消融或联合125I粒子植入术治疗肾癌11例报告

背景与目的:射频多极针消融和近距离放疗近年来被广泛用于治疗肝癌和前列腺癌等实体肿瘤。本研究探讨用射频多极针消融或联合125I粒子植入术治疗肾癌患者的可行性。方法:2000年6月至2004年2月,采用射频多极针消融或联合植入放射性125I粒子治疗原发性肾癌患者11例,共13个肿瘤结节。其中孤立肾6例,肾癌合并对侧输尿管结石导致肾功能严重受损2例,双侧肾肿瘤1例,高龄患者不能耐受手术2例。对这13个肿瘤结节,分别采用开放手术、单纯消融、消融联合肿瘤周边植入放射性125I钛壳粒子进行治疗。结果:11例患者,术后随访6～46个月,平均27个月。1例术后4个月死于心肌梗塞;2例分别于术后7、11个月肿瘤复发,再次消融;1例因尿毒症间断透析治疗;7例患者肾功能正常。结论:消融或125I粒子植入术是治疗孤立肾、双肾肿瘤和高危不能耐受手术患者的一种可供选择的方法。     

乳腺癌的射频消融治疗2例报告并文献回顾

目的探讨超声引导下经皮射频消融对早期乳腺癌治疗的安全性和彻底性。方法2例穿刺病理确诊的乳腺癌患者接受了乳腺原发病灶的射频消融治疗,消融后3个月内接受了乳腺癌根治性手术,术后进行了常规病理检查。随访12个月行影像学检查。结果切除后病理检查显示病例一原发肿瘤长径小于2cm（1．6cm）的病理检查未见癌残留;病例二原发肿瘤大于2cm（2．5cm）的病例显示肿瘤中心区为坏死组织,范围约3．5cm,周边见少量导管内癌成分。两例患者目前术后随访1年复查,影像学检查未见局部复发或远处转移病灶。结论射频消融术为原发且长径小于2cm的早期乳腺癌患者提供了一个创伤更小且更为美观的治疗选择。     

超声引导下微波消融和射频消融与手术切除治疗甲状腺微小乳头状癌的疗效观察

目的探讨超声引导下微波消融和射频消融与手术切除治疗甲状腺微小乳头状癌的疗效。方法选取2014年5月至2018年2月间南京明基医院收治的227例甲状腺微小乳头状癌患者进行回顾性分析,其中,使用超声引导下微波消融治疗的79例患者纳入A组,使用超声引导下射频消融治疗的75例患者纳入B组,使用手术切除治疗的73例患者纳入C组。观察A、B组患者治疗前后肿瘤直径,比较三组患者甲状腺激素水平、术前术后应激反应和并发症发生情况。结果与治疗前相较,A、B两组患者经过治疗后肿瘤直径均缩小,差异均有统计学意义(均P <0. 05),但组间比较,差异无统计学意义(P <0. 05)。治疗后,A、B两组患者促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)比较,差异无统计学意义(P> 0. 05)。C组TSH指标均高于A、B两组,FT3和FT4指标均低于A、B两组,差异均有统计学意义(均P <0. 05)。术后1d和3d,A、B两组患者肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)比较,差异无统计学意义(P> 0. 05)。C组患者TNF-α和IL-6指标均高于同期A、B两组,差异均有统计学意义(均P <0. 05)。三组患者术后并发症比较,C组患者发生率均高于A、B两组,差异均有统计学意义(均P <0. 05)。结论超声引导下微波消融与射频消融治疗甲状腺微小乳头状癌效果较好,患者肿瘤体积缩小率高,术后甲状腺激素水平稳定,应激反应恢复快,并发症少。     

CT导向射频消融治疗肺部恶性肿瘤

目的 探讨CT导向下经皮肺穿刺射频消融治疗肺部肿瘤的有效性、安全性及并发症。方法 对不能手术的74例原发肺癌（其中鳞癌23例,腺癌48例,鳞腺癌2例,大细胞癌1例）和14例转移性肺癌共96个病灶（其中最大直径≤3 cm31个,3～5 cm 56个,〉5 cm 9个）,在CT导向下行射频消融治疗,术后6个月随访评价疗效。结果 88例患者共行134次射频消融治疗,除1例术中癫痫发作中断手术而行二期射频消融治疗外,其余均顺利完成。术后6个月行CT复查,显示96个病灶体积中88个均进行性缩小,肿瘤内大片不规则低密度区,总有效率为91.7%。1年随访有效率为88.0%,1年无疾病进展生存率为95.5%。气胸发生率为7.9%。结论 CT导向下经皮肺穿刺射频消融治疗肺部肿瘤安全、有效,并发症较少,对不同肿瘤采取科学的射频消融治疗方案可取得较好的疗效。     

