The safety of radiofrequency thermal ablation in the treatment of liver malignancies

Introduction

Radiofrequency ablation (RFA) has become widely accepted as an important adjunct, and sometimes a viable alternative, to liver surgery. The aims of this study are to assess the risks associated with percutaneous RFA and to discuss the indications and contraindications to its use.

Patients and methods

This is a review of 130 consecutive patients who were treated for primary (n = 92) and metastatic (n = 38) liver tumours. Only complications after percutaneous RFA (83 patients) were evaluated. Interesting case studies are included to highlight potential complications following RFA and their management.

Results

One patient died of perforation of the colon and five others had major complications. There were 15 minor complications. Local recurrence rates reached 30% overall, and a further 25 patients developed a new hepatic lesion, different from the one treated by RFA. Median disease-free survival was 13 months. Overall survival rates at 1, 2 and 5 years were 85.3%, 71.3% and 57.6%, respectively.

Conclusion

Percutaneous RFA is a safe and efficient technique but not free of complications and with potential fatal outcome. It is also associated with significant local recurrence rates. The procedure should only be performed following adequate training and the indication should always be discussed in multidisciplinary meetings. Patient's liver function and general health as well as tumour size and position must be considered. Intraoperative or video laparoscopic RFA is useful for superficial tumours in order to avoid damage to viscera surrounding the liver surface.     

CT引导下脊髓射频热凝术治疗脊髓损伤继发性神经病理性疼痛的有效性和安全性

目的:评价CT引导下行脊髓射频热凝术治疗脊髓损伤继发性神经病理性疼痛的疗效及安全性。方法:2011年1月至2012年10月间脊髓损伤继发性神经病理性疼痛患者68例行CT引导下脊髓射频热凝术,评价治疗效果、疼痛评分（VAS）及不良反应发生情况。结果:患者治疗后3个月、6个月、1年和2年的总有效率逐渐提高,治疗2年68例患者均获得治愈或有效,未见无效病例。患者治疗后VAS评分较治疗前显著降低,且随着随访时间的延长,VAS评分不断下降,治疗后各时间点的VAS与治疗前比较有统计学意义（P＜0.01）。68例患者中2例出现轻度腹痛,2例出现浅感觉减退,1例有硬膜刺破后头痛,但均未经处理自行恢复,不良反应率为7.4%,患者未出现脑脊液漏、手术相关合并症等。结论:CT引导下应用脊髓射频热凝技术治疗脊髓损伤继发性神经病理性疼痛具有较好的有效性及安全性,治疗时应严格把握适应征,并掌握手术技巧。     

CT引导下经皮穿刺射频消融治疗特殊部位肝癌

目的 探讨CT引导下经皮穿刺射频消融（RFA）治疗特殊部位肝癌（直径≤3cm）的疗效及安全性。方法 回顾性分析2008年5月至2012年4月行CT引导下经皮穿刺RFA治疗47例肝癌患者,共消融63个特殊部位（指距离大血管、大胆管或肝外脏器5mm以内）病灶。所有患者术后均行增强CT复查及随访,统计肿瘤完全坏死率、肿瘤局部进展率、肿瘤肝内新生率、生存率及并发症。结果 所有患者均成功接受经皮穿刺RFA治疗。RFA术后1个月特殊部位肝癌完全坏死率为88.89％（56／63）;RFA术后3、6、12个月及1年以上的肿瘤局部进展率分别为4.77％（3／63）、3.17％（2／63）、3.17％（2／63）、1.59％（1／63）,肿瘤肝内新生率分别为15.87％（10／63）、4.76％（3／63）、12.70％（8／63）、3.17％（2／63）。至随访截止时间,47例患者的1、3、5年生存率分别为82.98％（39／47）、63.83％（30／47）、36.17％（17／47）。RFA术后,未出现任何严重并发症,6例（12.77％）出现肝包膜下少量血肿,10例（21.28％）术后发热,经对症处理后症状改善。结论 CT引导下经皮穿刺RFA治疗特殊部位肝癌是安全、有效的方法。     

Percutaneous CT-guided radiofrequency ablation for patients with extrahepatic oligometastases of hepatocellular carcinoma: long-term results

Background: The aim of this study was to evaluate the therapeutic outcome of percutaneous computed tomography (CT)-guided radiofrequency ablation (RFA) for extrahepatic oligometastases of hepatocellular carcinoma (HCC).

