肝癌射频消融后常规行经导管肝动脉化疗栓塞的临床分析

目的:探讨肝癌射频消融（RFA）联合经导管肝动脉化疗栓塞（TACE）的疗效及必要性。方法:对65例肝癌患者RFA后进行1次以上的TACE治疗。其中男54例，女11例。肿瘤最大长径1.5～10.0 cm，其中≤3 cm者14例， 3.1～5.0 cm者17例，＞5.0 cm者34例。按肝功能Child pugh分级，A级51例，B级14例。病理诊断肝细胞癌58例，胆管细胞性肝癌7例。采用RFA肿瘤治疗系统行RFA，并随后常规行CT以评价RFA的疗效，然后行TACE,术后1月行CT检查，以评价肿瘤消融情况，并观察生存率，以评价治疗效果。结果:RFA后完全消融24例，基本消融15例，部分消融26例。RFA+TACE的近期效果为根治性22例、亚根治性13例和姑息性30例。肿瘤消融程度与近期疗效密切相关(r=0.877，P＜0.001)。肝癌RFA+TACE治疗后总体1，2，3年生存率为78.2%，65.3%，44.0%。Cox回归模型分析显示消融程度，是最终与生存时间有关的因素，获得完全消融、基本消融或部分消融者3年生存率分别为73.5%，45.0%和0.0%。肿瘤较小的肝癌容易获得完全消融、近期及远期疗效较好；反之预后较差。结论:TACE对RFA后残余的癌灶或微小转移病灶可起治疗作用；中大肝癌RFA后联合TACE是必要的。     

超声引导经皮复合热消融技术治疗中、大肝细胞癌

目的　评估超声引导复合热消融技术治疗中、大肝细胞癌 (HCC)的应用价值。方法在超声引导下经皮采用多针插入、多点能量输出的射频消融 (RFA)或微波消融 (MWA)技术 ,治疗 6 8例HCC患者共 73个肿瘤结节 ,平均直径 (4 5± 1 7)cm (3 1～ 13 0cm) ,经 1 9～ 6 7 6个月 [平均(16 0± 14 8)个月 ]随访 ,检测局部及远期治疗效果。结果　治疗后合并肝包膜下血肿及皮肤烧伤的患者各 1例。肿瘤完全消融率 78 1% (5 7/73) ,2 4 6 % (14 /5 7)的病灶出现局部肿瘤进展 ,远处复发率 5 6 7% (38/6 7) ,1、3、5年生存率分别为 6 2 3%、2 9 6 %、2 1 6 % ,中位生存时间为 18 6个月 (95 %可信区间为 10 9～ 2 6 3个月 )。RFA与MWA在完全消融率、局部肿瘤进展率与远处复发率、生存率方面差异均无显著意义。结论　经皮复合热消融技术治疗不能手术切除的中、大肝细胞癌创伤小 ,可获得良好的局部控制和远期疗效 ,RFA与MWA疗效无明显差异     

Percutaneous radiofrequency ablation of pulmonary metastases in patients with colorectal cancer

INTRODUCTION: This study aimed to assess the safety and efficacy of imaging-guided percutaneous radiofrequency ablation (RFA) for local control of lung metastases from colorectal cancer (CRC). METHODS: Twenty patients with lung metastases from CRC were treated with a RITA Starburst XL electrode and RITA 1500 generator using temperature control and impedance monitoring. Patients received intravenous sedation and analgesia, or local anaesthetic, and stayed in hospital for at least 24 h after treatment. RFA was assessed with computed tomography (CT) at 1 week and 1 month, and then every 3 months. RESULTS: Forty-four CRC lung metastases in 19 patients were treated successfully at 25 treatment sessions. Five of 19 patients were retreated for new lesions. There were 13 pneumothoraces following the 25 treatments, and six patients required drainage. The median length of follow-up was 730 (range 148-924) days. Six months after treatment CT demonstrated that three lesions had progressed, 25 metastases were stable or smaller, and 11 were no longer visible. At 12 months five metastases had progressed, 11 were smaller or stable, and nine were not visible. CONCLUSION: Percutaneous imaging-guided RFA was associated with modest morbidity. RFA can achieve local control of CRC lung metastases: nine of 25 metastases were not visible on CT at 12 months after treatment.     

