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背景此研究对高危Ⅰ期非小细胞肺癌经射频消融治疗患者局部再发管理特性进行论述。方法选择2003—2010年经活检证实的Ⅰ期非小细胞肺癌患者,在CT引导下行射频消融治疗。所有患者被确认为不能手术或拒绝手术者。行射频消融治疗目的是治愈疾病。结果对45例1期非小细胞肺癌患者(年龄51～89岁)进行了55次消融术。随访中位数为32个月,行射频消融治疗后平均(12±10)个月内有21例(38%)出现局部再发。复发部位包括瘤床内18例(33%),局部淋巴结4例(7%),远处淋巴结2例(4%)。最大肿瘤直径为0.7～4.5 cm,平均(2.3±1.3)cm。直径>3 cm的肿瘤中10例(80%)与局部再发相关。复发病变再次做射频消融治疗(5例)、放疗(8例)、化放疗(5例)及化疗(2例)。5例经再次射频消融治疗患者中的2例(40%)及8例(100%)经放疗的患者病情得到局部控制,2例局部淋巴结复发病例治疗失败〔随访中位数为(40±13)个月〕。有无局部再发的患者的总生存率相似(32%与35%)。重复射频消融治疗与严重并发症或手术-相关30 d死亡率无关。结论 >3 cm及与大血管相邻的肿瘤,肺部射频消融的局部失败率上升。局部失败患者可迅速做立体定向放疗或重复做射频消融,并不影响总生存率。
Background This study discusses the management of local recurrence in patients with high-risk stage I non-small cell lung cancer treated by radiofrequency catheter ablation. Methods Patients with stage Ⅰ non-small cell lung cancer confirmed by biopsy from 2003 to 2010 were treated with CT guided radiofrequency catheter ablation. All patients were confirmed as not surgery or refused surgery. Radiofrequency ablation treatment is to cure the disease. Results Forty-five patients with stage I non-small cell lung cancer (age 51-89) underwent 55 ablations. The median follow-up was 32 months, with 21 (38%) local recurrences within 12 ± 10 months of radiofrequency ablation. The recurrent sites included 18 cases (33%) in the tumor bed, 4 cases (7%) of local lymph nodes, and 2 cases (4%) of distant lymph nodes. The largest tumor diameter of 0.7 ~ 4.5 cm, mean (2.3 ± 1.3) cm. Ten (80%) of the tumors> 3 cm in diameter were associated with local recurrence. Radiofrequency ablation (5 cases), radiotherapy (8 cases), chemoradiotherapy (5 cases) and chemotherapy (2 cases) were performed again in patients with recurrent disease. Two patients (40%) and eight patients (100%) treated by radiofrequency ablation were locally controlled in 5 patients, and two patients with partial lymph node recurrence failed to complete treatment (median follow-up was (40 ± 13) ) Months]. Patients with or without local recurrence had similar overall survival (32% vs 35%). Repeated radiofrequency ablation was not associated with serious complications or surgery-associated 30-day mortality. CONCLUSIONS: The local failure rate of lung radiofrequency ablation increased with tumors> 3 cm and adjacent to the large vessels. Patients with local failure can quickly do stereotactic radiotherapy or repeat radiofrequency ablation, does not affect the overall survival rate.