C臂CT引导经皮穿刺射频消融治疗不可切除Ⅰa期非小细胞肺癌  

C-arm CT-guided percutaneous radiofrequency ablation for unresectable stage Ⅰa non-small cell lung cancer

作　　者：邹旭公 李晓群[1] 陈源 黄大钡 张健[1] ZOU Xugong;LI Xiaoqun;CHEN Yuan;HUANG Dabei;ZHANG Jian(Interventional Therapy Center,Zhongshan Municipal People＇s Hospital,Zhongshan Affiliated Hospital of Sun Yat-sen University,Zhongshan,Guangdong Province 528403,China)

机构地区：[1]中山市人民医院中山大学附属中山医院介入治疗中心,广东528403

出　　处：《介入放射学杂志》2018年第11期1056-1059,共4页Journal of Interventional Radiology

摘　　要：目的探讨运用C臂CT引导经皮穿刺射频消融(RFA)治疗不可切除Ⅰa期非小细胞肺癌(NSCLC)的可行性、安全性和有效性。方法收集2012年3月—2016年3月经病理确诊Ⅰa期NSCLC应用C臂CT引导经皮RFA病例。穿刺精确性、穿刺时间及穿刺调整次数用于评价其可行性,常见不良反应事件评价标准(CTCAE-V4.0)评价其安全性,改良实体肿瘤的疗效评价标准(mRECIST)用于评价其有效性。结果 33例患者共38次RFA,肿瘤长径平均2.3 cm(0.9～3 cm),中位穿刺时间平均12 min(5～28 min)。中位穿刺调整次数平均4次(3～6次),穿刺精确性为(3±0.3) mm(0～9 mm),并发症包括气胸4例(grade2),咯血2例(grade2)。33例患者RFA治疗后的1年、2年总生存率为84.8%、75.7%,无瘤生存率为63.6%、45.5%;手术平均累积剂量和平均有效剂量分别为14 377.8μGy×m^2和24.3 mSv。结论 C臂CT引导经皮穿刺RFA治疗不可切除Ⅰa期NSCLC具有较高可行性和安全性;近中期有效性确切,是一种可供选择的影像引导方式。Objective To assess the feasibility, safety and therapeutic effectiveness of C-arm CT-guided percutaneous radiofrequency ablation（RFA） in treating unresectable stage Ⅰa non-small cell lung cancer（NSCLC）. Methods A total of 33 patients with pathologically-proved stage Ⅰa NSCLC, who received C-arm CT-guided percutaneous RFA during the period from March 2004 to March 2016, were included in this study. Its feasibility was assessed by the puncturing accuracy, the time spent for puncturing and the number of adjusting needle direction. Common terminology criteria for adverse events（CTCAE-V4.0） was used to evaluate its safety. Modified RECIST（mRECIST） was adopted to assess its therapeutic effectiveness.Results A total of 38 RFA procedures were performed in 33 patients. The mean long diameter of the lesion was 2.3 cm（0.9-3 cm）, and the median time spent for puncturing was 12 min（5-28 min）. The median manipulation number of adjusting the needle direction was 4 times（3-6 times）. The puncturing precision was（3±0.3） mm（0-9 mm）. Postoperative complications included pneumothorax（n=4, grade Ⅱ） and hemoptysis（n=2, grade Ⅱ）. After RFA, the one-year and 2-year overall survival rate were 84.8% and 75.7% respectively,and the one-year and 2-year disease free survival rate were 63.6% and 45.5% respectively. The average cumulative radiation dose and the average effective dose were 14 377.8 μGy×m^2 and 24.3 mSv respectively.Conclusion For the treatment of stage Ⅰa NSCLC, C-arm CT-guided percutaneous RFA is quite feasible and safe with reliable short-to-medium term effect. Therefore, it is an alternative image-guiding technique.

关 键 词：C臂CT 非小细胞肺癌 射频消融 

分 类 号：R734.2[医药卫生—肿瘤]