CT引导射频消融与瘤内化疗治疗早期非小细胞肺癌的临床研究

背景与目的射频消融（radiofrequency ablation, RFA）已经成为无法手术的早期非小细胞肺癌（non-small cell lung cancer, NSCLC）的局部治疗方法之一。本研究观察计算机断层扫描（computed tomography, CT）引导下RFA与瘤内化疗（intratumoral chemotherapy, ITC）（RFA-ITC）的有效性和安全性。方法自2005年1月至2015年12月研究组前瞻性入组经病理学证实为早期NSCLC，因心肺功能较差或伴发其他疾病而无法耐受手术或拒绝手术的患者，接受RFA-ITC治疗。RFA采用导向器辅助CT引导穿刺准实时步进法，适形伞状电极、单点或多点消融，完成治疗计划并当CT显示肿瘤周围正常肺组织呈现磨玻璃样后结束消融治疗，经电极针将卡铂200 mg缓慢注射到肿瘤内。随访评估安全性和有效性。结果110例患者125次RFA-ITC治疗，技术成功率为100%。中位生存期为48.0个月，总生存率为55.4个月，无进展生存期为55.1个月；1年、2年、3年、5年总生存率分别为100%、90.7%、62.7%、21.9%。消融后有和无磨玻璃样改变的生存期分别是68.3个月、40.1个月，有统计学差异（P=0.001）。肿瘤的大小及有无N1分期的生存率无差异。无围手术期死亡发生，气胸、肺内出血、胸腔积液、发热、术中胸痛、皮下气肿、术中咳嗽等并发症轻微可耐受。结论 CT引导RFA-ITC治疗不能手术的早期NSCLC，疗效好、并发症少，对患者损伤小，为不能手术治疗的早期NSCLC的治疗提供了一个良好方法。

CT Guided Radiofrequency Ablation Followed Intratumoral Chemotherapy in the Treatment of Early Stage Non-small Cell Lung Cancer

Background and objectiveRadiofrequency ablation (RFA) has become one of the local treatment for inoperable early stage non-small cell lung cancer (NSCLC). hTis study observes effectiveness and safety of computed tomog-raphy (CT) guided RFA followed intratumoral chemotherapy (RFA-ITC).MethodsFrom 2005 to 2015, our group perspec-tively enrolled inoperable early stage NSCLC underwent RFA-ITC duo to poor cardiopulmonary function or with other dis-eases or patient can't tolerate or reject surgery. RFA was performed by a directive apparatus assisted CT guided semi real-time and step-by-step puncture method, conformal umbrella-shaped electrode and single or multiple targets ablation. While the plan ifnished and CT showed normal lung tissue around the tumor present ground-glass opacity (GGO), the procedure ended, then 200 mg of carboplatinum were injected into the tumor via the electrode needle. Safety and effectiveness were evaluated byfollow-up.Results Technical success rates of 125 RFA-ITC treatments of 110 patients were 100%. hTe median survival was 48.0 months, overall survival (OS) was 55.4 months, progression-free survival was 55.1 months, 1, 2, 3, 5-year OS rates were 100%, 90.7%, 62.7%, 21.9%, respectively. Survival of GGO presence or not was 68.3 months and 40.1 months, respectively (P=0.001). hTe survival rates of the N1 staging and tumor size was no signiifcant difference. No perioperative deaths occurred, the main complicationsi.e. pneumothorax, pulmonary hemorrhage, pleural effusion, fever, intraoperative chest pain, subcuta-neous emphysema, intraoperative cough were slight and tolerable.ConclusionCT guided RFA-ITC provides a good method for treatment of inoperable early stage NSCLC with better survival, less complication and small damage.