Methods: Institutional review board approval was obtained for this retrospective study, and all patients provided written informed consent. Between April 2004 and December 2015, 116 oligometastases (diameter, 5–50?mm; 20.3?±?10.4) in 79 consecutive HCC patients (73 men and 6 women; average age, 50.3?years ±13.0) were treated with RFA. We focussed on patients with 1–3 extrahepatic metastases (EHM) confined to 1–2 organs (including the lung, adrenal gland, bone, lymph node and pleura/peritoneum) who were treated naïve with curative intent. Survival, technical success and safety were evaluated. The log-rank test and Cox proportional hazards regression models were used to analyse the survival data.

Results: No immediate technical failure occurred, and at 1 month, the technique effectiveness rate was determined to be 95.8%. After a median follow-up time of 28.0 months (range, 6–108 months), the 1-, 2- and 3-year overall survival (OS) rates were 91, 70 and 48%, respectively, with a median survival time of 33.5 months. Time to unoligometastatic progression (TTUP) of less than 6 months (p?p?=?0.001) were significant indicators of shorter OS. The 1-, 2- and 3-year disease free survival (DFS) rates were 34, 21 and 8%, respectively, with a median DFS time of 6.8 months. DFS was better for those with lung metastases (p?=?0.006). Major complication occurred in nine (9.5%, 9/95) RFA sessions without treatment-related mortality.

Conclusions: CT-guided RFA for oligometastatic HCC may provide favourable efficacy and technical success with a minimally invasive approach.     

Comparison between single- and dual-porosity models for fluid transport in predicting lesion volume following saline-infused radiofrequency ablation

A recent study by Ooi and Ooi (EH Ooi, ET Ooi, Mass transport in biological tissues: Comparisons between single- and dual-porosity models in the context of saline-infused radiofrequency ablation, Applied Mathematical Modelling, 2017, 41, 271-284) has shown that single-porosity (SP) models for describing fluid transport in biological tissues significantly underestimate the fluid penetration depth when compared to dual-porosity (DP) models. This has raised some concerns on whether the SP model, when coupled with models of radiofrequency ablation (RFA) to simulate saline-infused RFA, could lead to an underestimation of the coagulation size. This paper compares the coagulation volumes obtained following saline-infused RFA predicted based on the SP and DP models for fluid transport. Results showed that the SP model predicted coagulation zones that are consistently 0.5 to 0.9 times smaller than that of DP model. This may be explained by the low permeability value of the tissue interstitial space, which causes the majority of the saline to flow through the vasculature. The absence of fluid flow tracking in the vasculature in the SP model meant that any flow of saline into the vasculature is treated as losses and do not contribute to the saline penetration depth of the tissue. Comparisons with experimental results from the literature revealed that the DP models predicted coagulation zone sizes that are closer to the experimental values than the SP models. This supports the hypothesis that the SP model is a poor choice for simulating the outcome of saline-infused RFA.     

脊柱骨母细胞瘤的诊断与治疗

目的 探讨脊柱骨母细胞瘤的临床特点、治疗方法及预后.方法 回顾性分析2001年7月至2009年7月本院收治的12例脊柱骨母细胞瘤患者的临床表现、诊断和治疗方法.结果其中男4例,女8例;中位年龄21岁(9～63岁).累及颈椎1例,胸椎4例,腰椎3例,胸腰段1例,骶椎3例.均有疼痛,伴有神经损伤症状6例,伴有脊柱侧凸4例,1例患者存在肿块,1例存在脊髓压迫.7例为复发病例或术前活检明确诊断,4例患者术前影像学表现典型,考虑为骨母细胞瘤,其中1例误诊为骨肉瘤.所有患者均行手术治疗,根据肿瘤部位不同采取前路、后路或前后路联合肿瘤切除,并予以相应方式重建.手术时间平均3.3h(1.5-6.5h).出血量平均1975ml (300～4500ml).术后疼痛和神经根损害表现均消失,3例脊柱侧弯患者畸形得到纠正,2例患者4次出现脑脊液漏,经应用抗生素和床尾抬高治疗后愈合.10例随访平均4年(1-8年),2例分别于术后3个月、2年6个月复发,其余均无疼痛症状,未见肿瘤复发.结论 脊柱骨母细胞瘤临床特征复杂,临床表现、影像学检查结合穿刺病理有助于确诊.根据不同的肿瘤部位,采取不同的手术入路行彻底的切除肿瘤能够取得良好效果.     

