经皮微波消融治疗周围型早期非小细胞肺癌研究进展

山东省立医院肿瘤中心CenterofTumor,ShandongProvincialHospital

叶欣YeXin

yexintaian@

2015.8.15.福州.经皮微波/射频消融治疗早期周围型非小细胞肺癌临床研究进展Clinicalstudyonthepercutaneous

microwave/radiofrequencyablationof

peripheralearlystagenon-smallcelllungcancer肺癌微波/射频消融开展情况和目前规范指南

2000200420062008200920102011201220132014LIVER8.50012.00016.00038.000126.000250.000370,000460,000520,000642,000LUNG19003,00016,00056,000100,000210,000330,000431,000574,000KIDNEY1507001.50012.00042.00080.000130,000160,000192,000212,000BONE1207001.5008.00011.00030.00045,00056,00064,00082,000OTHERS1002001.00015.00019.00030.00070,000110,000182,000273,000TOTAL8,87114,50023,00089,000254,000490，000825,0001116，0001,389,0001,783,000欧美国家热消融治疗例数的估计Estimationof

thenumberofthermal

ablation

patientsinthe

EuropeanandAmerican

48硬膜外和鞘内止痛药2－6％2013;143(5)(Suppl):e278S–e313STheroleofablativetherapiesinthetreatmentofhigh-riskpatientswithstageINSCLCisevolving.RFablation,themoststudiedoftheablativemodalities,hasbeenusedeffectivelyinmedicallyinoperablepatientswithsmall(3cm)peripheralNSCLCthatareclinicalstageI.硬膜外和鞘内止痛药2－6％神经阻断、姑息手术1－5％硬膜外和鞘内止痛药2－6％(10)心肺功能等机体状况经评估无法接受手术的I期和Ⅱ期的NSCLC患者，可选择根治性放射治疗、射频消融治疗和药物治疗等。

PhilippeL,Pereira,MasalaSalvatore.StandardsofPractice:GuidelinesforThermalAblationofPrimaryandSecondaryLungTumors.Cardiovasc

Intervent

Radiol,2012,35:247-254.硬膜外和鞘内止痛药2－6％ThoracicCancer2015；6：112–121TranslLungCancerRes2015;4(3):310-321Radiology2014;273:241–260Energy-basedAblationThiscategoryincludesmodalitiesthatdestroyatumoreitherthroughthermal(heatorcold)ornonthermalmechanisms.Forthermaltherapies,energyis“applied.”Theterm“irradiationofenergy,”particularlyinregardtomicrowaveablation,isamisnomerandshouldthereforebeavoided.Thefollowingenergy-basedmodalitieshavebeendescribed.RFablation.—，Microwaveablation.—，Ultrasoundablation.—Laserablation.—，Cryoablation.Irreversibleelectroporation疗效观察和评价ClinicalEvaluationClinicalefficacyLocalefficacy,OverallsurvivalCT:contrast-enhancementT1W

enhancementMRI:

DWI(diffusion-weightedimaging)

ADC（apparentdiffusioncoefficient）

PET-CT:SUV硬膜外和鞘内止痛药2－6％CTFollow-upassessment*Disappearance*Cavitation*Fibrosis*Nodule*AtelectasisDisappearanceFibrosisNoduleAtelectasisCavitationDonC.Yoo,etal.AJR2011;197:334–3403months6months6months6months硬膜外和鞘内止痛药2－6％JournalofMedicalImagingandRadiationOncology••(2015)doi:10.1111/1754-9485.12330硬膜外和鞘内止痛药2－6％79-year-oldmalewithLUL24mmSCC.硬膜外和鞘内止痛药2－6％Semin

Intervent

Radiol2013;30:157–168硬膜外和鞘内止痛药2－6％硬膜外和鞘内止痛药2－6％1989–2003，101,844patientsinCaliforniastageI：mediansurvival13msoverallsurvivalforuntreatedpatientswithNSCLC,stageI-IV(n=22,954).5-yearsurvivalrateswerestageI：7%；stageII-IV：0%Chest.

2007Jul;132(1):193-9.硬膜外和鞘内止痛药2－6％2013;143(5)(Suppl):278S–313SBasedonsuchretrospectiveseriesofresectedstageIandstageIINSCLC,theprognosesforstageIandIINSCLC,expressedintermsof5-yearsurvivalrates,arecommonlyacceptedtobe60%to80%forstageIand30%to50%forstageIINSCLC.1-year,2-year,3-year,5-year(OSrates)

78%--100%,53%--86%,36%--88%,25%--61%.

1-year,2-year,3-year(cancer-specificsurvivalrates)89%--100%,92%--93%,59%--88%.Themediansurvivaltimerangedfrom29--67months.BioMedResearchInternational

2014;2014:152087Cancer2015;000:000-000.Theoverallsurvivalrate86.3%at1year69.8%at2years.Cardiovasc

Intervent

Radiol2015，38:160–166硬膜外和鞘内止痛药2－6％神经阻断、姑息手术1－5％PatientsMaxdiameterSD:3.0±0.9cm;Survivalrate:1y:69%,2y:54%,3y:49%EurJCardiothoracSurg.

