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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(nonsmall 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。
Background and Objective Radiofrequency ablation (RFA) has become one of the topical treatments for inoperable nonsmall cell lung cancer (NSCLC). This study investigated the effectiveness and safety of RFA and intratumoral chemotherapy (RFA-ITC) guided by computed tomography (CT). Methods From January 2005 to December 2015, prospectively enrolled patients in the prospective cohort were pathologically confirmed as early stage NSCLC, patients who were poorly cardiorespiratory or concomitant with other conditions and who were intolerant of surgery or refused surgery, and those receiving RFA-ITC treatment. RFA guided assisted CT guided puncture quasi- real-time step-by-step, conformal umbrella electrode, single point or multi-point ablation to complete the treatment plan and when CT showed normal lung tissue around the tumor appeared ground glass after ablation treatment, Needle carboplatin 200 mg slowly injected into the tumor. Follow-up assessment of safety and effectiveness. Results One hundred and ten patients underwent RFA-ITC treatment with a technical success rate of 100%. The median survival time was 48.0 months, the overall survival rate was 55.4 months and the progression-free survival time was 55.1 months. The overall survival rates at 1 year, 2 years, 3 years and 5 years were 100%, 90.7% and 62.7% , 21.9%. After ablation with and without ground glass-like changes in survival were 68.3 months, 40.1 months, a statistically significant difference (P = 0.001). There was no difference in the size of the tumor and the survival of the patients with or without N1 stage. No perioperative mortality, pneumothorax, intrapulmonary hemorrhage, pleural effusion, fever, intraoperative chest pain, subcutaneous emphysema, intraoperative cough and other complications were slightly tolerable. Conclusion CT guided RFA-ITC in the treatment of inoperable early stage NSCLC has good curative effect and less complications, which provides a good method for the treatment of early NSCLC which is not surgically treated.