一期结直肠癌切除与射频消融治疗肝转移癌

目的:探讨一期结直肠癌切除与射频消融治疗肝转移癌的临床价值。方法:对5例术前确诊为结直肠癌,经CT和B超发现肝脏有转移病灶的患者,在行结直肠癌切除术后,同时在手术中一期完成B超或腹腔镜下多电极射频消融治疗肝转移癌。结果:5例患者随访3个月至29个月,其中1例病灶较大(直径6cm)者在术后 12个月死于肺转移及全身衰竭,另外4例术后已经分别生存3个月、6个月、22个月、25个月。结论:一期结直肠癌切除与射频消融治疗肝转移癌,具有疗效满意、方法安全、创伤小及痛苦小、避免二次剖腹手术等优点。     

一期结直肠癌切除与射频消融治疗肝转移癌

目的:探讨一期结直肠癌切除与射频消融治疗肝转移癌的临床价值.方法:对5例术前确诊为结直肠癌,经CT和B超发现肝脏有转移病灶的患者,在行结直肠癌切除术后,同时在手术中一期完成B超或腹腔镜下多电极射频消融治疗肝转移癌.结果:5例患者随访3个月至29个月,其中1例病灶较大(直径6cm)者在术后12个月死于肺转移及全身衰竭,另外4例术后已经分别生存3个月、6个月、22个月、25个月.结论:一期结直肠癌切除与射频消融治疗肝转移癌,具有疗效满意、方法安全、创伤小及痛苦小、避免二次剖腹手术等优点.     

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。     

CT导向射频消融治疗肺部恶性肿瘤的护理

目的探讨肺部恶性肿瘤患者在CT引导下经皮肺穿刺行射频消融(RFA)治疗的护理。方法对2012年至2013年12月江苏省肿瘤医院收治的不能手术的74例原发性肺癌(其中鳞癌23例,腺癌48例,鳞腺癌2例,大细胞癌1例)和14例转移性肺癌患者共96个病灶(其中最大直径3 cm 31个,3~5 cm 56个,5 cm 9个)134次RFA治疗的术前准备、术中观察以及术后并发症的观察与护理进行回顾性总结分析。结果 88例共134次RFA治疗中除1例患者因术中癫痫发作而中断手术行二期射频消融治疗外,其余均顺利完成治疗。术中并发血气胸8例,咳嗽、痰中带血12例次,胸痛6例次;术后有24例次患者体温37.5℃~39.5℃。上述并发症经止血、控制感染、胸腔穿刺置管排气、排液等对症治疗以及加强护理,患者均在短时间内治愈。结论加强术前患者心理支持和围手术期护理,能保证RFA治疗的顺利实施,预防和减少并发症。     

CT引导射频消融术治疗非小细胞肺癌35例

为了探讨CT引导下射频消融术(RFA)治疗非小细胞肺癌(NSCLC)的疗效及安全性,对35例NSCLC进行了CT引导下RFA治疗,其中鳞癌12例,腺癌20例,鳞腺癌1例,大细胞癌2例;中央型肺癌4例,周围型肺癌31例.肿瘤直径≤3 cm 6例,3～5 cm 21例,>5 cm 8例.射频消融过程中多数病灶阴影增大,边缘模糊,部分病灶出现蜂窝气泡样改变,术后3个月复查CT显示28个病灶缩小,总有效率(CR+PR)为80.0%.术后出现少量咯血5例,气胸5例,轻度发热7例.初步研究结果提示,CT引导RFA术治疗NSCLC是一项安全有效的微创技术,值得推广应用.     

