早期肺癌消融

早期肺癌热消融技术的临床应用进展热消融技术原理射频消融（radiofrequency

ablation,

RFA）利用375-500kHz的高频交变电流在肿瘤组织内引起的离子相互磨擦、碰撞而产生的热生物学效应，局部温度可达60-120℃，当肿瘤组织被加热至60℃以上时，可引起细胞凝固性坏死。微波消融（microwave

ablation,

MWA）一般采用915MHz或2450MHz两种频率。在微波电磁场的作用下，肿瘤组织内的水分子、蛋白质分子等极性分子产生极高速振动，造成分子之间的相互碰撞、摩擦，在短时间内产生高达60-150℃的高温，从而导致细胞凝固性坏死。其他消融方式（激光、高强度聚焦超声、冷冻......）Dupuy

DE

et

al,

Am

J

Roentgenol.2000;

174(1):

57-59.冯威健,等.

中华肿瘤杂志2002;

24(4).热消融历史Diagnostic

and

Interventional

Imaging

2016;

97:

1019-1024.疗效：RFA1.2.3.4.MWA

can

produce

higher

intratumoral

temperatures

.Larger

tumor

ablation

volumes

with

faster

ablation

times.Available

MWA

systems

vessels

adjacent

to

lung

tumors

.MWA

is

associated

with

less

procedural

pain,

perhaps

from

lack

of

electrical

nerve

stimulation

associated

with

J

Thorac

Imaging

2016;

31(4):

228-237.

疗效：WMA

Vs.

RFAThe

major

advantage

of

RFAover

other

ablative

techniQues

is

experience.MWA

has

emerged

as

a

potentially

superiortreatment

option

to

RFAdue

to

a

much

broader

energy

deposition

capable

of

producing

a

larger

zone

of

active

heating.中国肺癌杂志

2018;

21(2):

76-88.中国专家共识：射频消融中国肺癌杂志

2017;

20(7):

433-445.中国专家共识：热消融中国专家共识：英文版J

Can

Res

Ther

2018;

14:

730-744.StageINSCLCRFA（62）wedgeresection（59）pMedianfollow-up42ms36ms0.539localprogression23%2%0.0021-yearOS93%(87%),100%(96%),2-yearOS72%(63%),96%(90%)5-yearOS35%(55%)52%(76%)0.044/0.01硬膜外和鞘内止痛药

2－6％Eur

Respir

J

2015;

45(4):

1089-1097.RFA

can

be

considered

an

option

for

inoperable

patients,

especially

for

those

withstage

T1N0M0.疗效比较：RFA

VS.

手术Int

J

Clin

Oncol

2015;

20:

499–507.RFA（47）SBRT（48）p

diameterlocal

progression

3-yearOS

2.0

±

0.8（0.6-3.9）

9.6

%

86.4

%,2.1

±

0.9

（0.8-

4.7）

7.0

%,

79.6

%

0.5390.7460.738疗效比较：RFA

VS.

SBRTRespiration

2015;

89(6):

550-557.手术

VS.

RFA

VS.

SBRT硬膜外和鞘内止痛药

2－6％Stage

I

NSCLCSurgerySBRTAblationHistory1800

19002000

ProfessionalsMedical

equipmentTreat-time/

hospitalizationIn-hospital

/3ms

mortalityComplications

5-7

Complicated

4-5

h/

7-10

d

2.8-5.5%

/

5.0-7.5%Anesthesia，infection，Hemorrhage

4-5

Very

complicated

2-4

weeks/

0-1d

0.6-0.9%

/1.5-3.2%Radiation

pneumonitis

3-4

Relatively

simple

1-1.5

h

/

1-3d

0.5-1.3%

/0.8-1.5%PneumothoraxCost5-year

survival

rates＄10,000--15,000

55-75%＄

12,000-21,000

35-60%＄

3,500—6,000

25-61%1.JThoracOncol.

2015

Jun;10(6):960-4.

2.

RespirInvestig.

2014

Jul;52(4):221-6.

3.

BiomedRes

Int.

2014;2014:152087.

4.Thorac

SurgClin.

2007May;17(2):251-9.

5.LancetOncol.

2013Jan;14(1):e28-37.

6.Chest2013;

143(5)(Suppl):278S–313S

7.JVascInterv

Radiol

2013;

24:476–482

8.JThoracCardiovasc

Surg2013;145:692-99

9.EurRespirJ.

2015

Apr;45(4):1089-97

10.J

Vasc

Interv

Radiol.

2015Jun;26(6):787-91.11.JOncolPract.

2014May;10(3):e130-6.

12.

IntJRadiatOncolBiolPhys.

2011

Nov

15;81(4):964-73.13.

J

Thorac

Oncol.

2015

Dec;10(12):1776-84.手术

VS.

AB

VS.

SBRT

Cost-Effectiveness

Analysis

Comparing

Surgery

SBRT

&

Ablation硬膜外和鞘内止痛药

2－6％指南推荐（NCCN）多发单发Ann

Oncol

2014;

25(8):

1462-1474.指南推荐（ESMO）The

role

of

ablative

therapies

in

the

treatment

of

high-riskpatients

with

stage

INSCLC

is

evolving.

RF

ablation,

the

most

studied

of

the

ablative

modalities,has

been

used

effectively

in

medicallyinoperable

patients

with

small

(3

cm)peripheral

NSCLC

that

are

clinical

stage

I.Chest

2013;

143(5)(Suppl):

278-313.指南推荐（CHEST）硬膜外和鞘内止痛药

2－6％支修益,等.

中华肿瘤杂志

2015;

37(1).指南推荐（中国诊疗规范）Fortschr

Röntgenstr

2017;

189:

828 - 843.消融：较好的非手术干预选择左肺上叶腺癌，T1aN0M0，90岁微波消融后随访：瘢痕形成，逐渐缩小病例一：高龄患者右肺上叶肉瘤，T1bN0M0，肺纤维化微波消融后随访：结节缩小病例二：心肺功能差右肺上叶、右肺下叶腺癌，T1a(2)N0M0微波消融后随访：瘢痕形成，逐渐缩小病例三：多原发肺癌左肺上叶腺癌（ROSE），T1bN0M0病理现场确认后即刻行微波消融病例四：活检后即刻消融左肺上叶腺癌，T1aN0M0，消融后即刻活检微波消融后随访：瘢痕形成病例五：消融后即刻活检左肺上叶腺癌，薄层CT显示内部实性成分为血管“No

Touch”夹持消融，消融后即刻活检病例六：消融后即刻活检右肺下叶腺癌，（固化）消融后即刻活检