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目的探讨经支气管动脉化疗栓塞(TACE)联合射频消融术(RFA)对较大肺癌局部肿块的灭活作用。方法2008年5-11月我科共收治4例肺癌患者(肿瘤最大径均>5 cm,最大肿瘤为10 cm×8 cm×8 cm)。所有肿瘤均经病理活检证实为低分化腺癌。4例患者中2例介入治疗前曾接受系统化疗+靶向治疗(NP方案+恩度),2例曾接受普通化疗,均因无法耐受化疗反应转而寻求介入治疗。对4例患者均先经支气管动脉行病灶侧TACE,术后3～7天给予CT引导下RFA治疗,均于局麻联合静脉强化麻醉下完成。术后1个月增强CT扫描评价疗效,如有不同程度的肿瘤组织残留或复发征象则再次行TACE+RFA治疗。所有患者均定期影像随访至本研究结束。结果4例患者均接受2次TACE+RFA联合治疗,第1次联合治疗后1个月CT增强扫描示均有不同程度的肿瘤组织残留征象;第2次联合治疗后1个月CT增强扫描均未见残存肿瘤组织征象。经2次TACE+RFA联合治疗后随访至本研究结束6～12个月,影像学随访示局部射频灶均有不同程度的缩小,未见残存或复发征象。结论TACE+RFA联合治疗可以有效地灭活直径>5 cm肺癌局部病灶,近期疗效较好,远期疗效有待于长期随访。
Objective To investigate the inactivation of local mass in lung cancer patients by transcatheter arterial chemoembolization (TACE) combined with radiofrequency catheter ablation (RFA). Methods From May to November in 2008, 4 cases of lung cancer were treated in our department (the maximum tumor diameter was> 5 cm and the maximum tumor size was 10 cm × 8 cm × 8 cm). All tumors were confirmed by pathological biopsy as poorly differentiated adenocarcinoma. Two of the four patients received systemic chemotherapy plus targeted therapy (NP regimen + Endostar) before 2 interventions and 2 received conventional chemotherapy, all of whom were unable to tolerate the chemotherapy response and sought interventional therapy. All 4 patients underwent TACE via the bronchial artery and CT-guided RFA 3 to 7 days postoperatively, all under local anesthesia and intravenous intensive anesthesia. One month after surgery to enhance CT scan evaluation of efficacy, if there is varying degrees of residual tumor or recurrence of signs again TACE + RFA treatment. All patients were followed up regularly until the end of the study. Results All 4 patients underwent TACE + RFA combined therapy. CT scan at 1st month after the first combination therapy showed different degrees of residual tumor tissue. One month after the second combination therapy, CT enhanced scanning No residual tumor tissue signs. After 2 times TACE + RFA combined treatment followed up to the end of this study 6 to 12 months, imaging follow-up showed local radiofrequency were reduced to varying degrees, no signs of residual or recurrent. Conclusion TACE + RFA combination therapy can effectively inactivate the local lesions of> 5 cm in diameter. The recent curative effect is good and long-term follow-up remains to be achieved.