CT引导下射频消融技术治疗结肠癌肺转移1例

射频消融 (RFA)治疗是近年来新兴的一种肿瘤局部治疗手段 ,在对肝癌的治疗中取得了显著的效果。肺脏是仅次于肝脏的结肠癌常见的转移部位 ,许多患者发现时已经不能够手术治疗 ,同时放疗和化疗的效果又不尽如人意。我们在实际工作中将射频消融技术应用于 1例结肠癌肺转移的患者 ,现报告如下 :材料和方法一　临床资料　患者男 ,76岁 ,曾于 6年前因升结肠肿瘤行右半结肠切除术 ,术后应用氟尿嘧啶和丝裂霉素联合化疗 9次。后因近 4个月来自觉体重减轻、乏力、倦怠 ,咳嗽等症状入院。查体 :一般状况差 ,中度贫血貌 ,锁骨上淋巴结未触及 ,心律齐…     

CT引导下射频消融治疗中晚期非小细胞肺癌的近期疗效观察

背景与目的 近年来,射频消融术(Radio-Frequency Ablation,RFA)作为一种新的局部治疗手段运用于肺部肿瘤的治疗.取得了很好的临床效果.本文探讨CT引导下射频消融治疗中晚期肺癌的临床价值.方法 对66例中晚期非小细胞肺癌的68个病灶(其中2例病人各治疗2个病灶)在三维重建CT引导下进行射频消融治疗,观察近期疗效.结果 66例病人经CT引导下射频消融,即刻及1个月复查CT提示病灶阴影增大.而64个病灶CT值降低,占94.1%,4个病灶CT值增加,占5.9%.1个月复查SPECT提示T/N降低至正常值以下的患者占82.4%(56/68).治疗后3个月CT扫描显示在68个肿瘤中,没有肿瘤完全消失(CR)者,肿瘤缩小者(PR)73.5%(50/68),肿瘤无变化者(SD)2.9%(2/68),肿瘤增大者(PD)8.8%(6/68),6例增大的病灶进行了第2次消融;3个月复查SPECT提示T/N降低至正常值以下的患者占79.496(54/68).无严重并发症,无围手术期死亡.结论 CT6[导下射频消融治疗中晚期非小细胞肺癌安全可行,近期疗效明显.     

高温射频消融治疗周围型肺部恶性肿瘤

目的CT引导经皮肺穿刺高温射频消融治疗89例周围型肺部恶性肿瘤的近期疗效观察.方法集束聚能刀高温射频消融治疗89例周围型肺部恶性肿瘤,包括原发性周围型肺癌65例,肺转移癌24例,共计226个肿瘤.结果胸部CT或X线平片复查,肿瘤经射频消融治疗后绝大多数病例的肿瘤在3个月左右明显缩小(CR+PR,82.0%).术后并发症包括气胸32例、少量血胸3例和局部疼痛15例.结论高温射频消融治疗周围型肺部恶性肿瘤,近期疗效确切,严重并发症少,是一种较为安全有效的治疗方法.     

肝细胞癌射频消融治疗后肿瘤残留的危险因素及预后分析

目的 探讨肝细胞癌(HCC)射频消融(RFA)治疗后肿瘤残留的危险因素及预后.方法 回顾性分析2001年5月至2007年3月114例经RFA治疗的HCC患者临床资料,分析可能与RFA后肿瘤残留有关的临床因素以及残留HCC的预后.结果 114例HCC患者经RFA治疗一次后,完全消融90例,肿瘤残留24例.90例肿瘤完全消融患者的中位生存期为40个月,24例肿瘤残留患者的中位生存期为29个月,二者差异无统计学意义(P=0.242).在24例肿瘤残留患者中,经再次治疗后达到无肿瘤残留者11例,其中位生存期为53个月;经再次治疗后仍有残留者13例,其中位生存期为28个月.RFA治疗一次后肿瘤完全消融患者与再次治疗后达到无肿瘤残留患者的中位生存期比较,差异无统计学意义(P=0.658);与再次治疗后仍有肿瘤残留患者的中位生存期比较,差异有统计学意义(P=0.012).多因素分析表明,肿瘤＞3 cm(P=0.007)和靠近大血管(P=0.042)是HCC经RFA治疗后肿瘤残留的独立危险因素.结论 肿瘤＞3 cm和靠近大血管是HCC行RFA治疗后肿瘤残留的独立危险因素.对未能达到完全消融的HCC患者,应积极采取进一步治疗措施,争取达到完全根治肿瘤,以改善预后.     