超声造影在肝脏残留复发性恶性肿瘤射频消融中的应用

目的探讨超声造影在肝脏残留复发性恶性肿瘤射频消融中的应用。方法选取2014年6月至2016年6月间山东省临沂市肿瘤医院收治的78例肝脏残留复发性恶性肿瘤患者(113个病灶)为超声造影引导组,另选取同期接受常规超声检查的80例患者(118个病灶)为常规超声引导组。记录超声造影引导组患者治疗前后病灶数量、大小、边界及内部回声情况,将其术前肿瘤检出率、术中穿刺成功率及术后射频消融准确率,与常规超声引导组进行比较。结果超声造影引导组射频消融术后,实时谐波超声造影诊断,113个病灶中有6个(5.3%)可见动脉相内有局部增强区,门脉及延迟相增强区快速消退呈现低增强,判断仍存在残留。余107个(94.7%)病灶行超声造影始终未见增强,边界清晰,判断肿瘤已经完全灭活。超声造影引导组术前肿瘤检出率、术中穿刺成功率和肿瘤完全消融率分别为92.0%、92.9%和94.7%,常规超声引导组分别为80.5%、76.3%和83.9%,两组比较,差异均有统计学意义(均P<0.05)。结论超声造影在判断肝脏残留复发性恶性肿瘤射频消融术效果方面,提高了肿瘤诊断的敏感性、穿刺成功率和射频治疗准确性。     

超声引导下微波消融治疗25例复发性肝癌

[目的]探讨超声引导下微波消融治疗术后复发性肝癌的疗效。[方法]25例原发性肝癌术后复发患者共32个病灶在超声引导下行微波消融治疗,术后超声造影评价治疗效果。[结果]治疗1个月后,超声造影检查显示一次消融率达到87.5%（28/32）,4个病灶（12.5%）未完全坏死而接受第2次微波消融治疗,术后均完全消融。随访6-18个月,22例患者存活,3例因肝功能衰竭死亡。[结论]超声引导下微波消融治疗术后复发性肝癌疗效好,创伤小,是一种有效的治疗方法。     

射频消融治疗肝癌的临床报告（附40例）

目的:探讨多电极射频消融治疗肝癌的临床应用价值.方法:超声引导下经皮穿刺组织学证实的40例肝癌患者的62个病灶,在超声引导下利用多电极射频消融技术进行治疗;直径3cm以下的病灶采用"一针穿刺、一点消融"的空间布针方案、直径3cm以上的病灶采用"多针穿刺、多点消融"的空间布针方案,最大限度损毁病灶.结果:射频治疗后,所有病灶超声均显示为不均匀的回声增强.其中直径≤3cm的35个病灶,追踪观察3个月,超声显示病灶体积缩小24个,无明显改变11个;直径>3cm的27个病灶中,15个病灶体积缩小,9个无缩小,所有患者的临床症状改善.1年生存率为57.5%,并发症发生率为20%,住院期间死亡3例.结论:射频消融是微创疗法,治疗肝癌效果确切、适应范围广、创伤小、痛苦少,患者的临床表现得到明显改善,生活质量得以提高.     

超声造影与增强CT对肝癌射频消融效果的一致性评价

  目的  对超声造影与增强CT对肝癌射频消融术后评价效果一致性进行分析。  方法  对35例患者共68个肿瘤病灶进行超声或CT引导下射频消融治疗,术后同时定期进行增强CT以及超声造影检查评价射频消融效果,分析超声造影以及增强CT在肿瘤完全消融率、残留率,复发率、准确性以及超声造影与增强CT一致性。  结果  68个病灶中,超声造影评价肿瘤总体完全消融率以及残留率分别为84%及16%,增强CT分别为90%及10%,二者之间比较差异无统计学意义(χ2=0.576 3,P=0.447 8),具有很高的一致性(K=0.882 9,Sk=0.120 4),68个病灶中24个月内共有13个病灶为复发病灶,超声造影对复发病灶检出率为92%(12/ 13),与增强CT 100%(13/13)之间比较差异无统计意义(P>0.05)。以增强CT作为判断RFA后肿瘤残留及复发的金标准,超声造影对68个肿瘤病灶总体诊断准确性为92%(63/68),5个病灶判断不一致。  结论  超声造影在肝癌射频消融效果评价中与增强CT具有很高准确性及一致性,能为肿瘤射频消融术后治疗提供可靠诊断依据。      

