医学交流课件：微波消融与射频消融在治疗实体肿瘤中的比较研究

1、,微波消融与射频消融在治疗实体肿瘤中的比较研究,New Ablation Device: Key ?,What can it do ?,Is it safe ?,Is it better than other alternatives ?,Tutti i diritti riservati di propriet degli autori. vietata la riproduzione anche parziale.,CR= 92,PR= 8%,Stratification according to TUMOR SIZE,Size 5 cm,CR 96% CR 93% CR 82% CR 6

2、2%,PR 4% PR 7% PR 18% PR 38%,Technical success mRECIST for HCC CR : Disappearance of any intratumoral arterial enhancement in all lesions PR : At least a 30% decrease in the sum of diameters of viable tissue,1 cm gained ?,Ablation Tutti i diritti riservati di propriet degli autori. vietata la riprod

3、uzione anche parziale,Resection Ablation,Italian Multicenter Study (14 Centers, 312 mets in 178 pts),Responses According to the Lesion Size,Responses According the the Distance of the,Lesions from the Vessels,New Ablation Device: Key ?,What can it do ?,Is it safe ?,Is it better than other alternativ

4、es ?, Liang P, Radiology 2009:, 2.6% in 1136 pts (single Center) (no correlation with size), Livraghi T, CVIR 2012:, 2.9% in 736 pts (multicenter Italian Study), 2013 Italian Multicenter Study: 0.6% in 178 pts. with CRC mets,Major complication rates,Liver abscess and pleural empyema,Data on 670 pts

5、- 14 major complications reported (2 %),14. One procedure related death (0.12%),HCC 20 mm IV segm,60W - 10 min CT at 1 month,MR 3 months after LMWH,T=6 minutes; P=100 watts Microsulis 5.7 mm antenna,MWA: Conduction of Steam,Possible “chimney effect”,PRE -,POST-,CONs - higher cost of devices - learni

6、ng curve - few clinical results yet,PROs - faster - larger (fewer insertions) - less heat sink - lower LTP rate - no circulating current - equal major complications - no interferences with pacemakers & metallic .,CONCLUSIONS MWA,微波消融治疗肿瘤问世的时间仅十余年，尚有许多问题有待解决,由于肿瘤的大小、形状、位置等病灶条件的不同，技术难度和临床疗效也有差别，尤其肿瘤过大、形态欠规整、浸润性强或靠近重要脏器时给治疗带来困难，效果也较差 国内外的研究已证实，微波消融治疗肿瘤在使之原位灭活的同时，机体外周血和局部的免疫功能也会增强，这是其区别于手术治疗的特色，这也有利于杀灭残存的癌细胞，但如何长期增强机体的细胞免疫，巩固疗效，是临床上面临的实际问题 如何进一步增强微波消融的疗效，如微波消融联合生物治疗、微波消融联合 TACE（肝动脉化疗栓塞）、微波消融联合超抗原等方法还需研究,展 望,影像引导下微波消融治疗恶性肿瘤以其肿瘤完全坏死率高，疗效好，并发症少，且能增强机体免疫功能 等优点为肝癌的治疗开辟了新的途径 可以相信随 着消融技术的研究和影像学的发展