Safety and efficacy of radiofrequency ablation of brain: a potentially minimally invasive treatment for brain tumours.

INTRODUCTION: Cerebral metastases are associated with a very poor prognosis. The best survival results are seen after surgical resection. However this involves a relatively invasive procedure and many patients are not suitable for surgical resection. We have evaluated the safety and efficacy of radiofrequency ablation of the brain in a sheep model. METHODS: We produced ablations of 1 - 3 cm diameter in the brain of sheep using the RITA starburst XL probe and RITA 1500 generator. We varied the time of RF application between 1 minute and 5 minutes and observed the animals for between 24 hours and 3 weeks for short-term and long-term effects and measured the intracranial pressure (ICP) in 2 animals following RFA. RESULTS: A total of 8 ablations were produced in 8 sheep. There was no change in the ICP measurements and there were no neurological complications in the 5 sheep with superficial ablation of up to 2 cm. Three sheep failed to regain consciousness due to large ablations near the brain stem and cerebellum. The sizes of the ablations were confirmed on necropsy and there was no other evidence of damage to the surrounding brain. Satisfactory ablation of brain was achieved at 70 degrees C and an ablation time as short as 3 minutes produced a 1.5 - 2.0 cm diameter of ablation. CONCLUSION: Cerebral RFA is a relatively safe and effective technique capable of producing a predictable ablation with no damage to surrounding brain. The potential of this technique requires further evaluation but likely advantages include the ability to treat multiple tumours and perform repeated treatment with a minimally invasive approach.     

Radiofrequency ablation for eradication of pulmonary tumor in rabbits

BACKGROUND: Radiofrequency ablation (RFA) has emerged as an alternative for surgery in clinical oncology. This animal experiment was conducted to evaluate the feasibility of RFA in the treatment of pulmonary tumor. METHODS: Eighteen rabbits with pulmonary implantation of VX2 tumors were divided into two groups. Group A (n = 12) was treated with RFA by using a cooled-tip electrode technique. Group B (n = 6) received sham operation. The therapeutic efficacy was evaluated by survival rate, magnetic resonance imaging (MRI), postmortem microangiography, and histology. RESULTS: All animals in group B died within 3 months after tumor implantation. Tumor eradication was achieved in 9 of 12 rabbits (75.0%) in group A, of which 4 rabbits survived longer than 3 months free of disease and another 5 rabbits were found free of viable tumor when sacrificed. One rabbit was subjected to incomplete tumor ablation and two rabbits suffered from local tumor relapse and/or lung metastasis. The 3-month survival rate of RFA-treated rabbits was significantly higher (P < 0.01) than that of control rabbits. The typical MRI appearances of the acute RFA lesion consisted of five characteristic concentric zones, which corresponded to central needle track (zone A), tumor coagulation (zone B), pulmonary parenchyma coagulation (zone C), peripheral hemorrhage (zone D), and inflammatory layer (zone E) on histology. CONCLUSIONS: Eradication of pulmonary tumor could be achieved with current RFA technique in rabbits. MRI is a useful modality for assessment of lung tumor ablation.     

Risk factors and prognostic factors of local recurrence after radiofrequency ablation of hepatocellular carcinoma

BACKGROUND: Local recurrence rates after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) vary from 2% to 36% in the literature. Limited data were available about the prognostic significance of local recurrence. STUDY DESIGN: Between April 2001 and March 2006, 273 patients with 357 hepatocellular carcinoma nodules underwent RFA, with radiologically complete tumor ablation after a single session of RFA. The risk factors of local recurrence and its impact on overall survival of patients were analyzed. RESULTS: With a median followup period of 24 months, local recurrence occurred in 35 patients (12.8%). By multivariate analysis, tumor size > 2.5 cm was the only independent risk factor for local recurrence. There was no notable difference in overall survival between patients with and without local recurrence. By multivariate analysis, local recurrence more than 12 months after RFA and complete response after additional treatment of local recurrence were associated with better overall survival in patients with local recurrence. CONCLUSIONS: This study demonstrated that tumor size > 2.5 cm was the main risk factor for local recurrence after RFA of hepatocellular carcinoma. Our data suggested that additional aggressive treatment of local recurrence aimed at complete tumor response improves overall survival of patients. Late local recurrence was also associated with better prognosis, suggesting different tumor biology between early and late local recurrent tumors after RFA.     