多电极射频治疗42例小肝癌疗效观察

目的:探讨多电极射频疗法对小肝癌的治疗效果.方法:应用直径3.5cm多电极射频针在B超引导下经肋间或肋下经肝实质刺入肿瘤组织中.射频针的十根电极呈“伞形”分布,一次烧灼后形成直径3.5m～3.9cm,高度为1.2cm～1.5cm的半球形毁损区,重复多次直至将肿瘤区域完全覆盖.结果:42例患者行多电极射频治疗,23例AFP阳性患者,术后2月内全部转阴.病灶内动静脉血流频谱均消失,5例患者行肝动脉造影,也证实肿瘤内血供消失.术后3月复查,肿瘤均有所缩小,最大达1/2.所有患者均存活超过3个月.结论:多电极射频治疗将来可代替手术切除成为小肝癌治疗的首选方法.     

微波消融治疗肝转移癌临床疗效及影响生存率的相关因素研究

目的 研究微波消融(MWA)治疗肝转移癌的临床疗效及影响生存率的相关因素.方法 收集经检查确诊为肝转移癌行MWA治疗的100例患者的病历资料,所有病例原发肿瘤均已控制.MWA 1个月后根据患者情况选行B超、超声造影、CT、MRI检查判断疗效.术后1个月后行B超、肝功能及肿瘤标志物检查,定期复查.定时进行电话或门诊随访.结果 不同肿瘤直径患者的完全消融率比较,差异有统计学意义(P﹤0.05);不同肿瘤直径患者的复发率比较,差异无统计学意义(P﹥0.05).原发肿瘤部位、肿瘤直径、肿瘤数目、分化程度与患者的生存率有关(P﹤0.05);性别、年龄、是否肝外转移与患者的生存率无关(P﹥0.05).多因素分析结果表明原发肿瘤部位与肿瘤数目均为肝转移癌患者预后的独立危险因素(P﹤0.05).结论 MWA对治疗肝转移癌的治疗效果良好,具有操作简单、耐受性好等优点;原发肿瘤部位与肿瘤数目均为肝转移癌患者预后的独立危险因素.     

Percutaneous thermal ablation of medium and large hepatocellular carcinoma

BACKGROUND:

Radiofrequency ablation (RFA) and microwave ablation (MWA) were found to be effective in treating hepatocellular carcinoma (HCC) smaller than 3 cm; however, to the authors' knowledge, the usefulness of thermal ablation in treating larger HCC, especially those >5 cm, has not been well documented. The present study evaluated the therapeutic efficacy of percutaneous thermal ablation with curative intention for HCC measuring between 3.0 cm and 7.0 cm.

METHODS:

Percutaneous RFA or MWA were used to treat 109 HCC patients with at least 1 tumor measuring between 3.0 cm and 7.0 cm. Fifty?eight patients received thermal ablation as the first treatment, and the remaining 51 were treated for posthepatectomy recurrent HCC. A total of 89 patients had a main tumor measuring 3.0 cm to 5.0 cm, and 20 patients had main tumors measuring 5.0 cm to 7.0 cm. Local therapeutic efficacy, long‐term outcome, and prognostic factors were analyzed.

RESULTS:

There were no treatment‐related deaths, and the major complication rate was 9.2%. Complete ablation rate was 92.6%. Local recurrence (LR) occurred in 22% patients, with a median time to LR of 4.6 months. Distant recurrences developed in 53.2% patients. The 1‐year, 3‐year, and 5‐year survival rates were 75.8%, 30.9%, and 15.4%, respectively. Univariate analysis indicated that incomplete tumor ablation, posthepatectomy recurrence, and preablation α‐fetoprotein (AFP) ≥200 ng/mL were 3 unfavorable prognostic factors for long‐term survival (P = .000, .015, and .008, respectively). Cox regression analysis confirmed that incomplete tumor ablation, recurrent tumors, and preablation AFP ≥200 ng/mL were independent unfavorable prognostic factors, with an exp(B) of 4.158 (P = .001), 1.568 (P = .082), and 1.593 (P = .082), respectively.

CONCLUSIONS:

Percutaneous thermal ablation was effective and safe in treating HCC between 3 cm and 7 cm, with acceptable local tumor control and long‐term outcomes. Completeness of ablation, previous history of treatment, and preablation AFP level were significant prognostic factors. Cancer 2009. © 2009 American Cancer Society.     

