射频消融治疗肿瘤的现状与展望

射频消融（RFA）是一种肿瘤治疗新方法,近年来发展很快.现综述RFA的治疗原理及其临床应用现状,并对RTA的进一步发展进行展望.     

规范化射频消融治疗肝脏肿瘤

目的 探讨规范化射频消融治疗肝脏肿瘤的疗效、适应证、并发症和治疗规范.方法 严格按照术前评估、术中完全损毁和术后即时评价的规范化操作程序,对421例肝脏肿瘤患者进行冷循环射频消融治疗,共634处病灶,行射频消融1121次.结果 全组421例患者无术中死亡.全部634处病灶中有514处完全消融,占81.1%.其中最大径＜3 cm病灶的完全消融率为91.4%(382/418),3～5 cm病灶为78.9%(97/123),>5 cm病灶为37.6%(35/93).术后有147例(34.9%)出现一过性发热,136例(32.3%)出现腹痛,38例(9.0%)出现恶心,12例(2.9%)出现胸腔积液,2例(0.5%)出现肝脓肿,1例(0.2%)出现胆漏.结论 规范化射频消融治疗肝脏肿瘤效果确切,无严重并发症发生.     

射频消融治疗肿瘤的现状与展望

射频消融(RFA)是一种肿瘤治疗新方法,近年来发展很快.现综述RFA的治疗原理及其临床应用现状,并对RTA的进一步发展进行展望.     

老年肝脏肿瘤病人射频消融治疗时的麻醉

[目的]对射频消融（RFA）治疗老年和非老年肝肿瘤病人时实施有监测的麻醉看护，观察用药量和镇静深度是否与年龄有关。[方法]以超声引导RFA治疗的324例肝肿瘤患者为研究对象，按照年龄（60岁）分为老年组和非老年组，按照肿瘤的部位又分为老年组深部肿瘤、老年组浅部肿瘤、非老年组深部肿瘤和非老年组浅部肿瘤，采用芬太尼、咪唑安定、丙泊酚的静脉麻醉方法，达到满意的清醒镇静，镇痛。记录用药量和镇静程度。[结果]老年组使用心血管活性药物的比例高于非老年组。若肿瘤的部位相同，治疗大肿瘤（3～5cm）需要的麻醉药多于同组小肿瘤（≤3cm），镇静深度也高于后者（P〈0．05）；若肿瘤的部位和大小相同，老年病人用药量和镇静程度低于非老年病人。[结论]RFA治疗时老年病人需要的麻醉药少，应维持在相对较浅的镇静深度。     

射频消融治疗肝脏肿瘤后的炎症反应

据美国学者报道，对于无法切除的肝脏恶性肿瘤，射频消融(RFA)治疗较之冷冻治疗不会出现以细胞因子增多为特点的全身炎性反应。美国佛罗里达大学医学院外科系的Scott R．Schell博士指出，RFA治疗正在逐步开展，其预后较好、并发症少于冷冻疗法。研究人员选取因具有无法切除的原发或转移性肝脏肝瘤而接受RFA治疗的17例年龄为40～85(平均64．2)a的患者(11例男性，6例女性)进行研究。     

超声引导射频消融治疗腹膜后肿瘤的临床价值

目的探讨超声引导射频消融治疗腹膜后肿瘤的临床价值。方法回顾性分析2018年1月至2020年1月郑州大学第一附属医院行超声引导下射频消融治疗的13例腹膜后肿瘤患者的临床资料, 评价消融疗效, 观察术后并发症, 比较射频消融治疗前后肿瘤体积变化。结果射频消融术后患者疼痛、消化不良等症状均明显改善, 住院时间为(9.2±2.9)d。10例患者肿瘤完全消融, 1例肿瘤残留, 2例肿瘤转移。1例患者术后十二指肠穿孔并发腹腔内感染, 其余患者未出现严重并发症。13例患者共20个病灶, 术前及术后1、3、6个月最大径分别为(39.5±15.9)mm、(30.6±4.9)mm、(15.6±7.7)mm和(9.9±3.1)mm, 术后1、3、6个月均小于术前(均P<0.05)。结论超声引导下射频消融是一种实时、精准、安全有效、并发症少的微创治疗手段, 对于腹膜后肿瘤具有较高的临床应用价值。     

