Laser interstitial thermotherapy in stereotactical neurosurgery

The authors present their first experience with laser interstitial thermotherapy, (ITT). Four patients with deep-seated non-infiltrative benign tumours (three astrocytomas, one oligodendrocytoma) underwent ITT. Previously, a stereotactic procedure had been performed to determine the exact location of the tumour, its spatial configuration and its histological diagnosis. The MRI controls confirmed the efficacy of hyperthermia on the tumour tissues. The authors discuss the possible ITT mechanisms. The indications of such laser ITT in neurosurgery should be enlarged to malignant tumours (gliomas, metastases) and to certain hypophyseal adenomas.     

The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine

A biomechanical study comparing simulated lytic vertebral metastases treated with laser-induced thermotherapy (LITT) and vertebroplasty versus vertebroplasty alone. To investigate the effect of tumor ablation using LITT prior to vertebroplasty on biomechanical stability and cement fill patterns in a standardized model of spinal metastatic disease. Vertebroplasty in the metastatic spine is aimed at reducing pain, but is associated with risk of cement extravasation in up to 10%. Six pairs of fresh-frozen cadaveric thoracolumbar spinal motion segments were tested in axial compression intact, with simulated metastases and following percutaneous vertebroplasty with or without LITT. Canal narrowing under load, pattern of cement fill, load to failure, and LITT temperature and pressure generation were collected. In all LITT specimens, cement filled the defect without extravasation. The canal extravasation rate was 33% in specimens treated without LITT. LITT and vertebroplasty yielded a trend toward improved posterior wall stability (P = 0.095) as compared to vertebroplasty alone. Moderate rises in temperature and minimal pressure generation was seen during LITT. In this model, elimination of tumor by LITT, facilitates cement fill, enhances biomechanical stability and reduces the risk of cement extravasation.     

射频热疗与腔内化疗治疗恶性胸腔积液的疗效观察

目的 评价热化综合治疗恶性胸腔积液（malignant pleural effusion,MPE）的疗效、毒副反应及对生活质量的影响.方法 101例病人均是经过手术、放射治疗和/或多程化疗后复发及广泛转移的患者;先行穿刺引流并以单药或二联化疗药物行腔内注射,腔内化疗1～6次,平均3次;患者一般情况改善后行全身化疗,根据不同病种选择不同用药方案;每次腔内及静脉化疗后即行射频透热,2次/周,平均6次,腔内温度控制在42℃左右并维持40～60 min.结果 101例胸水患者中CR 54例,PR 36例,有效率89.1%;不同病种有效率不同,以乳腺、肺、卵巢及胃肠道肿瘤并积液者疗效较好.治疗后Karnofsky评分80～100组由0%上升到26.7%,60～70组由21.8%上升到治疗后的41.6%,0～30组治疗前后无明显变化.与热疗相关的主要副反应为局部皮肤疼痛（17%）和皮下脂肪硬结（11%）.结论 热化综合治疗恶性胸腔积液有较好疗效,并可明显改善患者生活质量,毒副反应可耐受.     

The effect of intravitreal bevacizumab and transpupillary thermotherapy on choroidal metastases and literature review

Aims:

To represent the effects of transpupillary thermotherapy (TTT) and intravitreal bevacizumab on choroidal metastases and review the literature.

Settings and Design:

A retrospective, interventional, noncomparative case series.

Materials and Methods:

A retrospective, interventional, noncomparative case series of five eyes in three patients with choroidal metastases was conducted. Fundus findings of choroidal metastases were divided into two types: Solitary or diffuse type. The size of the tumor was termed small (<10 mm diameter), medium (10–15 mm diameter) or large (>15 mm diameter). All eyes received one session of TTT followed by 3 weekly intravitreal bevacizumab injections as an adjuvant therapy. The parameters of treatment for TTT were 1.2–3 mm spot size, 150–300 mW, 60 s with the whole lesion covered confluently. The changes in preoperative and postoperative best-corrected visual acuity (BCVA) were recorded. Serial color fundus photography and optical coherent tomography were performed to measure the treatment efficacy.