High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer

BACKGROUND AND OBJECTIVES: To report and discuss the effect, complications and mortality of cool-tip radiofrequency ablation (RFA) for unresectable pancreatic cancer. METHODS: During October 2003 to July 2004, sixteen patients with unresectable pancreatic cancer were treated by open cool-tip RFA. One-half of the 16 patients had tumors located in the pancreatic head. A 5-mm minimum safe distance between RFA site and major peripancreatic vessels was kept to avoid injury to the vessels. RESULTS: Six of twelve patients with back pain got pain relief postoperatively. Pancreatic fistula occurred in three patients (18.8%) and healed smoothly in 7-10 days with routine abdominal drainage. The mortality was 25% (4/16). In the four death cases, tumors were all located in the pancreatic head; three patients with tumor close to portal vein died suddenly of massive gastrointestinal hemorrhage on the 4th, 30th, 40th postoperative day respectively and a 79-year-old patient died of acute renal failure on the 2nd postoperative day. CONCLUSIONS: Standard use of cool-tip RFA was dangerous for pancreatic head cancer close to portal vein, in which a 5-mm minimum safe distance between RFA site and major peripancreatic vessels might not be enough to avoid injury to the vessels.     

Bipolar radiofrequency ablation of benign thyroid nodules using a multiple overlapping shot technique in a 3-month follow-up

Purpose The aim of this study was to evaluate the decrease of benign thyroid nodules after bipolar radiofrequency ablation (RFA) in a 3-month follow-up using a multiple overlapping shot technique (‘MOST’).

Methods A total of 18 patients with 20 symptomatic benign thyroid nodules (17 cold nodules, 3 hyperfunctioning nodules) were treated in one single session by bipolar RFA. Bipolar ablation was performed using MOST. The nodule volumes were measured prior to ablation and 3 months after the procedure using ultrasound. The population consisted of either solid (>80% solid tissue within the volume of interest), complex, or cystic nodules (<20% solid tissue within the volume of interest).

Results Bipolar RFA resulted in a highly significant (p?<?0.0001) decrease of nodule volume (ΔV), median 5.3?mL (range 0.13–43.1?mL), corresponding to a relative reduction in mean of 56?±?17.9%. Median initial volume was 8?mL (range 0.48–62?mL); 3 months after ablation a median volume of 2.3?mL (range 0.3–32?mL) was measured. Nodule growth ≥50% occurred in 70% (14 nodules). At the follow-up no complications such as infections, persisting pain, nerve injuries or immunogen stimulation occurred. Patients with cold nodules (15) remained euthyroid, with hyperfunctioning nodules either euthyroid (2) or latent hypofunctional (1).

Conclusion The use of bipolar RFA is an effective, safe and suitable thermoablative technique to treat benign thyroid nodules. Combined with the multiple overlapping shot technique it allows sufficient ablation.     

CT引导下兔肺内VX2肿瘤的射频消融治疗

背景与目的：外科手术切除、放疗和化疗是治疗肺恶性肿瘤的主要方法,但对失去手术机会、肺内多发转移或放化疗失败的患者,积极探索新的治疗方法成为亟待解决的问题。近年来,射频消融作为肺恶性肿瘤新的治疗方法,受到广泛关注。本研究旨在观察CT引导下CelonLab射频仪治疗兔肺内VX2肿瘤的影像学表现、病理演变,评价治疗效果,进一步探索肺恶性肿瘤的射频治疗参数。方法：采用同轴套管针经皮穿刺的新方法建立兔VX2肺肿瘤模型。实验组27只予以射频治疗,对照组9只予以假性治疗。两组均于设定时间点行CT扫描,观察影像学表现。实验组18只于治疗后不同时间点随机处死,观察病理演变;其余9只待其自然死亡,评估疗效、计算生存期。对照组9只均待其自然死亡,计算生存期。结果：射频后即刻CT扫描见病灶周围磨玻璃影可伴内部空洞或小空泡。与病理HE染色切片对照发现,术后随访中CT增强扫描无强化不能完全除外肿瘤细胞残留。术后24 h大体解剖见病灶由中心向外周形成4条沿能量梯度分布的反应带：中央炭化或蒸发中心(电极穿刺针道),灰白色凝固性坏死带,棕红色出血带,粉红色充血渗出带。术后肿瘤病灶周围出现不同程度炎性反应,4周后基本吸收,最终残留厚壁纤维组织层包绕中央凝固性坏死及少量陈旧性出血。实验组待其自然死亡的9只中,完全缓解率78%。实验组与对照组生存时间分别为(38.0±5.9) d与(24.0±3.1) d,差异有统计学意义(t=2.634,P=0.018)。射频能量与病灶直径之间存在直线回归关系,回归系数的检验P=0.000,直线回归方程为Y^=-2.3372+1.4361X。结论：采用同轴套管针经皮穿刺法建立兔VX2肺肿瘤模型安全、迅速,短期内成瘤率高。射频消融治疗肺内肿瘤疗效确切,安全、微创,并发症少。术后射频区域有一个发展演变的过程,疗效评估可以术后1个月为新基线。射频能量与病灶直径之间存在直线回归关系。     