肿瘤射频消融治疗后的免疫反应及抗肿瘤效应

射频消融治疗不仅造成局部肿瘤细胞的坏死,产生免疫原性的肿瘤相关抗原,还可产生大量炎性细胞因子和多种免疫原性介质,促进免疫细胞的局部浸润和活化,刺激免疫系统产生一定的抗肿瘤效应,但是这种抗肿瘤作用的强度较弱,不足以抵抗肿瘤生长。将射频消融治疗联合特定的免疫治疗如免疫刺激剂、过继免疫细胞治疗、树突状细胞疫苗、单克隆抗体等,可以取得最大临床获益,是免疫治疗有机融人肿瘤综合治疗的一个很好的模式。     

射频消融治疗100例肺部肿瘤的远期疗效

背景与目的手术切除是治疗肺部肿瘤的首选治疗手段,而对高龄、肺功能差的患者,射频消融治疗是一个很好的选择。本文总结了射频消融治疗100例肺部肿瘤的远期疗效和并发症。方法对不能手术的100例肺部肿瘤患者行射频消融治疗,定期复查胸部增强CT扫描、肿瘤SPECT或PET显像并随访,观察远期疗效及并发症。结果 100例肺部肿瘤病例的106个病灶接受了射频消融治疗。其中男性62例,女性38例,年龄36岁-91岁,平均66.6岁。原发性肺癌86例,肺转移瘤14例。所有病例完成射频消融治疗,无严重并发症和围手术期死亡。全组总生存时间为13.0个月,1年生存率51.0%,2年生存率32.5%,原发性肺癌与肺转移瘤相比无统计学差异(P=0.922)。早期肺癌的中位生存时间为28个月,2年总生存率为57.7%。结论 CT引导下射频消融治疗肺癌具有安全、有效、定位准确和微创的优点,是不能耐受手术的早期肺癌患者的选择之一,对中晚期肺癌是一种局部减瘤手段。     

肺部肿瘤射频消融治疗的临床应用与进展

肺癌是全世界因肿瘤死亡的首位原因.近年来,射频消融作为一种微创治疗方法在原发性和继发性肺部肿瘤治疗中得到越来越多的应用,并取得了较大进展.射频消融术后的疗效评价并不简单,推荐使用CT、MRI和PET综合评价.本文对其原理、基础研究、临床应用、疗效、进展等方面进行综述.     

超声引导射频消融治疗肺肿瘤的临床观察

射频消融治疗肺部肿瘤,目前主要是在CT引导下进行,而超声引导射频消融（radiofrequency ablation,RFA）治疗肺部肿瘤的报道较少。我们对21例肺部肿瘤患者在超声引导下进行RFA治疗,现将结果报告如下。     

Percutaneous radiofrequency ablation of painful osseous metastases

BACKGROUND:

The study was conducted to determine whether radiofrequency ablation (RFA) can safely reduce pain from osseous metastatic disease.

METHODS:

The single‐arm prospective trial included patients with a single painful bone metastasis with unremitting pain with a score >50 on a pain scale of 0‐100. Percutaneous computed tomography‐guided RFA of the bone metastasis to temperatures >60°C was performed. Endpoints were the toxicity and pain effects of RFA before and at 2 weeks, 1 month, and 3 months after RFA.

RESULTS:

Fifty‐five patients completed RFA. Grade 3 toxicities occurred in 3 of 55 (5%) patients. RFA reduced pain at 1 and 3 months for all pain assessment measures. The average increase in pain relief from pre‐RFA to 1‐month follow‐up is 26.3 (95% confidence interval [CI], 17.7‐34.9; P < .0001), and the increase from pre‐RFA to 3‐month follow‐up is 16.38 (95% CI, 3.4‐29.4; P = .02). The average decrease in pain intensity from pre‐RFA to 1‐month follow‐up was 26.9 (P < .0001) and 14.2 for 3‐month follow‐up (P = .02). The odds of lower pain severity at 1‐month follow‐up were 14.0 (95% CI, 2.3‐25.7; P < .0001) times higher than at pre‐RFA, and the odds at 3‐month follow‐up were 8.0 (95% CI, 0.9‐15.2; P < .001) times higher than at pre‐RFA. The average increase in mood from pre‐RFA to 1‐month follow‐up was 19.9 (P < .0001) and 14.9 to 3‐month follow‐up (P = .005).