多电极高温射频消融治疗肺转移瘤的临床研究

目的：对CT引导下经皮肺穿刺多电极高温射频消融治疗肺转移瘤的有效性和安全性进行研究评价。方法：对34例206个不同病理类型的肺转移瘤行多电极高温射频消融治疗,观察治疗过程中血压、脉搏和周围血氧饱和度的变化;治疗前后肝肾、肺功能的改变;以及CT扫描肿瘤组织中低密度影和肿瘤体积的变化。结果：34例肺转移瘤患者多电极高温射频消融治疗中血压、脉搏和周围血氧饱和度无明显改变;治疗后肝肾功能、肺功能无明显影响;治疗后1个月内CT扫描见肿瘤体积较术前有所增大,3个月后206个肿瘤中出现CR46个（100％缩小）,PRa107个（80％-100％缩小）,PRb49个（50％～80％缩小）,NR4个（缩小〈50％）;治疗后第3个月肿瘤内低密度影Ⅰ型6个,Ⅱ型86个,Ⅲ型114个。结论：多电极高温射频消融治疗肺转移瘤创伤小,近期效果好,比较安全,可能为临床提供了一种新的安全有效的治疗方法。     

F-18] fluorodeoxyglucose positron emission tomography as a tool for early recognition of incomplete tumor destruction after radiofrequency ablation for liver metastases

BACKGROUND AND OBJECTIVES: To assess the value of FDG positron emission tomography (PET) for early detection of incomplete tumor destruction after radiofrequency ablation (RFA) for liver metastasis. METHODS: Twenty-eight unresectable liver metastases in 17 patients were treated by RFA. Patients underwent computed tomography (CT) and FDG-PET preoperatively, at 1 week, 1 month, and 3 months postoperatively. Postoperative CT and FDG-PET at 1 week and 1 month were analyzed to identify hypervascular and hypermetabolic residual tumors at the RFA site. These results were correlated with follow-up CT and, in case of reintervention, with pathologic results. RESULTS: In 24/28 of RFA-treated metastases, CT and FDG-PET at 1 week and 1 month showed no tumor residues. During follow-up, none of these 13 patients developed local recurrence at RFA site. In four patients, FDG-PET at 1 week and 1 month showed peripheral hypermetabolic residue after RFA, whereas CT did not revealed residual tumor. In three patients, local persistence of viable tumor cells was biopsy-proven at reintervention. In the fourth, follow-up CT showed subsequent development of a local recurrence. CONCLUSIONS: FDG-PET accurately monitors the local efficacy of RFA for treatment of liver metastases, as it early recognizes incomplete tumor ablation, not detectable on CT.     

Endoscopic radiofrequency ablation for liver metastasis of colorectal cancer

The application of radiofrequency ablation (RFA) for liver metastasis of colorectal cancer has not yet acquired an established status in clinical cancer therapy research. Removing as much tumor tissue as possible is desirable, but some cases do not allow optimal surgical ablation due to general condition of the patient and tumor status. We introduced endoscopic RFA for liver cancer in 2003, and have applied the procedure to 6 cases with H1 or H2 liver metastases of colorectal cancer to which surgical ablation could not be applied due to the poor general health of patients. Mean tumor diameter was 22.9 mm, and mean number of tumors per patient was 1.2. Tumor location was: S4, n = 2; S5, n = 1; S4, n = 1; S7, n = 2; and S8, n = 1. Mean frequency of session was 3.0. No complications occurred in any cases, and no reoperations were required. Although no recurrence of tumors in the vicinity of ablation was observed, 2 cases of each lung metastasis and intrahepatic recurrence were identified. Intrahepatic recurrence underwent hepatic arterial infusion (HAI) chemotherapy for simultaneous metastatic hepatic tumors (H2) prior to RFA, and relapses occurred in the metastatic focus where the efficacy of HAI was observed. At this point, 2 deaths were reported, 1 each from cancer and other diseases, and mean duration of survival after the procedure was 451.2 days. These results indicate that endoscopic RFA with good local control should be an available treatment for cases involving colorectal cancer with metastasis to the liver in which surgical ablation is difficult to apply.     

