术中磁共振引导激光消融术在肺癌脑转移瘤治疗中的初步应用  

Preliminary application of intraoperative magnetic resonance-guided laser interstitial thermal therapy in the treatment of brain metastases from lung cancer

作　　者：薛湛[1] 管修东 马顺昌[1,2] 原林皓 许钦 金书丞 张诚楷 贾旺 Xue Zhan;Guan Xiudong;Ma Shunchang;Yuan Linhao;Xu Qin;Jin Shucheng;Zhang Chengkai;Jia Wang(Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科学中心,北京100070 [2]北京市神经外科研究所,北京100070

出　　处：《中华神经外科杂志》2023年第2期145-149,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(82003075);北京市医管局"青苗"计划(QML20210502);北京天坛医院横向科研项目(HX-A-2022029)。

摘　　要：目的初步探讨术中磁共振(MR)引导激光消融术(LITT)治疗肺癌脑转移瘤的临床疗效。方法前瞻性纳入2021年6月至2022年4月首都医科大学附属北京天坛医院神经外科学中心收治的肺癌脑转移患者,所有患者颅内转移病灶数≤4个。每例患者均选取1个主要病灶实施术中MR引导的LITT治疗。观察LITT治疗的相关并发症,术后30、90、180 d行影像学和临床随访,评估肿瘤的控制情况。结果共纳入11例患者,其中非小细胞肺癌9例,小细胞肺癌2例。11个治疗的颅内转移瘤的中位体积为2.97 cm^(3)(0.70~7.20 cm^(3)),中位激光发射时间为17.23 min(2.88~37.15 min),中位消融操作时间为28.10 min(7.68~63.40 min);中位病灶消融率为97.5%(29.2%~100.0%)。患者术后头颅CT检查均未见术区出血,其中1例出现一过性肌力下降。LITT后30、90、180 d,MRI显示平均病灶体积分别为术前体积的2.30倍(1.29~3.52倍)、1.21倍(0.35~2.02倍)及0.80倍(0.09~2.40倍)。LITT后90 d随访时,共有2例患者颅内转移瘤复发;1例患者术后4个月因脑出血死亡(与治疗操作无关)。术后90、180 d患者肿瘤得到控制的比例为9/11、8/10。结论初步观察显示,术中MR引导LITT治疗肺癌脑转移瘤发生手术相关并发症的比例低,短期肿瘤得到控制的比例高。Objective To preliminarily study the clinical efficacy of intraoperative magnetic resonance(MR)-guided laser interstitial thermal therapy(LITT)in the treatment of brain metastases from lung cancer.Methods Patients with brain metastases from lung cancer admitted to the Neurosurgery Center of Beijing Tiantan Hospital,Capital Medical University from June 2021 to April 2022 were prospectively included,and all patients had≤4 intracranial metastatic lesions.In each patient,one major lesion was selected for intraoperative MR-guided LITT treatment.Complications related to LITT treatment were observed,and imaging and clinical follow-up were performed 30,90,and 180 days after operation to evaluate the tumor control.Results A total of 11 patients were included,including 9 cases of non-small cell lung cancer and 2 cases of small cell lung cancer.The median volume of the 11 treated intracranial metastases was 2.97 cm^(3)(0.70-7.20 cm^(3)),the median laser emission time was 17.23 minutes(2.88-37.15 minutes),and the median ablation operation time was 28.10 minutes(7.68-63.40 minutes).The median ablation rate of lesions was 97.5%(29.2-100.0%).No hemorrhage was found in the postoperative cranial CT examination of the patients,and one of them had a transient decrease in muscle strength.At 30,90,and 180 days after LITT,MRI showed that the average lesion volume was 2.30 times(1.29-3.52 times),1.21 times(0.35-2.02 times)and 0.80 times(0.09-2.40 times)the preoperative volume,respectively.During the 90 day follow-up after LITT,2 patients had recurrence of intracranial metastases;1 patient died of cerebral hemorrhage 4 months after operation(unrelated to the treatment procedure).At 90 and 180 days after operation,the proportion of patients whose tumor was controlled was 9/11 and 8/10 respectively.Conclusion Preliminary observations show that intraoperative MR-guided LITT in the treatment of brain metastases from lung cancer has a low rate of surgery-related complications and a high rate of short-term tumor control.

关 键 词：肺肿瘤 肿瘤转移 脑 激光消融术 术中磁共振 治疗结果 

分 类 号：R734.2[医药卫生—肿瘤] R739.41[医药卫生—临床医学]