CONCLUSIONS:

This cooperative group trial strongly suggests that RFA can safely palliate pain from bone metastases. Cancer 2010. © 2010 American Cancer Society     

Multiple applicator approaches for radiofrequency and microwave ablation

Treatment of tumours greater than 2?cm by radiofrequency (RF) or microwave ablation typically use multiple sequential applications, since most currently available ablation devices are limited to use of a single applicator at a time. A major focus of current ablation research is on methodologies that allow increasing the coagulation zone to more rapidly treat large tumours. The ability to use multiple applicators simultaneously would satisfy this need. It would significantly reduce treatment time and may lead to a reduction in local tumour progression, especially in perivascular locations. Several methods have been suggested that potentially allow simultaneous use of multiple applicators, both with radiofrequency (RF) and microwave (MW) ablation. This review compares the different methods of multiple applicator use, investigating advantages and disadvantages of each modality.     

Post‐radiofrequency ablation syndrome after percutaneous radiofrequency of abdominal tumours: One centre experience and review of published works

The aim of this study was to evaluate prospectively post‐radiofrequency ablation (RFA) syndrome and to determine its effect on the quality of life in the 15 days after percutaneous RFA treatment. We carried out an internal review board‐approved prospective study of the delayed symptoms that occurred after 71 consecutive RFA sessions in 53 patients (12 women and 41 men; age range 45–83 years; mean age 71.6 years) with 45 primary liver tumours, 34 liver metastases, 3 renal cell carcinoma (RCC), 2 residual lesions from RCC after nephrectomy and 1 pancreatic metastases from RCC. Postablation symptoms occurred in 17 of 53 (32%) patients. Six of 17 patients developed low‐grade fever (from 37.5 to 38.5°C). Other symptoms included delayed pain (9/17), nausea (7/17), vomiting (3/17), malaise (3/17) and myalgia (1). Postablation syndrome is a common phenomenon after RFA of solid abdominal tumours. Not only in our study but also in the previous ones the occurrence is observed in approximately one‐third patients. Patients should be informed that these symptoms are self‐limiting after RFA and most patients should be able to resume near‐complete preprocedural levels of activity within 10 days after the procedure.     

Low-power bipolar radiofrequency ablation and vertebral augmentation for the palliative treatment of spinal malignancies

Aim: To investigate the analgesic properties and the safety of low power bipolar radiofrequency ablation (RFA) performed with internally cooled electrodes and vertebral augmentation for the treatment of painful spinal malignancies.

Materials and methods: Consent was waived for retrospective study participation. Review of electronic records identified 11 consecutive patients (6 females; 5 males; mean age 61.3?±?11.6?years) with one-index painful spinal tumour, who were treated between June 2016 and October 2017 with bipolar RFA and vertebral augmentation. Patients were treated if they presented with focal pain (≥4/10 on a 0–10 visual analogic scale in the 24-h period) corresponding to a metastatic vertebral level on cross sectional imaging. The Wilcoxon test was used to evaluate the significance of the post-operative pain.

Results: Lumbar levels were treated in 72.7% cases; metastatic epidural involvement was noted in 81.8% cases; 54.5% patients received associated treatments in addition to RFA, which was coupled to vertebral augmentation in all cases. Two (18.2%) complications were noted. Mean pain score measured at last clinical follow-up available (mean 1.9?±?1.4?months) was 3.5?±?2 (versus 7.8?±?1.1 at baseline; p?<0.01).

Conclusions: Low-power bipolar RFA performed with internally cooled electrodes and coupled to vertebral augmentation provides safe and effective early analgesia in patients affected by painful spinal malignancies.     

Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: A systematic review and meta-analysis

Purpose: Radiofrequency ablation (RFA) and microwave ablation (MWA) are the two main percutaneous techniques for the treatment of unresectable hepatocellular carcinoma (HCC). However, to date, studies comparing the two therapies have provided discordant results. The aim of this meta-analysis is to evaluate the efficacy and safety of the two treatments for HCC patients. Materials and methods: A computerised bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. The rates of complete response (CR), local recurrence (LRR), 3-year survival (SR) and major complications were compared between the two treatment groups by using the Mantel-Haenszel test in cases of low heterogeneity or the DerSimonian and Laird test in cases of high heterogeneity. Sources of heterogeneity were investigated using subgroup analyses. In order to confirm our finding, sensitivity analysis was performed restricting the analysis to high-quality studies. Results: One randomised controlled trial (RCT) and six retrospective studies with 774 patients were included in the meta-analysis. A non-significant trend of higher CR rates in the patients treated with MWA was found (odds ratio (OR)?=?1.12, 95% confidence interval (CI) 0.67–1.88, p?=?0.67]. Overall LRR was similar between the two treatment groups (OR 1.01, 95% CI 0.53–1.87, p?=?0.98) but MWA outperformed RFA in cases of larger nodules (OR 0.46, 95% CI 0.24–0.89, p?=?0.02). 3-year SR was higher after RFA without statistically significant difference (OR 0.95, 95% CI 0.58–1.57, p?=?0.85). Major complications were more frequent, although not significantly, in MWA patients (OR 1.63, 95% CI 0.88–3.03, p?=?0.12). Conclusions: Our results indicate a similar efficacy between the two percutaneous techniques with an apparent superiority of MWA in larger neoplasms.     

Durable oncologic outcomes after radiofrequency ablation

BACKGROUND:

Long‐term oncologic outcomes for renal thermal ablation are limited. The authors of this report present their experience with radiofrequency ablation (RFA) therapy for 243 small renal masses (SRMs) over the past 7.5 years.

METHODS:

The authors' institutional, prospectively maintained RFA database was reviewed to determine intermediate and long‐term oncologic outcomes for patients with SRMs (generally <4 cm) who underwent RFA. Particular attention was placed on patients who had a minimum 3 years of follow‐up. Patients were excluded from the analysis if they had received previous treatment for renal cell carcinoma (RCC) on the ipsilateral kidney or if they did not have at least 1 imaging study available for follow‐up.

RESULTS:

Two hundred eight patients (with 243 SRMs) who had no evidence of previous ipsilateral renal cancer treatment underwent RFA and had follow‐up imaging studies available for review. Overall, tumor size averaged 2.4 cm, and follow‐up ranged from 1.5 months to 90 months (mean, 27 months). Of the 227 tumors (93%) that underwent preablation biopsy, RCC was confirmed in 79%. The initial treatment success rate was 97%, and the overall 5‐year recurrence‐free survival rate was 93% (90% for 160 patients who had biopsy‐proven RCC). During follow‐up, 3 patients developed metastatic disease, and 1 patient died of RCC, yielding 5‐year actuarial metastasis‐free and cancer‐specific survival rates of 95% and 99%, respectively.

CONCLUSIONS:

RFA provided successful treatment of SRMs and produced a low rate of recurrence as well as prolonged metastasis‐free and cancer‐specific survival rates at 5 years after treatment. Although longer term follow‐up of RFA will be required to determine late recurrence rates, the current results indicated a minimal risk of disease recurrence in patients who are >3 years removed from RFA. Cancer 2010. © 2010 American Cancer Society.     

Comparison of microwave ablation and radiofrequency ablation for hepatocellular carcinoma: a systematic review and meta-analysis

Background: Microwave ablation (MWA) has several advantages over radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). We aimed to compare the efficacy and safety of MWA with those of RFA for HCC from the perspectives of percutaneous and laparoscopic approaches.

Methods: PubMed/MEDLINE, Embase, the Cochrane library, and China Biology Medicine databases were searched. Studies comparing the efficacy and safety of MWA with those of RFA in patients with HCC were considered eligible. Complete ablation (CA), local recurrence (LR), disease-free survival (DFS), overall survival (OS), and the major complication rate were compared between MWA and RFA.

Results: Four randomized controlled trials and 10 cohort studies were included. For percutaneous ablation, no significant difference was found between MWA and RFA regarding CA, LR, DFS, OS, and the major complication rate. A subgroup analysis of tumors measuring ≥3?cm revealed no difference in CA and LR for percutaneous ablation. For laparoscopic ablation, a significantly lower LR rate and a non-significant trend toward a higher major complication rate were observed for the MWA group (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.16–4.02, p?=?.01 for LR; OR 0.21, 95% CI 0.04–1.03, p?=?.05 for major complication rate). CA, DFS, and OS were similar between the two groups.