内皮抑素联合微波消融治疗裸鼠肾癌移植瘤研究

目的研究内皮抑素联合微波消融对裸鼠肾癌移植瘤的抑制作用。方法将人源性肾癌细胞接种到48只小鼠的背部皮下,肿瘤直径约1.5 cm时随机分成4组,对照组：隔日尾静脉生理盐水;联合治疗组：隔日尾静脉推注内皮抑素＋皮下肿瘤微波消融;微波消融组：皮下肿瘤微波消融;内皮抑素组：隔日尾静脉推注内皮抑素。首先对联合治疗组及微波消融组局部皮下肾移植瘤进行微波消融治疗,其后经尾静脉注射药物。14天后每组处死6只小鼠,比较各组瘤重,计算抑瘤率,检测血浆VEGF浓度,剩余6只小鼠观察其存活期。结果联合治疗组小鼠肿瘤体积显著小于其他各组（P〈0.0 5）,其血浆VEGF水平较其他各组显著减低（P〈0.0 5）,存活时间较其他各组显著延长（P〈0.05）。结论内皮抑素联合微波消融抗肿瘤作用优于单用内皮抑素或微波消融治疗,并使小鼠存活期延长。     

Radiofrequency ablation of lung and bone tumors]

Radiofrequency ablation was initially used for treatment of liver primary and metastatic disease. Recently the technique has been used for treatment of kidney, bone, lung, and mammary neoplasms. Radiofrequency electrode is positioned in the target tumor under imaging guidance. For lung or bone tumors, computed tomography is the only method of guidance. Radiofrequency ablation of lung tumor is performed in order to cure the disease and consequently pre-imaging work-up must be equivalent t pre-surgical work-up. Today lung radiofrequency ablation is mostly performed in patients bearing less than 5 tumors and tumors smaller than 4 cm. In such a population of patients radiofrequency ablation has demonstrated a local efficacy of 92% at 9 months, with 95% and 87% for tumor smaller and larger than 2 cm, respectively. Survival benefit still remains unclear. Bone tumors are mostly treat for pain palliation. In a population of 45 patients with a minimal pain of 4 on a scale from 0 to 10, radiofrequency was able to provide a drop of at least 3 points in 84% of patients. Radiofrequency provides a minimally invasive cure of small tumors. It can also be used as a palliative tool.     

冷循环射频消融治疗肝肿瘤近期疗效观察

目的：观察冷循环射频消融治疗肝肿瘤的近期疗效。方法：运用HG-3000型单针冷极射频肿瘤治疗机对43例肝癌患者总计117个瘤体进行消融治疗。运用CT及B超观察瘤体的变化,测定AFP、CEA、肝功能,并与治疗前进行比较。结果：117个瘤体的生长均受到明显抑制,AFP值较治疗前明显下降（P〈0.05）;CEA值呈持续升高趋势,治疗后第3、4、5月CEA值与治疗前比较有明显差异（P〈0.05）;肝功能在治疗后1、2周变化较为明显,4、5周后恢复治疗前水平。结论：冷循环射频消融治疗肝肿瘤近期疗效满意,并发症少。     

Radiofrequency ablation for hepatocellular carcinoma and metastatic liver tumors: a comparative study

BACKGROUND: This study compared the effectiveness of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and liver metastases. METHODS: We compared the outcomes of 240 patients with HCC and 44 patients with liver metastases treated with RFA. Data were prospectively collected and retrospectively analyzed. Effects of different variables on recurrences were studied. RESULTS: A total of 406 tumor nodules were treated. The median size of the largest ablated tumor was 2.5 cm, and the median tumor number was 1. Complete tumor ablation was achieved in 91.2%. Local recurrence rate was 15.4% after a median follow-up of 24.5 months. There was no significant impact of tumor pathology on local recurrence. However, patients with liver metastasis had higher extrahepatic recurrence rate (P = 0.019) and shorter disease-free survival (P = 0.007). Patients with multiple tumors had higher local (P = 0.047) and extrahepatic (P = 0.019) recurrence rates than those with a solitary tumor. Tumor size had an impact on local recurrence rate only in patients with liver metastasis with a higher rate in those with tumor > 2.5 cm in diameter (P = 0.028). CONCLUSIONS: Tumor pathology does not appear to have a significant impact on local recurrence rates. RFA is effective in local tumor control for both HCC and liver metastasis.     

