转移性肺癌热消融治疗的研究进展

Research progress of thermal ablation therapy for metastatic lung cancer

肺是最常见的恶性肿瘤转移部位之一。近年来,经皮肿瘤消融治疗凭借其微创的方式得到了越来越多关注,成为失去手术机会的转移性肺癌患者新兴的治疗手段。射频消融、微波消融和冷冻消融是肺中广泛使用的三种热能消融方式。其中射频消融、微波消融是通过施以交变高频电流或者电磁场振荡的方式引发肿瘤组织中的分子碰撞和摩擦,产生热量从而实现肿瘤细胞的凝固性坏死。多项研究均报告了这两种消融方式处理转移性肺癌的安全性和有效性,但目前仍缺乏随机对照试验为该技术的应用提供更多的循证医学证据。冷冻消融对靶病变施以低温处理,导致蛋白质变性、细胞膜破裂和微血管血栓形成,从而诱导细胞死亡和组织损伤。冷冻消融为目前消融治疗领域的热点话题,其在最新的前瞻性研究中表现良好,但是现有的相关生存资料较为有限,特别是长期随访资料仍十分缺乏。转移性肺癌的三种消融治疗方式各有优劣,对于消融方式的具体选择需依据患者病情以及各中心实际情况,进行多学科评估,并制订个体化的治疗方案。鉴于日益增长的临床需求,笔者就目前转移性肺癌热消融治疗的相关研究进展进行综述,以期协助临床决策。

Lung is one of the most common metastatic sites of malignant tumors.In recent years,percutaneous tumor ablation has attracted more and more attention due to its minimally invasive approach,and it has become a new treatment for metastatic lung cancer patients who have lost the opportunity of surgery.Radiofrequency ablation,microwave ablation and cryoablation are three widely used thermal ablation methods in the lung.Among them,radiofrequency ablation and microwave ablation induce molecular collision and friction in tumor tissues through the application of alternating high-frequency current or electromagnetic field oscillation,generating heat to achieve coagulation necrosis of tumor cells.Several studies have reported the safety and efficacy of these two ablation methods for metastatic lung cancer,but there is still a lack of randomized controlled trials to provide more evidence-based medical evidence for the use of this technology.Cryoablation of target lesions at low temperature leads to protein denaturation,cell membrane rupture,and microvascular thrombosis,thereby inducing cell death and tissue injury.Cryoablation is currently a hot topic in the field of ablation therapy,and it has performed well in the latest prospective studies.However,the existing survival data are limited,especially the long-term follow-up data are still lacking.Each of the three ablation methods for metastatic lung cancer has its advantages and disadvantages.The specific selection of ablation methods needs to be evaluated by multiple disciplines according to the patient's condition and the actual situation of each center,and an individualized treatment plan should be formulated.In view of the increasing clinical demand,this paper reviews the current research progress of thermal ablation therapy for metastatic lung cancer,with a view to assisting clinical decision-making.