Bilateral adrenal leiomyosarcoma treated with multiple local therapies

A 62-year-old woman presented with right flank pain, and computed tomography (CT) showed bilateral adrenal tumors (right, 8 cm; left, 4 cm). There were no abnormal findings on physical examination, and adrenal hormone levels in serum and urine were within normal limits. Radiological studies showed a right adrenal tumor with intratumoral hemorrhage, a cystic tumor in the left adrenal gland, and no sign of distant metastasis. Because laboratory tests showed normal levels of adrenal hormones, we considered the tumors to be nonfunctioning adrenal tumors. The right adrenal tumor was surgically removed because it was thought to be malignant, and histological examination revealed that it was a leiomyosarcoma. Postoperative CT showed a pleural metastasis in the right chest wall. The patient received combination chemotherapy with cyclophosphamide, vincristine, adriamycin, and dacarbazine. The metastasis was also treated with radiofrequency ablation (RFA). Because the left adrenal tumor grew rapidly despite two courses of the chemotherapy, it too was surgically removed. After the operation, metastasis in the right iliac bone was treated with RFA and radiotherapy. Positron emission tomography detected bilateral femoral metastases, and these were treated with radiotherapy in combination with a low dose of cisplatin. A liver metastasis and a small metastasis in the left kidney were treated with RFA and a metastasis in the pancreatic tail was removed surgically. Sixteen months after the right adrenalectomy, the patient died due to systemic spread of the disease. Multiple local treatments including RFA, radiotherapy, and resection were effective for the local control of metastatic lesions of adrenal leiomyosarcoma.     

Adrenalectomy for solitary adrenal metastasis from colorectal carcinoma

A 60-year-old man underwent anterior resection for advanced rectal carcinoma. Seven years and 2 months later, right lower pneumonectomy was performed for a metastatic lung tumor. Two years and 2 months thereafter, left adrenalectomy was performed for solitary adrenal metastasis. The patient remained disease-free for 10 months postoperatively, until multiple lung metastases appeared. The patient is alive and well, under mild chemotherapy with oral doxifluridine, 3 years and 5 months after left adrenalectomy. We conclude that patients with solitary adrenal metastasis may benefit from surgical resection and that resection could be considered as a therapy for solitary adrenal metastasis from colorectal carcinoma.     

Multidisciplinary treatment including pneumonectomy for squamous cell carcinoma of the anal canal-a case report

In August 2008, a 52-year-old woman presented to our hospital with a complaint of bleeding upon defecation. The patient underwent lower gastrointestinal endoscopy with biopsy. PRb indicated a type 2 lesion in one-third of the circumference. The patient was diagnosed with squamous cell carcinoma by biopsy. Imaging did not reveal any metastasis to other organs. In September, she underwent an abdominoperineal resection of the rectum. Postoperative histopathological findings were PRb, type 2, A, N3, H0, P0, M0, and Stage III b. Adjuvant chemotherapy of oral S-1 was started. In January 2009, contrast-enhanced abdominal CT revealed a pelvic recurrence, and the patient underwent chemoradiotherapy. In October, chest CT showed a 5-mm solitary pulmonary metastasis in the right apex of the lung. In March 2010, chest CT showed a slight enlargement of the tumor in the right apex, but no other metastatic lesion was observed. In April, the patient underwent a thoracoscopic partial pneumonectomy. It has been 16 months postoperatively, and no recurrence has been observed. In the present report, we describe a case of squamous cell carcinoma of the anal canal that underwent multidisciplinary treatment including pneumonectomy. We also include a brief literature review.     

A case of recurrent esophageal cancer with lymph node and lung metastases, successfully treated with systemic chemotherapy and radiofrequency-ablation

We report a case of recurrent esophageal cancer with lymph node and lung metastases, successfully treated with systemic chemotherapy and radiofrequency-ablation(RFA). A 45-year-old man was diagnosed with thoracic esophageal cancer.Radical esophagectomy with three-field lymphadenectomy was performed.After 6 months, mediastinal lymph node recurrence occurred.Although the size of the recurrent mediastinal lymph nodes were reduced after 10 courses of systemic chemotherapy, two new lung metastatic nodules appeared in the right segments 8 and 9.CT -guided percutaneous RFA was successfully achieved for the 2 lesions.However, 6 months after the RFA, a local recurrence at the RFA site of segment 9 occurred, and an additional RFA was performed for this tumor.Five years and four months after the first operation, the tumor marker level remained within a normal range, and the patient is doing very well without any signs of recurrence. RFA appears to be an effective and minimally invasive technique for controlling local recurrence of esophageal cancer when combined with systemic chemotherapy.     