2013

Apr;43(4):683-6.RFA,≤2cmcanbecompletedablatedin78-96%MWA≤5cmcanbecompletedablatedin95%Fornodules≤3cm,thesurvivalrateishigher:50%atfiveyears.Pulmonarymetastasis,lesionsare≤5cm.EurJCardiothorac

Surg.

2013

Apr;43(4):683-6.硬膜外和鞘内止痛药2－6％神经阻断、姑息手术1－5％JVasc

Interv

Radiol2014;25:1–9

Resectiongroup:90days,1year,and2years100%,88.3%,and75.8%Ablationgroup:98.6%,88.7%,and66.1%.硬膜外和鞘内止痛药2－6％JVasc

Interv

Radiol2013;24:476–482

硬膜外和鞘内止痛药2－6％

1-,2-,3-yOS:Surgery:100%,95%,83%RF:91%,73%,55%Themediancostpermonthlived

RF:$620.74Surgery:$1,195.92Conclusions:

Patientstreatedwithsurgeryshowedasignificantincreaseinsurvival;however,thosetreatedwithRFablationweresignificantlyolder.Forpatientswhoarenotsurgicalcandidates,RFablationprovidesanalternativetreatmentoptionatasignificantlylowercost.

硬膜外和鞘内止痛药2－6％LancetOncol

2015;16:630–37张玉蛟JoeYChang3yOS:96%:79%3yRFS:86%:80%硬膜外和鞘内止痛药2－6％JVasc

Interv

Radiol.2013Aug;24(8):1139-45

硬膜外和鞘内止痛药2－6％55.8%/3y,59%/3y,47%/5y,40%/5y,IntJClin

Oncol(2015)20:499–507RFA（47）SBRT（48）pdiameter

2.0

±

0.8

（0.6-3.9）2.1

±

0.9（0.8-4.7）

0.539localprogression9.6

%

7.0

%,0.7463-yearOS86.4

%,79.6

%0.738硬膜外和鞘内止痛药2－6％JThorac

Cardiovasc

Surg2013;145:692-99Respiration.2015;89(6):550-7116patientsstageINSCLCSublobarresection(n=42),Radiofrequencyablation(n=25)Radiotherapy(n=49)Conclusions:

OurstudysuggeststhatSLRwasassociatedwithahigherprimarytumorcontrolratecomparedtoRFAorRT.AlthoughtheOSswerenotdifferent.

Theseresultsshouldbeconfirmedinprospectivetrials.Theprobabilitiesof1-and2-yearOSwere94and85%fortheSLRpatients,86and74%forRFApatientsand93and69%fortheRTpatients,respectively.Respiration.2015;89(6):550-7

1-2-yearSLR：9485%RFA：8674%RT：9369%116patientsstageINSCLCSublobarresection(n=42),Radiofrequencyablation(n=25)Radiotherapy(n=49)JVasc

Interv

Radiol2014;25:333–3391-year,3-year,5-year(OS)

100%,96.4%,96.4%1-year,3-year,5-year(cancer-specificsurvival)100%,100%,100%,（33consecutivepatients，meanfollow-upof42months

）Cardiovasc

Intervent

Radiol(2015)38:409–4151-year,5-year,93.3%,93.3%,1-year,5-year,(cancer-specificsurvival)100%,100%,（16consecutivepatients，meanfollow-upof61.5months

）硬膜外和鞘内止痛药2－6％53monthsafterRFAFollow-up5yearsFollow-up30msFollow-up40ms硬膜外和鞘内止痛药2－6％JMedImagingRadiat

Oncol.2015Feb;59(1):82-90.

75-y,F.T1N0M0.PETscan5monthspost-conclusionofXRTshowsresiduallocaltumouravidity;MedianOS：62ms.4yr

controlrate：44.1%.Retreatedupto4times.Size(

>2cm).Numberof

metastases

(

≥3).SignificantlyassociatedwithOS.AnnalsofOncology26:987–991,2015Radiology.

2015Jun8:141153.[Epubaheadofprint]1-yearlocalprogressionrate:12.7%largevesselorabronchus:30.4%;No-largevesselorabronchus:0%;1-,2-,3-yearOS84.1%,79.2%,66.0%68.6%,34.3%,0%(uncontroll-extr-lung)我们的工作和经验Ourworkandexperience12ms24msM,67y,Largecellcarcinoma,

2.9cm硬膜外和鞘内止痛药2－6％神经阻断、姑息手术1－5％M,78y,Squamouscellcarcinoma,2.5cm硬膜外和鞘内止痛药2－6％神经阻断、姑息手术1－5％1月3月6月24月M,72y,Adenocarcinoma2.9cm硬膜外和鞘内止痛药2－6％Female:70‐year‐oldpatientwith5.0cm4.5cmrightlungcancer(squamous)a:Tumorlesion(arrow)seenonCTimmediatelypriortoMWA.b:Twomicrowaveantennapunctureintothelesion(arrow).c:AblatedlesionwithsurroundingGGOseenonrepeatCTscanimmediatelypost‐MWA.d:6msafterablation,lesionslightlyshrinking(arrow).e:12monthsafterablation.f:36msshowsa