Results:

All eight choroidal metastases were solitary type. The size of six tumors was small, the size of one tumor was medium, and the size of one tumor was large. All five eyes of the three patients had improvement of BCVA after treatment. Fundus photos revealed tumor shrinkage and the mean shrinkage percentage was 61.27 ± 21.71%. Optical coherence tomography revealed complete resolution of serous retinal detachment. There was no recurrence after 6 months follow-up.

Conclusions:

TTT combined with intravitreal bevacizumab injections brought about beneficial effects in reducing tumor size and improving vision in all five eyes of the three patients. Despite the retrospective nature of our study, the absence of control group and the size limitation that, of course, limit the statistical power, TTT combined with intravitreal bevacizumab seems to be efficient in providing another cost-reducing and time-saving treatment option for patients with choroidal metastases. The antineoplastic properties of bevacizumab make it a viable adjunctive therapy. Studies with more cases and a longer follow-up period are warranted.     

热疗联合大剂量甘露聚糖肽胸腔注射治疗恶性胸腔积液的临床观察

目的：观察热疗联合大剂量甘露聚糖肽胸腔注射治疗恶性胸腔积液的临床疗效。方法：将36例恶性胸腔积液患者随机分为两组,采用胸腔闭式引流尽可能排尽胸腔积液后,治疗组18例用大剂量甘露聚糖肽胸腔注射后行射频热疗,对照组18例单用大剂量甘露聚糖肽胸腔注射治疗,比较两组的疗效、生活质量改善率和毒副反应。结果：治疗组和对照组治疗有效率分别为88.9%和66.7%,差异有统计学意义（P<0.05）;两组治疗前后生活质量改善率的差异没有统计学意义（P>0.05）;热疗主要的毒副反应为皮下脂肪硬结、局部皮肤灼伤。结论：热疗联合大剂量甘露聚糖肽胸腔注射治疗恶性胸腔积液疗效满意,毒副反应可以耐受,值得临床推广。     

体外局部高频热疗联合放疗治疗进展期肝细胞癌患者临床疗效研究

目的 研究体外局部高频热疗辅助放疗治疗进展期肝细胞癌(HCC)患者的临床疗效。方法 采用随机数字表法将66例进展期HCC患者分为对照组33例和观察组33例,分别采取放疗或在放疗的基础上联合体外局部高频热疗治疗,随访12个月。结果 观察组客观缓解率(ORR)为 63.6%,显著高于对照组的35.5%(P＜0.05);治疗后,观察组血清甲胎蛋白异质体L3(AFP-L3)水平为(4.2±1.0)ng/ml,高尔基糖蛋白-73(GP73)水平为(55.1±2.6)ng/ml,血管内皮生长因子(VEGF)水平为(200.5±55.7)pg/ml,均显著低于对照组[分别为(5.9±0.9)ng/ml、(62.1±3.5)ng/ml和(265.7±60.3)pg/ml,P＜0.05];观察组放射性肝损伤发生率为21.2%,显著低于对照组的45.2%(P＜0.05);观察组中位总生存时间(OS)为8(95%CI:7～9)个月,1 a累积生存率为14.3%,对照组中位OS为6(95%CI:6～7)个月,1 a累积生存率为11.8%(x²=1.674,P=0.171)。结论 采取体外局部高频热疗辅助放疗治疗进展期HCC患者有一定的临床疗效,可使生存获益,并能减轻放射性肝损伤。     

经瞳孔温热疗法治疗老年黄斑变性所致黄斑中心凹下脉络膜新生血管的长期观察(英文)

