31.67%), and pulmonary infection (2.50%). CONCLUSIONS: This research describes and confirms that 3D-VAPS is a feasibility and safe method for MWA of stage I NSCLC treatment. 3D-VAPS may be helpful to optimize the puncture path, assess reasonable ablative parameters, and minimize complications.
背景：微波消融（MWA）治疗肺部肿瘤是一项依赖于消融医师专业水平的技术。选择最佳穿刺路径和确定合适的消融参数是该手术成功和安全的关键。本研究旨在描述一种新型的三维可视化消融规划系统（3D-VAPS）在辅助治疗 I 期非小细胞肺癌（NSCLC）中的临床应用。
方法：这是一项单臂、单中心、回顾性研究。自 2020 年 5 月至 2022 年 7 月，113 例经知情同意的 I 期 NSCLC 患者在 120 次 MWA 治疗中接受了 MWA 治疗。3D-VAPS 用于确定：（1）大体肿瘤区域与模拟消融区域的重叠；（2）体表合适的体位和适当的穿刺部位；（3）穿刺路径；（4）预设初步消融参数。患者在 1、3 和 6 个月以及此后每 6 个月接受增强 CT 扫描监测。主要终点是技术成功率和完全消融率。局部无进展生存率（LPFS）、总生存率（OS）和合并症是次要研究目标。
结果：肿瘤平均直径为 1.9±0.4cm（范围 0.9-2.5cm）。平均手术时间为 5.34±1.28min（范围 3.0-10.0min）。平均功率输出为 42.58±4.23W（范围 30.0-50.0W）。中位随访时间为 19.0 个月（6.0-26.0 个月）。技术成功率为 100%。术后 3 个月完全消融率为 97.35%。6、9、12 和 24 个月的 LPFS 率分别为 100%、98.23%、98.23%和 96.46%。1 年和 2 年 OS 率均为 100%。无患者在手术过程中和 MWA 后 30 天内死亡。MWA 后并发症包括气胸（38.33%）、胸腔积液（26.67%）、肺内出血（31.67%）和肺部感染（2.50%）。
结论：本研究描述并证实 3D-VAPS 是治疗 I 期 NSCLC 的一种可行且安全的方法。3D-VAPS 可能有助于优化穿刺路径、评估合理的消融参数并减少并发症。
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