经支气管动脉化疗栓塞联合射频消融术治疗>5 cm肺癌

目的探讨经支气管动脉化疗栓塞（TACE）联合射频消融术（RFA）对较大肺癌局部肿块的灭活作用。方法2008年5-11月我科共收治4例肺癌患者（肿瘤最大径均〉5 cm,最大肿瘤为10 cm×8 cm×8 cm）。所有肿瘤均经病理活检证实为低分化腺癌。4例患者中2例介入治疗前曾接受系统化疗＋靶向治疗（NP方案＋恩度）,2例曾接受普通化疗,均因无法耐受化疗反应转而寻求介入治疗。对4例患者均先经支气管动脉行病灶侧TACE,术后3～7天给予CT引导下RFA治疗,均于局麻联合静脉强化麻醉下完成。术后1个月增强CT扫描评价疗效,如有不同程度的肿瘤组织残留或复发征象则再次行TACE＋RFA治疗。所有患者均定期影像随访至本研究结束。结果4例患者均接受2次TACE＋RFA联合治疗,第1次联合治疗后1个月CT增强扫描示均有不同程度的肿瘤组织残留征象;第2次联合治疗后1个月CT增强扫描均未见残存肿瘤组织征象。经2次TACE＋RFA联合治疗后随访至本研究结束6～12个月,影像学随访示局部射频灶均有不同程度的缩小,未见残存或复发征象。结论TACE＋RFA联合治疗可以有效地灭活直径〉5 cm肺癌局部病灶,近期疗效较好,远期疗效有待于长期随访。

Transcatheter bronchi arterial chemoembolization combined with radiofrequency ablation for the treatment of large lung cancer

Objective To observe the effect of transcatheter bronchi arterial chemoembolization combined with radiofrequency ablation （TACE＋RFA） for the treatment of large lung cancer. Methods From May 2008 to Nov 2008, 4 patients with large lung cancer （the maximal diameter 〉5 cm） were enrolled. The biggest tumor was 10 cm×8 cm× 8 cm. All the tumors were pathologically confirmed as poorly differentiated adenocarcinoma. Two patients received sequential chemotherapy and targeted therapy （NP therapy plus endostar）, while the other 2 patients received conventional chemotherapy. They all couldn＇t stand the side effects of further chemotherapy. For 4 patients, ipsilateral bronchial artery TACE was performed, and then RFA was performed under local anesthesia 3-7 days after TACE. One month after TACE＋RFA, CT scan was performed, and further treatment was given when CT showed necessary. Up to the end of this study, imaging follow up was made for all the patients. Results All the patients had been given twice combined therapy of TACE＋RFA. One month after first therapy, CT scan showed the different sign of residual tumor. No residual tumor sign was noted on CT after the second time of combined therapy of TACE＋RFA. CT follow-up showed shrinkage of the coagulation zone in all patients, and no sign of residual tumor or tumor recurrence. Conclusion Repeated TACE＋RFA can effectively inactivate the local tumors even with a big size. Short-term therapy is effective, but long-term effect needs further follow-up.