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

Evaluation of Three-Dimensional Reconstruction CT in Percutaneous Radiofrequency Ablation (RFA) of the Unresectable Lung Tumor with a Clustered Electrode

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79.4%(54/68)。无严重并发症,无围手术期死亡。结论CT引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。

Background and objective Radiofrequency ablation （RFA） of lung tumours has recently received much attention for the promising results achieved. Here, to evaluate the value of three-dimensional reconstruction CT in radiofrequency ablation （RFA） of advanced non-small cell lung cancer. Methods Sixty-six cases of advanced non-small cell lung cancer with 68 lesions （2 patients had 2 lesion treated in one session） were underwent three-dimensional reconstruction CT-giuded percutaneous RFA therapy. To evaluate short-term therapeutic effect of lung tumors using spiral CT scanning in 1-3 months after RFA to investigate the alterations of tumor size and density pre-and post-procedure, and complications, to observe the short-term curative effect. Results Our experiences have shown an initial increase in lesion size at immediate follow-up CT. The density of 64 lesions was lowered （94.1%） and 4 lesion is increased （5.9%） at immediate and one month follow-up CT. SPECT scan findings that 82.4% （56/68） cases of FDG uptake in tumors after RFA with tumor/non-tumor of lower than 2.5 at one month follow-up. The change in treated lesion size over time, radiologically assessed through measurements of the lesions on axial CT scans in the lung window setting no lesions had complete response, 50 lesions （73.5%） had partial response, 2 lesions with stable disease, 6 lesions showed progressive disease at 3 month follow-up CT. SPECT scan findings that 79.4% （54/68） cases of FDG uptake in tumors after RFA with tumor/non-tumor of lower than 2.5 at 3 month follow-up. Conclusion The percutaneous RFA therapy under the guidance of three-dimensional reconstruction CT scan is safe and effective, with few complications, and can serve as a new method to the treatment of advanced non-small cell lung cancers.