Percutaneous radiofrequency thermal ablation of primary and metastatic lung tumors.

OBJECTIVE: Primary lung cancer is the leading cause of death from cancer. For patients with inoperable lung cancer, percutaneous radiofrequency thermal ablation (RFA) under CT-guidance represents a minimally invasive treatment. It can also be applied in combination with radiation therapy and chemotherapy. MATERIALS AND METHODS: In a period of 18 months, RFA under CT-guidance 27 ablations were applied on 22 patients, 14 patients with primary lung cancer and 8 patients with metastatic lung tumor. There were 15 men and 7 women ranging in age between 48 and 79 years. All patients were not surgical candidates either due to the advanced stage or due to comorbid diseases, while five denied surgery. The lesions' size was no bigger than 6 cm (range 1-6 cm) with an average of 3.8 cm. The diagnosis of all treated lesions was obtained with percutaneous biopsy under CT guidance. The procedure was performed under local anesthesia. RESULTS: There were no major complications observed, but a small pneumothorax and a minor hemoptysis in four cases, all conservatively treated. All patients were hospitalized for 24h. Follow-up was initially done in 1, 3, 6 and 12 months after RFA and it was accomplished by personal interview or by telephone call up to December 2005. Median progression free intervals were 26.4 months for primary lung cancer and 29.2 months for metastatic tumor. CONCLUSION: RFA is a minimally invasive technique that can be used as a palliative treatment in nonsurgical candidates with primary or metastatic lung tumor with a low morbidity and mortality.     

Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis

OBJECTIVE: To determine the treatment efficacy, safety, local tumor control, and complications related to radiofrequency ablation (RFA) in patients with cirrhosis and unresectable hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA: Most patients with HCC are not candidates for resection because of tumor size, location, or hepatic dysfunction related to cirrhosis. RFA is a technique that permits in situ destruction of tumors by means of local tissue heating. METHODS: One hundred ten patients with cirrhosis and HCC (Child class A, 50; B, 31; C, 29) were treated during a prospective study using RFA. Patients were treated with RFA using an open laparotomy, laparoscopic, or percutaneous approach with ultrasound guidance to place the RF needle electrode into the hepatic tumors. All patients were followed up at regular intervals to detect treatment-related complications or recurrence of disease. RESULTS: All 110 patients were followed up for at least 12 months after RFA (median follow-up 19 months). Percutaneous or intraoperative RFA was performed in 76 (69%) and 34 patients (31%), respectively. A total of 149 discrete HCC tumor nodules were treated with RFA. The median diameter of tumors treated percutaneously (2.8 cm) was smaller than that of lesions treated during laparotomy (4.6 cm). Local tumor recurrence at the RFA site developed in four patients (3.6%); recurrent HCC subsequently developed in other areas of the liver in all four. New liver tumors or extrahepatic metastases developed in 50 patients (45. 5%), but 56 patients (50.9%) had no evidence of recurrence. There were no treatment-related deaths, but complications developed in 14 patients (12.7%) after RFA. CONCLUSIONS: In patients with cirrhosis and HCC, RFA produces effective local control of disease in a significant proportion of patients and can be performed safely with minimal complications.     

多电极射频治疗肝癌的体会

目的 探讨多电极射频（RFA）治疗肝癌的作用。方法 采用RFA治疗肝癌18例,其中肝细胞性肝癌12例,转移性肝癌6例。B超引导经皮穿刺射频治疗8例,术中射频治疗10例,共24个结节,直径2－8cm,平均4.2cm。结果 18例患者术后1d肝功能轻到中度升高,7d恢复正常。随访－8个月（平均4.2个月）,21个结节完全坏死,局部复发结节3个,经再次RFA治疗有效。无一例严重并发症发生。结论 多电极射频治疗是一种安全、有效且依从性好的肝癌治疗手段,开腹射频治疗可有效预防其并发症的发生,但射频治疗的远期疗效还需要十泊研究。     