目的:评价经瞳孔温热疗法(TTT)治疗年龄相关性黄斑变性(AMD)所致黄斑中心凹下脉络膜新生血管(CNV)的长期疗效。方法:AMD所致黄斑中心凹下脉络膜新生血管14例14眼。平均年龄67.1岁。记录详尽的眼科检查结果,拍摄彩色眼底相,并行黄斑部光学相干断层成像(OCT)检查。在初诊及随后的复诊中行眼底荧光素血管造影和吲哚青绿血管造影。TTT的治疗参数为:时间1min,光斑大小2 ~3mm,激光能量650 ~800mW。随诊时间5 ~64mo,平均28.6mo。结果:在14眼中,典型性CNV有10眼,典型为主性有2眼,1眼为少量典型性,1型隐匿性CNV有1眼。共4例患者出现治疗后出血,均在短期内吸收。有1眼在治疗后立刻出现了黄斑无灌注区。多数患眼在随诊中可见渗出逐渐减少。在平均28.6mo的随诊中,14只患眼,有5眼视力提高,8眼保持稳定,1眼视力下降。结论:经瞳孔温热疗法在AMD患者中能封闭黄斑中心凹下的CNV,促进网膜下积液的迅速吸收,从而稳定患者的视力。它可以作为一种治疗典型和典型为主性黄斑中心凹下脉络膜新生血管的激光治疗手段。     

热疗联合胸腔置管化疗治疗恶性胸腔积液临床研究

目的观察热疗联合胸腔置管化疗治疗恶性胸腔积液的临床疗效及其毒副反应。方法62例恶性胸腔积液患者随机分为射频热疗联合胸腔置管化疗组(治疗组)和单纯胸腔置管化疗组(对照组)各31例。对照组先行胸腔闭式引流后,将顺铂60 mg、氟尿嘧啶1.0 g、吡喃阿霉素40 mg各加生理盐水50 ml胸腔内注射,再将地塞米松20 mg胸腔内注射后夹管,每周1次,灌注2次后拔管观察,治疗组于胸腔注射药物后行热疗,当周再行1次单纯热疗,一疗程4次。结果对照组胸腔积液控制有效率为54.8%,治疗组为83.9%,两组差异有显著性(P<0.05)。对照组生活质量改善率为48.4%,治疗组为77.4%,两组差异有显著性(P<0.05)。两组化疗毒副反应发生率差异无显著性。与热疗相关的毒副反应为局部皮肤疼痛4例(13.0%),皮下脂肪硬结3例(9.7%)。结论热疗联合胸腔置管化疗治疗恶性胸腔积液是一种安全可靠、高效低毒的治疗方法,值得临床推广使用。     

热、化疗联合治疗晚期非小细胞肺癌的疗效观察

目的:观察异长春花碱(NVB),顺铂(DDP)静脉化疗与热疗联合治疗晚期非小细胞肺癌的疗效。方法:44例晚期非小细胞肺癌患者随机分为两组,单纯化疗组(22例)仅予常规NP方案化疗,28天为一周期,完成2周期,热化疗组22例使用NP方案化疗联合射频热疗,每周热疗2次,共12次。结果:热化疗组PR9例,有效率41%,单纯化疗组PR6例,有效率27%,两组生活质量改善情况差异有显著性(P<0.05),毒副反应相似,主要毒性为骨髓抑制以及胃肠道反应。结论:NP方案联合热疗治疗晚期非小细胞肺癌方便、安全,近期疗效较好。     

脉络膜新生血管经TTT治疗前后微视野变化

目的 应用微视野检查技术评价经瞳孔温热疗法（TTT）治疗脉络膜新生血管（CNV）前后的视功能变化.方法 12例13只经荧光素眼底血管造影证实有CNV的年龄相关性黄斑病变（AMD）和高度近视患眼,在接受TTT治疗前后分别行微视野检查.结果 TTT治疗前,6眼有相对暗点,7眼有绝对暗点.治疗后与治疗前相比较,6眼TTT前检出相对暗点的患眼中,治疗后视力提高者4眼,1眼视力下降,1眼视力无明显变化;6眼中5眼TTT治疗后激光照射处视网膜的光敏度提高,1眼降低.所有被检出有绝对暗点的患眼治疗后视力均无明显变化,视网膜的光敏度不变.结论 微视野检查能客观评估TTT治疗CNV的疗效.