射频消融联合经皮椎体成形术治疗脊柱转移瘤的疗效观察

目的:探讨射频消融(radiofrequency ablation,RFA)联合经皮椎体成形术(radiofrequency ablation,PVP)治疗脊柱转移瘤的临床疗效。方法:选取2013年2月至2018年10月我院骨二科收治的76例脊柱转移瘤患者为研究对象。根据治疗方式不同将患者分为观察组(n=39例)和对照组(n=37例),对照组行经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗,观察组行PVP+RFA治疗。记录两组骨水泥渗漏率;采用疼痛视觉模拟评分(Visual Analogue Scale,VAS)评估患者疼痛情况、卡氏功能状态评分(Karnofsky Performance Score,KPS)评价患者体能状态、脊柱肿瘤不稳定评分(Spinal Instability Neoplastic Score,SINS)评估脊柱稳定性情况;比较两组术后6个月肿瘤复发率;采用Kaplan-Meier法评估两组生存情况。结果:观察组骨水泥渗漏率低于对照组(P＜0.05);观察组术后1月、3月、6月和12月VAS评分均低于对照组(P＜0.05);两组术后1月、3月KPS评分组间比较差异无统计学意义(P＞0.05);观察组术后1月、3月SINS评分均低于对照组(P＜0.05);观察组术后6月肿瘤复发率低于对照组(P＜0.05);Kaplan-Meier法生存分析显示,两组术后生存时间比较差异无统计学意义(P＞0.05)。结论:PVP联合RFA治疗脊柱转移瘤的临床疗效与单独PVP治疗相近,但PVP联合RFA治疗能更有效缓解疼痛,增强脊柱稳定性,减少骨水泥外渗及术后肿瘤复发。     

Percutaneous CT-guided radiofrequency ablation for unresectable hepatocellular carcinoma pulmonary metastases

Purpose: This study aimed to evaluate the safety and efficacy of percutaneous CT-guided radiofrequency ablation (RFA) for unresectable hepatocellular carcinoma pulmonary metastases (HCCPM) and to identify the prognostic factors for survival.

Materials and methods: We reviewed the medical records of 320 patients with HCCPM treated between January 2005 and January 2012. Among them, 29 patients with 68 lesions of unresectable HCCPM underwent 56 RFA sessions. Safety, local efficacy, survival and prognostic factors were evaluated. Survival was analysed using the Kaplan-Meier method. Univariate analyses were evaluated by the log-rank test.

Results: Pneumothorax requiring chest tube placement occurred in five (8.9%, 5/56) RFA sessions. During the median follow-up period of 23 months (range 6–70), 18 patients (62.1%, 18/29) died of tumour progression and 11 (37.9%, 11/29) were alive. The 1-, 2- and 3-year overall survival rates were 73.4%, 41.1% and 30%, respectively. The median progression-free survival was 18 months (95% confidence interval (CI) 9.8–26.2) and the median overall survival time was 21 months (95%CI, 9.7–32.3). The maximum tumour diameter ≤3?cm (p?=?0.002), the number of pulmonary metastases ≤3 (p?=?0.014), serum AFP level ≤400?ng/mL (p?=?0.003), and the controlled status of intrahepatic tumour after lung RFA (p?=?0.001) were favourable prognostic factors for overall survival.