A case of gastric cancer patient with liver metastasis treated by radiofrequency ablation therapy combined with intra-arterial chemotherapy

We performed radio-frequency ablation (RFA) therapy combined with intra-arterial chemotherapy for a 71-year old female gastric cancer patient with liver metastasis. She underwent total gastrectomy due to advanced gastric cancer in July of 1996. Because CT scans revealed multiple liver tumors with her, she also underwent intra-arterial chemotherapy comprising of 5-fluorouracil, cis-platinum and Leucovorin. Although her liver tumors decreased in size and number, after 9 months, we had to remove the catheter because of hepatic artery obstruction. Immediately after the removal, 5 hepatic metastases appeared, which were 3.5 cm in maximum diameter. After RFA therapy, CT scans revealed homogenously attenuated lesions. Liver biopsy demonstrated a complete coagulation necrosis. She is currently alive going into 19 months after liver metastasis and 7 months after RFA.     

A case with a single liver metastasis from pancreatic cancer surviving for 29 months

We report a 62-year-old man with advanced pancreatic cancer who underwent pancreatoduodenectomy and was then found to have a single hepatic metastasis. Hepatic resection was performed after 19 months of systemic chemotherapy. The patient survived for 29 months after diagnosis of the hepatic metastasis without occurrence of further metastatic lesions. The patient was given a diagnosis of pancreatic head cancer and underwent pancreatoduodenectomy in September 2001. A single hepatic metastasis was found in July 2002. No local recurrence, lymph node metastasis, distant metastasis or peritoneal metastasis were noted on imaging studies. Chemotherapy with S-1 was performed. The hepatic metastasis remained single and there were no other metastatic lesions for 19 months. A metastasis was found in the right lung in May 2004. The patient died in December 2004 without local recurrence, lymph node metastasis or new hepatic metastasis.     

Penile metastasis from lung cancer.

A case of metastatic tumor of the penis from lung cancer is reported. The patient, who had received a right pneumonectomy 17 months previously for a squamous cell carcinoma of the lung, complained of urinary retention and painful erection of the penis. He underwent an emergency suprapubic cystostomy. Twenty days after the procedure, he died of disseminated lung carcinoma. The autopsy demonstrated massive metastasis to the penis from squamous cell carcinoma of the lung. Penile metastasis from lung cancer is a very rare condition and only 14 cases of this secondary carcinoma have been reported.     

A case report of thyroid gland metastasis associated with lung metastasis from colon cancer

Thyroid gland metastasis of malignant tumors is observed in 1.9% to 9.5% of histologically examined autopsy cases. Thyroid metastasis from colon cancer is extremely rare and the prognosis is poor. Here we report a case of lung metastasis and thyroid gland metastasis following sigmoid colon cancer surgery. In 2000, a 58-year-old woman underwent a sigmoid colectomy for sigmoid colon cancer. In 2005, a metastatic lung tumor was detected by chest CT. The patient underwent a partial thoracoscopic resection of the left lung in April 2005. On a CT scan taken 3 years and 4 months after the lung resection, a tumor mass was observed in the left lung and a low-absorption region with an unclear border was seen in the left lobe of the thyroid gland. Thyroid aspiration cytology showed adenocarcinoma, and a diagnosis of thyroid gland metastasis from sigmoid colon cancer was made. In April 2008 a subtotal thyroidectomy was performed. Following surgery, the patient underwent chemotherapy with mFOLFOX6 and bevacizumab. Nevertheless a number of lung metastases and expressions of lung metastasis were subsequently observed. Histopathological examination revealed a number of metastases of differentiated papillary adenocarcinoma in the thyroid gland from colon cancer.