Percutaneous ultrasound-guided radiofrequency ablation for kidney tumors in patients with surgical risk

OBJECTIVE: The aim of this study was to describe our experience with percutaneous ultrasound-guided radiofrequency ablation of kidney tumors. METHODS: From July 2002 to August 2005, 45 radiofrequency ablations (RFA) in 42 selected patients with kidney tumor were performed. The patients had either contraindications to surgery procedures or had a solitary kidney. The average tumor size was 37.5 mm (range, 18-59 mm) with the mean age of 68 years (range, 28-83 years). RFA were performed based on radiographic findings. Needle biopsy was made only twice. Monopolar Cool-tip Tyco or bipolar Celon Olympus radiofrequency devices were used. The procedure was performed under conscious sedation with local anesthesia. Treatment efficacy was assessed by computed tomography and by Doppler ultrasound. The absence of contrast enhancement on computed tomography was considered to be a successful treatment. RESULTS: The average follow up was 14 months (range, 3-36 months). In 42 tumors (93%), total absence of contrast enhancement was obtained after the initial RFA and in three tumors (7%) after the second ablation session. There were no complications following 41 procedures, including all ablations in small (<35 mm) renal masses. In four procedures, minor complications were observed. All patients are alive. There has been no need for chronic hemodialysis and, until now, we have not observed any local recurrences with the exception of one metastasis to an ipsilateral adrenal gland. CONCLUSIONS: RFA of kidney tumors is a promising alternative treatment which could be considered for patients who are not suitable for surgery.     

eRFA: Excision Followed by RFA—a New Technique to Improve Local Control in Breast Cancer

Introduction Excision followed by RFA (eRFA) may allow improved cosmesis while ensuring negative margins in patients with breast cancer. This technique utilizes heat to create an additional tumor-free zone around the lumpectomy cavity. We hypothesized that eRFA will decrease the need for re-excision of inadequate margins.Methods Between July 2002 and January 2005, we conducted a multiphase trial of RFA of prophylactic mastectomy specimens and of women desiring lumpectomy. In both models, a lumpectomy was performed, the RFA probe was deployed 1 cm circumferentially into the walls of the lumpectomy cavity and maintained at 100°C for 15 min. Whole mount slides were used to measure the zone of ablation for ex vivo specimens. Hematoxylin and eosin staining of in vivo lumpectomy margins <3 mm was considered inadequate.Results Nineteen prophylactic mastectomy ablations revealed a consistent perimeter of ablation. Forty-one patients (mean age 63 ± 14 years) had an average tumor size of 1.6 ± 1.5 cm underwent in vivo eRFA, and 25% had inadequate margins: one focally positive, one <2 mm, eight <1 mm and one grossly positive. Only the grossly positive margin was re-excised. Overall complication rate of in vivo ablations was 7.5%. Twenty-four of 41 patients did not have post-eRFA XRT. No in-site local recurrences have occurred during a median follow-up of 24 months (12–45 months). Two patients have occurred elsewhere.Conclusions The ex vivo ablation model reliably created a 5–10 mm perimeter of ablation. In vivo, this zone reduced the need for re-excision for inadequate margins by 91% (10/11). Short-term follow-up suggests that eRFA could reduce re-excision surgery and local recurrence.     

Skin implant metastasis after percutaneous radio-frequency therapy of liver metastasis of a colorectal carcinoma

Percutaneous radio-frequency ablation (RFA) of liver tumors has been reported to be an effective approach. Skin implant metastases have been described after RFA of hepatocellular carcinoma. A 56-year-old man underwent resection of the transverse colon for an adenocarcinoma (pT3N2M0) following by adjuvant chemotherapy. He developed multiple liver metastases and underwent RFA. Six weeks after RFA, the patient noticed a painful skin lesion at the entrance side of the probe in the right upper abdominal quadrant. Ultrasound examination and computed tomography scan revealed an intracutaneous tumor of 2-cm diameter. The tumor was excised and revealed a metastasis of the previously described adenocarcinoma. CPT-11 monotherapy was started; however, due to tumor progression, the patient died 35 months after colonic resection and 10 months after RFA. This is the first case of an implant skin metastasis after RFA of secondary liver tumors. Although RFA is a promising option in the palliation of such tumors, such rare complications have to be considered.     