Conclusions: Our study indicates that percutaneous CT-guided RFA, as an alternative treatment procedure to pulmonary metastasectomy, can be a safe and effective therapeutic option for unresectable HCCPM.     

Low-dose CT protocols for guiding radiofrequency ablation for the treatment of small renal cell carcinomas

Objective: Computed tomography (CT)-guided radiofrequency ablation (RFA) results in a high radiation dose. This study aimed to assess low-dose CT protocols for guiding RFA and oncologic outcomes for the treatment of small renal cell carcinoma (RCC).

Materials and methods: Between December 2011 and December 2014, CT-guided RFA was performed in 31 patients with 31 biopsy-proven RCCs (median, 2.1?cm). RFA included planning, targeting, monitoring and survey phases. The dose length product (DLP), CT dose index volume (CTDIvol), effective dose, number of scans, scan range, tube current and exposure time of RFA phases were compared. The 3-year recurrence-free survival rate was recorded. Nonparametric or parametric repeated-measures ANOVA with Dunn’s or Tukey–Kramer multiple comparisons and Kaplan–Meier analysis were used for statistical analysis.

Results: The median total DLP, CTDIvol and effective dose of CT-guided RFA procedures per session were 1238.8 mGy (range 517.4–3391.7 mGy), 259.7 mGy (10.7–67.9 mGy) and 18.6 mSv (7.8–50.9 mSv), respectively. The median DLP, CTDIvol, effective dose, number of scans, tube current and exposure time during the targeting phase were higher than those during the other phases (p?p?>?0.05) but smaller than those in the planning and survey phases (p?Conclusions: Low-dose CT protocols for guiding RFA may reduce radiation dose without compromising oncologic outcomes. Reducing the number of scans during the targeting phase contributes to dose reduction.     

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.     

A polyacrylamide gel phantom for radiofrequency ablation

A polyacrylamide gel (PAG) containing bovine serum albumin (BSA) is introduced as a new tissue-mimicking phantom for the purpose of visualizing three-dimensional coagulation temperature distribution during radiofrequency ablation (RFA). The coagulation temperature of the phantom can be changed at the same range of biological tissue (50–60°C) by adjusting the pH from 4.3 to 4.7. The phantom is transparent except in thermal coagulation regions which are ivory white. The physical properties of the phantom, such as density, electrical conductivity and specific heat capacity, are very favorable, similar to those of soft tissues. We illustrate the usefulness of the phantom in visualizing RFA lesions. This phantom has magnetic resonance properties which change drastically upon thermal coagulation, enabling its use for the characterization of RFA device, quality assurance, treatment planning and treatment verfication. The PAG containing BSA, whose pH was adjusted from 4.3 to 4.7, is an attractive tissue-mimicking phantom suitable for RFA investigations.     

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.     

同步放化疗联合射频消融术治疗非小细胞肺癌的临床观察

目的:探讨同步放化疗联合射频消融术治疗非小细胞肺癌的临床疗效.方法:将40例非小细胞肺癌患者随机分为放化疗联合射频消融术(综合组,n=19)和单纯放化疗(对照组,n＝21).化疗采用常规EP方案,放疗为适形放疗.分别于治疗完成后3、6个月和1、2、3年复查,从KPS、肿瘤大小、生存率对患者进行临床评价,研究综合治疗的临床疗效.结果:综合治疗的KPS评分及肿瘤体积减小明显高于对照组,且差异有统计学意义,P＜0.05.有效率(CR+PR)综合组为78.9％,而对照组为42.9％.综合组6个月、1、2和3年生存率分别约为100.0％(19/19)、89.4％ (17/19)、73.6％(14/19)和57.9％(11/19);对照组分别为100％(21/21)、76.2％(16/21)、47.6％(10/21)和28.6％ (6/21),3年生存率差异有统计学意义,P=0.03.结论:放化疗联合射频消融治疗非小细胞肺癌能显著增强疗效,提高患者生存率,是目前较理想、值得临床广泛推广的一种综合治疗方法.     

A comparison of laser with radiofrequency ablation for the treatment of benign thyroid nodules: a propensity score matching analysis

Abstract

Purpose: To compare technique efficacy and safety of laser ablation (LA) and radiofrequency ablation (RFA) in treatment of benign thyroid nodules.