Conclusions: Percutaneous (P)-MWA had similar therapeutic effects compared with P-RFA for HCC. Patients undergoing laparoscopic MWA had a lower LR rate; however, their major complication rate appeared to be higher. The superiority of MWA over RFA remains unclear and needs to be confirmed by high-quality evidence.     

经皮肝穿刺射频热凝对复发性肝癌的治疗意义

目的 探讨对于无再次手术指征的复发性肝癌行B超引导经皮肝穿刺射频热凝(PRFA)治疗的意义。方法 1999年10月～2001年7月经病理证实为原发性肝癌，术后影像学和血清肿瘤标记物证实为肝癌复发的47患者进行B超引导PRFA治疗。复发瘤灶为单发者24例、多发者23例，其中复发灶为单发且小于3．5cm者12例。定期随访，复查AFP、肝功能和B超，1个月后复查MRI或CT了解肿瘤坏死情况，以后每3个月复查。Kaplan—Meier法计算累积生存率。结果 复发灶为单发者1、2、3年的生存率分别为65.2％、37．5％、37．5％，复发灶为单发且小于3.5cm者1、2、3年的生存率分别为83.3％、51．4％、51．4％。复发灶为多发者1、2年的生存率为41．7％、19．5％。结论 B超引导经皮肝穿刺射频热凝是肝癌综合治疗中一种重要手段，对于无再次手术指征的复发性肝癌可以根据复发瘤灶的大小、范围、复发时间，决定单独或结合TACE给予B超引导经皮肝穿刺射频热凝(PRFA)治疗，可以更加有效地控制复发、提高生存率。     

Mathematical spatio-temporal model of drug delivery from low temperature sensitive liposomes during radiofrequency tumour ablation

Purpose: Studies have demonstrated a synergistic effect between hyperthermia and chemotherapy, and clinical trials in image-guided drug delivery combine high-temperature thermal therapy (ablation) with chemotherapy agents released in the heating zone via low temperature sensitive liposomes (LTSL). The complex interplay between heat-based cancer treatments such as thermal ablation and chemotherapy may require computational models to identify the relationship between heat exposure and pharmacokinetics in order to optimise drug delivery.

Materials and methods: Spatio-temporal data on tissue temperature and perfusion from heat-transfer models of radiofrequency ablation were used as input data. A spatio-temporal multi-compartmental pharmacokinetic model was built to describe the release of doxorubicin (DOX) from LTSL into the tumour plasma space, and subsequent transport into the extracellular space, and the cells. Systemic plasma and tissue compartments were also included. We compared standard chemotherapy (free-DOX) to LTSL-DOX administered as bolus at a dose of 0.7 mg/kg body weight.

Results: Modelling LTSL-DOX treatment resulted in tumour tissue drug concentration of ～9.3 µg/g with highest values within 1 cm outside the ablation zone boundary. Free-DOX treatment produced comparably uniform tissue drug concentrations of ～3.0 µg/g. Administration of free-DOX resulted in a considerably higher peak level of drug concentration in the systemic plasma compartment (16.1 µg/g) compared to LTSL-DOX (4.4 µg/g). These results correlate well with a prior in vivo study.

Conclusions: Combination of LTSL-DOX with thermal ablation allows localised drug delivery with higher tumour tissue concentrations than conventional chemotherapy. Our model may facilitate drug delivery optimisation via investigation of the interplays among liposome properties, tumour perfusion, and heating regimen.     

射频消融治疗恶性肿瘤现状

目前,恶性肿瘤的治疗多强调以手术切除为主的多学科综合治疗,而对于一些不能手术切除的肿瘤患者,微创介入疗法是一种较好的肿瘤姑息治疗手段。射频消融(radiofrequency ablation,RFA)是一种针对肿瘤局部的微创介入性疗法,已被证实是一种有效、安全、并发症少、定位准确的治疗恶性实体肿瘤的微创技术。近年来,此项技术已被广泛应用于多种恶性肿瘤,如肝癌、肺癌、乳腺癌等。随着RFA治疗原理研究的不断深入、射频消融技术的不断改进,局部肿瘤治疗的疗效将进一步提高,但仍需要随机化的研究和长期的随访来证实RFA在肿瘤治疗中的重要意义。