Pacella C M, Bizzarri G, Ferrari F S, Anelli V, Valle D, Bianchini A, Rossi Z, Stefani M, Crescenzi A, Guazzi G, Minuto S, Stefani P
Dipartimento di Radiologia e Diagnostica per Immagini, Albano Laziale, Roma.
Radiol Med. 1996 Oct;92(4):438-47.
Interstitial laser photocoagulation (ILP) causes tumor necrosis with local hyperthermia produced by laser light energy. We treated with US-guided ILP 14 patients (7 men and 7 women; mean age: 67 years) and 20 metastases: 9 of them were < 3 cm in max. diameter and 11 were > 3 cm (mean diameter: 2.9 cm); 14 metastases were from colon carcinoma, 5 from breast cancer and 1 from lung cancer. ILP was performed with 300 and 600 microns quartz fiberoptic guides advanced in 21-18G Chiba needles and a continuous-wave Nd: YAG laser with 1064 nm wavelength. We used single expositions of 5-6 minutes with an irradiation power of 5 watts and scheduled 3 treatment sessions, performing CT scans and biopsies at the end of each session. The extent of induced necrosis was classified as follows on the basis of CT findings: grade 1 = 100% necrosis; grade 2 = necrosis > 50%; grade 3 = necrosis < 50%. The average follow-up was 6 months. After the 3 scheduled treatment sessions, CT showed grade 1 necrosis in all the lesions < 3 cm in diameter and in 4/9 (44%) lesions > 3 cm and grade 2 and 3 necrosis in the remaining cases (necrosis > 50% in 95% of the lesions and 92% of the patients). The cytologic findings were in agreement with CT results in all grade 2 and 3 cases, but in one grade 1 necrosis cytology showed residual viable tumor. To conclude, ILP is a safe and well-tolerated procedure. Maximum efficacy was observed in the lesions < 3 cm, while lesion volume was markedly reduced in the lesions > 3 cm. US is a useful tool in the real-time monitoring of this procedure and CT is the most accurate imaging technique to assess treatment efficacy.
间质激光光凝术（ILP）通过激光能量产生局部高温，从而导致肿瘤坏死。我们对14例患者（7例男性和7例女性；平均年龄：67岁）的20处转移瘤进行了超声引导下的ILP治疗：其中9处最大直径<3 cm，11处>3 cm（平均直径：2.9 cm）；14处转移瘤来自结肠癌，5处来自乳腺癌，1处来自肺癌。使用300和600微米的石英光纤导管，通过21-18G千叶针推进，并使用波长为1064 nm的连续波Nd:YAG激光进行ILP治疗。我们采用单次照射5 - 6分钟，照射功率为5瓦，安排3次治疗疗程，每次疗程结束时进行CT扫描和活检。根据CT检查结果，诱导坏死的程度分类如下：1级 = 100%坏死；2级 = 坏死>50%；3级 = 坏死<50%。平均随访时间为6个月。在预定的3次治疗疗程后，CT显示所有直径<3 cm的病变以及4/9（44%）直径>3 cm的病变出现1级坏死，其余病例出现2级和3级坏死（95%的病变和92%的患者坏死>50%）。在所有2级和3级病例中，细胞学检查结果与CT结果一致，但在1例1级坏死病例中，细胞学检查显示有残留的存活肿瘤。总之，ILP是一种安全且耐受性良好的治疗方法。在直径<3 cm的病变中观察到最大疗效，而在直径>3 cm的病变中病变体积明显减小。超声是该治疗过程实时监测的有用工具，CT是评估治疗效果最准确的成像技术。