Materials and methods: Institutional review board approval was obtained, and patients’ consent was waived. 601 nodules were treated from May 2009 to December 2014 at eight centres, 449 (309 females, age 57?±?14?years) with LA and 152 (107 females, age 57?±?14?years) with RFA. A matched cohort composed of 138 patients from each group was selected after adjustment with propensity score matching. Factors influencing volume reduction at 6 and 12?months and complications were evaluated.

Results: No significant differences were observed in the baseline characteristics between groups after propensity score matching adjustment. Mean nodule reduction at 6 and 12?months was ?67?±?19% vs. ?57?±?21% (p?<?0.001)???70?±?19% vs. ?62?±?22% (p =?0.001) in LA group and in RFA group, respectively. Nodules with volume?>30?mL had significantly higher percentage volume reduction at 6 and 12?months (?69?±?19 vs. ?50?±?21, p?=?0.001) and (?73?±?18 vs. ?54?±?23 8, p?=?0.001) in the LA group than in the RFA group, respectively. In both groups, operator’s skills affected the results. Major complications occurred in 4 cases in each group (p?=?0.116)

Conclusions: LA and RFA showed nearly similar outcome but LA was slightly more effective than RFA in large nodules. Operator’s skills could be crucial in determining the extent of nodule volume reduction regardless of the used technique.     

肿瘤射频消融治疗的相关并发症及预防

目的总结肿瘤病人射频消融治疗的临床经验，对相关并发症及其预防进行探讨。方法分析200例肿瘤患者射频消融治疗的临床资料，观察和总结射频消融治疗后相关并发症的发生率、发生原因和预防措施。结果200例肿瘤病人射频治疗后其相关并发症发生率为20．5％，其中主要并发症18例（9％），其他并发症23例（11．5％），无严重并发症及死亡发生。结论射频消融是多种实体肿瘤的一种安全有效的微创治疗技术，加强管理、注重预防是避免和减少并发症的关键。     

Recurrence-free survival after radiofrequency ablation of hepatocellular carcinoma. A registry report of the impact of risk factors on outcome

BACKGROUND: Despite the high complete necrosis rate of radiofrequency ablation (RFA), tumor recurrence, either local tumor recurrence or new tumor formation, remains a significant problem. Purpose of this study is to evaluate the pattern and risk factors for intrahepatic recurrence after percutaneous RFA for hepatocellular carcinoma (HCC). METHODS: We studied 40 patients with 48 HCCs (< or = 3.5 cm) who were treated with percutaneous RFA. The mean follow-up period was 24.1 +/- 15.7 months. We evaluated the cumulative disease-free survival of overall intrahepatic recurrence, local tumor progression (LTP) and intrahepatic distant recurrence (IDR). Thirty host, tumoral and therapeutic risk factors were reviewed for significant tie-in correlation with recurrence: age; gender; whether RFA was the initial treatment for HCC or not; severity of liver disease; cause of liver cirrhosis; contact of tumor to major hepatic vessels and liver capsule; degree of approximation of tumor to the liver hilum; ablation time; degree of benign pre-ablational enhancement; sufficient safety margin; tumor multinodularity; tumor histological differentiation; tumor segmental location; maximum tumor diameter; degree of tumor pre-ablational enhancement at arterial phase CT, MRI or CT-angiography; and laboratory markers pre- and post-ablation (AFP, PIVKA II, TP, AST, ALT, ALP and TB). RESULTS: The incidence of overall recurrence, LTP and IDR was 65, 23 and 52.5%, respectively. The cumulative disease-free survival rates were 54.6, 74.8 and 78.3% at 1 year, 27.3, 71.9 and 46.3% at 2 years and 20, 71.9 and 29.4 at 3 years, respectively. Univariate and multivariate analysis showed that the significant risk factors for LTP were: tumor size > or = 2.3 cm, insufficient safety margin, multinodular tumor, tumors located at segments 8 and 5, and patient's age > 65 years (P < 0.05). No significant risk factor relationship for IDR could be detected. CONCLUSION: Our results would have clinical implications for advance warning and appropriate management of patients scheduled for RFA. Patients at risk of LTP should be closely monitored in the first year. Furthermore, regular long-term surveillance is essential for early detection and eradication of IDR.