Impact of tumor size on the outcome of patients with small renal cell carcinoma

Background: ?This study aims to establish potential correlation between tumor size and outcomes in patients with T1a kidney cancer registered within the surveillance, epidemiology and end results (SEER) database.

Methods: SEER database (2004-2013) has been accessed through SEER*Stat program to determine the correlation between tumor size and cancer-specific survival in patients with T1a kidney cancer. Survival analysis was conducted through Kaplan-Meier analysis and log-rank testing.

Results: Five year kidney cancer-specific survival rates show progressive decline with increasing tumor size. Moreover, kidney cancer-specific survival has been compared according to the initial local treatment modality (observation, ablation, partial or radical nephrectomy) across different size categories (<1 cm, 1-2 cm, 2-3 cm and 3-4 cm). Survival curves of different treatment modalities were almost overlapping for patients with renal mass < 1cm. For patients with tumor size 1-2 cm, treatment modalities were overlapping at the first 60 months then the curve of observation diverged (P <0.0001). For patients with tumor size 2-3 cm and 3-4 cm, the curve of observation diverged early in the time course (P <0.0001).

Conclusion: Primary tumor size is an important factor that should be taken into consideration when evaluating the different treatment options for patients with small kidney cancers.?     

Percutaneous radiofrequency ablation: minimally invasive therapy for renal tumors

Currently, up to 60% of renal tumors are detected incidentally by abdominal imaging. Most of these tumors are small and localized to the kidney. Owing to the shift to lower stage at diagnosis, radical nephrectomy has fallen out of favor and has been replaced by nephron-sparing surgery. Currently, partial nephrectomy is the treatment of choice for patients with small renal tumors. As the trend towards less invasive therapy continues, laparoscopic and percutaneous ablation techniques have gained popularity for the treatment of renal tumors in patients who are high-risk surgical candidates, or have a solitary kidney, limited renal function or multifocal disease. Percutaneous radiofrequency ablation is a safe, minimally invasive treatment option for those patients.     

Radiofrequency ablation of small breast cancer followed by surgical resection

BACKGROUND: With the growing demand from patients for less-invasive procedures, the shift from surgical extirpation to ablative local control of breast tumors is an emerging focus in breast cancer care. This study was performed to determine the feasibility and safety of treating small breast cancer with radiofrequency (RF) ablation. METHODS: Patients with biopsy-proven invasive or non-invasive breast cancer underwent RF ablation under general anesthesia. Before RF ablation, all patients were confirmed to have a localized lesion using imaging modalities. Wide excision or total mastectomy with sentinel lymph node biopsy or axillary lymph node dissection was performed. The resected tumor was examined histologically with hematoxylin-eosin (H&E) and nicotinamide adenine dinucleotide-diaphorase (NADH) staining. RESULTS: Ten patients completed the treatment without RF ablation-related complications. The mean tumor size was 1.1 cm (range: 0.5-2.0 cm). Histological evaluation of the ablated tissue using H&E staining revealed a spectrum of changes ranging from complete coagulation necrosis of tumor cells to normal-appearing tumor cells. However, NADH-diaphorase showed no staining of viable tumor cells in the RF-ablated region in all of the patients. CONCLUSIONS: RF ablation is promising as a minimally invasive ablation technique in the local treatment of invasive or non-invasive breast cancer. However, further study is necessary before RF ablation can replace conventional breast conservation therapy for patients with small breast cancer.     

原发性肝癌射频消融预后的影响因素分析

目的:探讨原发性肝癌射频消融预后的影响因素。方法:选取原发性肝癌采取射频消融治疗的患者254例,回顾患者的临床资料,并进行随访,统计患者的生存期。结果:254例患者成功随访218例,随访率85.83%。1年、2年、3年以及5年累积生存率分别为81.19%、67.43%、52.75%和41.28%。不同年龄、术前AFP水平、是否伴有肝硬化和肝炎史、射频次数和引导方式的患者生存期差别不大,无统计学意义（P＞0.05）。BCLC分期为A期、肝功能Child分级为A级、肿瘤≤3cm、单发肿瘤、无血管癌栓的患者生存期明显长于其他患者（P＜0.05）。经多因素分析,肿瘤BCLC分期、肝功能分级、肿瘤大小、肿瘤数量以及是否有血管癌栓形成是影响肝癌射频消融治疗患者预后的独立因素。结论:射频消融术是治疗肝癌的重要手段,其治疗效果受到多种因素的影响,在对患者进行治疗前通过相关因素评价可以更好的选择治疗的适应证,并对患者的预后进行评价,提高肝癌治疗水平。