Radiofrequency ablation for renal tumors: Our experience

Objectives:   To report our results of percutaneous radiofrequency ablation (RFA) for renal tumors and to assess predictors of therapeutic efficacy.
Methods:   Forty patients (median age 73 years) with renal tumors were treated with RFA under local or epidural anesthesia. All of them had high surgical risk or refused radical surgery. Tumors were punctured percutaneously using the Radionics Cool-tip RF System under computed tomography or ultrasonographic guidance. Median tumor diameter was 24 mm. After RFA, contrast-enhanced computed tomography or magnetic resonance imaging was performed within 1 month. Complete response (CR) was defined as no enhancement inside the tumor. Factors related to the outcome and to renal function were assessed.
Results:   Median follow up was 16 months. CR was observed in 34 cases (85.0%). A significant difference in CR rate was observed between tumors ≤30 mm and those >30 mm. Outcomes tended to be better for tumors in the mid to lower kidney, and those away from the renal hilum. Recurrence was observed in one case (2.9%), but a CR was obtained again by additional RFA. Out of a total of 77 RFA procedures, complications occurred in only three cases (3.9%), and conservative treatment was possible in all cases. Serum creatinine levels 3 months after RFA did not differ from those before RFA.
Conclusions:   Percutaneous RFA is a safe and effective treatment for small renal tumors in patients with high surgical risk or who refuse radical surgery.     

Radiofrequency ablation for the treatment of non-small cell lung cancer in marginal surgical candidates

OBJECTIVE: Treatment options for patients with non-small cell lung cancer who are not surgical candidates or who refuse operation are limited. Radiofrequency ablation represents a potential less invasive option for these patients. Our initial experience with radiofrequency ablation for peripheral, primary non-small cell lung cancer is reported. METHODS: We treated 21 tumors in 18 patients. Median age was 75 (range 58-86) years. Cancer stages were I (n = 9), II (n = 2), III (n = 3), and IV (n = 4). Patients with stage IV disease included 3 with recurrence after previous lobectomies and 1 with a synchronous liver metastasis also treated with radiofrequency ablation. Median tumor diameter was 2.8 cm (range 1.2-4.5 cm). Radiofrequency ablation was delivered by minithoracotomy in 2 cases and by a computed tomography-guided percutaneous approach in 16 patients. Computed tomographic and positron emission tomographic scans were used to evaluate recurrence and radiographic response in ablated nodules. RESULTS: One postoperative death occurred from pneumonia after open radiofrequency ablation. Median hospital stay was 2.5 days. A chest tube or pigtail catheter was required in 7 patients (38.9%) for procedure-related pneumothoraces. At a median follow-up of 14 months, 15 patients (83.3%) were alive. Local progression occurred in 8 nodules (38.1%). Mean and median progression-free intervals were 16.8 and 18 months, respectively. For stage I cancers, mean progression-free interval was 17.6 months. Median progression-free interval was not reached. CONCLUSION: This study demonstrates the feasibility of radiofrequency ablation for small, peripheral non-small cell lung cancer tumors. Local control is comparable to, if not better than, that provided by radiotherapy. Radiofrequency ablation should continue to be evaluated by thoracic surgeons as a noninvasive therapy for the high-risk patient with non-small cell lung cancer.     

Pilot study of radiofrequency interstitial tumor ablation (RITA) for the treatment of radio-recurrent prostate cancer

BACKGROUND: To prospectively evaluate the feasibility, safety, morbidity, and preliminary efficacy of radiofrequency interstitial tumor ablation (RITA) for the focal treatment of patients with local prostate cancer recurrence. METHODS: Eleven patients with biopsy-proven, hormone-na?ve, clinically localized prostate cancer were enrolled in a prospective phase I/II trial. Eight patients had failed prior radiation therapy and three were not candidates for curative primary therapy (median Gleason score 7 and 6, respectively). Median follow-up was 20 months. All patients were treated with RITA in an office setting, under intravenous sedation and were discharged after the procedure. Radiofrequency energy was applied via needles placed transperineally under transrectal ultrasound guidance. RESULTS: The placement of 1/4 lesions was aborted in two patients due to increasing rectal temperature. Complications included transient macrohematuria (19%), bladder spasms (9%), and dysuria (9%). Serum PSA levels decreased after RITA >50% in 90% of patients, > 70% in 72% of patients, and > 80% in 46% of patients. The mean PSA doubling time after RITA was slower than that before RITA (37 +/- 22 months vs. 14 +/- 13 months, P = 0.008). At 12 months after RITA, 50% of patients with sufficient follow-up had no residual cancer on repeat systematic 12-core biopsy cores and 67% were cancer-free in biopsy cores sampled from the RITA-treated areas. CONCLUSIONS: RITA treatment is a minimal invasive, rapid, user-friendly, office-based procedure that is well tolerated. Focal ablation with RITA results in effective local disease control in patients with non-metastatic prostate cancer recurrence. Larger, prospective, multicenter clinical studies are needed to confirm these findings.     

Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma

OBJECTIVE: To assess the long-term efficacy of radiofrequency ablation (RFA) and percutaneous ethanol (EtOH) injection treatment of local recurrence or focal distant metastases of well-differentiated thyroid cancer (WTC). BACKGROUND: RFA and EtOH injection techniques are new minimally invasive surgical alternatives for treatment of recurrent WTC. We report our experience and long-term follow-up results using RFA or EtOH ablation in treating local recurrence and distant focal metastases from WTC. METHODS: Twenty patients underwent treatment of biopsy-proven recurrent WTC in the neck. Sixteen of these patients had lesions treated by ultrasound-guided RFA (mean size, 17.0 mm; range, 8-40 mm), while 6 had ultrasound-guided EtOH injection treatment (mean size, 11.4 mm; range, 6-15 mm). Four patients underwent RFA treatment of focal distant metastases from WTC. Three of these patients had CT-guided RFA of bone metastases (mean size, 40.0 mm; range, 30-60 mm), and 1 patient underwent RFA for a solitary lung metastasis (size, 27 mm). Patients were then followed with routine ultrasound, I whole body scan, and/or serum thyroglobulin levels for recurrence at the treatment site. RESULTS: No recurrent disease was detected at the treatment site in 14 of the 16 patients treated with RFA and in all 6 patients treated with EtOH injection at a mean follow-up of 40.7 and 18.7 months, respectively. Two of the 3 patients treated for bone metastases are free of disease at the treatment site at 44 and 53 months of follow-up, respectively. The patient who underwent RFA for a solitary lung metastasis is free of disease at the treatment site at 10 months of follow-up. No complications were experienced in the group treated by EtOH injection, while 1 minor skin burn and 1 permanent vocal cord paralysis occurred in the RFA treatment group. CONCLUSIONS: RFA and EtOH ablation show promise as alternatives to surgical treatment of recurrent WTC in patients with difficult reoperations. Further long-term follow-up studies are necessary to determine the precise role these therapies should play in the treatment of recurrent WTC.     

Treatment of invasive breast carcinoma with ultrasound-guided radiofrequency ablation

BACKGROUND: Radiofrequency ablation (RFA) is a minimally invasive thermal ablation technique. This study reports the safety and efficacy of RFA as a minimally invasive strategy for breast cancers <3 cm diameter in postmenopausal women. METHODS: Twenty-two postmenopausal women (aged 60 years or older) with clinical T-1N0 core biopsy proven breast cancers were studied. Thermocoagulation was undertaken using a sonographically guided RF probe under local anesthesia and sedation. The ablated tumor was resected between 1 and 2 weeks later. Endpoints were technical success, completeness of tumor kill, marginal clearance, skin damage, and patient reports of pain and procedural acceptability. RESULTS: The procedure was well tolerated and cosmesis was excellent. Pathology revealed a central ablation zone surrounded by hyperemia. Coagulative necrosis was complete in 19 of 22 patients. Disease at the ablation zone margin was found in 3 patients and 5 patients had disease distant to the ablation zone consisting of multifocal tumors (2), in-transit metastasis (1), and extensive ductal carcinoma in situ with microinvasive carcinoma (2). Ninety-five percent of patients would be willing to have RFA again. CONCLUSIONS: Radiofrequency ablation can be safely applied in an outpatient setting with acceptable patient tolerance. By itself, RFA cannot be considered effective local therapy. Trials to evaluate RFA complemented with breast irradiation are justified.     

肝癌射频消融技术及疗效评价方法

目的 总结肝癌射频消融(RFA)的临床经验并探讨评价RFA疗效的方法 .方法 对49例肝癌病人进行了统一方案的RFA治疗,其中男43例,女6例;年龄39～72岁,平均(56.4±9.3)岁.肿瘤直径1.5～10 cm,其中≤3 cm 16例,3.1～5 cm 15例,>5 cm 18例.按肝功能Child-Pugh分级,A级41例,B级8例.病理诊断为肝细胞癌44例,胆管细胞性肝癌5例.采用RITA射频消融肿瘤治疗系统(RF-1500)行RFA.在RFA后3～4周常规行CT及TACE,以评价肝癌RFA的效果及巩固疗效.结果 全部病例RFA术后恢复顺利,总体1、2、3年生存率为77.5%、56.5%和44.0%,肝癌RFA后3～4周,AFP阳性(≥25μg/L)者转阴率62.9%(22/35).改进的肝癌RFA方法 可对直径5 cm以下的肿瘤进行比较彻底的消融,≤5 cm者1、2、3年生存率为100%、79.6%和61.9%.将肝癌消融近期疗效分为3个级别,RFA术后获得根治性消融(19例)、亚根治消融(9例)、姑息性消融(21例)者2年生存率分别为85.7%、60.0%和24.3%.结论 肝癌RFA相当于从机能上切除了肿瘤,肝癌消融近期疗效三级分类法可以比较客观地评价RFA的效果,以指导辅助治疗的选择.     

Radiofrequency ablation of breast cancer

Radiofrequency ablation (RFA) is currently under study as a candidate for nonsurgical removal or destruction of breast tumors. RFA of solid tumors is produced by frictional heating caused when ions in the tissue attempt to follow the changing directions of a high-frequency alternating current. The radiofrequency probe is typically placed into the tumor under ultrasound guidance, and the ablation is performed with real-time ultrasound monitoring. Preliminary studies in which RFA was followed by standard surgical resection have indicated that this technique is effective for the surgical ablation of small (< or = 2 cm) primary breast tumors. A new study at the University of Texas M.D. Anderson Cancer Center will use RFA as the sole local treatment of breast tumors < or = 1.5 cm in size to determine whether this technique is oncologically and cosmetically appropriate for the local treatment of primary breast cancer. Twenty patients with small tumors that are clearly identifiable and measurable by ultrasound will be enrolled in the study. Local control will be assessed by core and fine-needle biopsies, and long-term outcomes will be assessed using imaging studies and quality-of-life measurement scales for 5 years after treatment.     

电视胸腔镜辅助小切口诊疗肺部小结节

目的探讨电视胸腔镜辅助小切口诊治肺部小结节的价值。方法2007年2月～2008年2月,对53例40岁以上肺孤立性小结节（直径≤3cm）应用电视胸腔镜辅助小切口技术行肺小结节病灶切除,术中快速冰冻切片,对恶性病变按恶性肿瘤手术原则进一步手术,良性病变则结束手术。结果诊断恶性病变39例,其中34例原发性肺癌行胸腔镜辅助小切口肺癌根治术,2例双侧肺癌和3例肺转移癌行胸腔镜辅助小切口病灶切除术;14例术中病理诊断为肺良性病变,仅行病灶切除术。34例原发性肺癌中1例失访,余33例随访2～12个月,平均7个月,31例无瘤生存,2例术后6个月内复发,行肺叶切除术。2例双侧肺癌和3例肺转移癌均死亡,生存时间2～6个月,平均4个月。14例良性病变随访3～12个月,平均7.5月,无复发。结论电视胸腔镜辅助小切口诊治肺部小结节,创伤小,诊断准确,具有很大优势。