RESUMEN
PURPOSE: To evaluate the feasibility, safety, and effectiveness of combining segmental pulmonary arterial chemoembolization (SPACE) and percutaneous radiofrequency (RF) ablation in patients with unresectable lung neoplasms or patients with resectable neoplasms who refused surgery and to compare the local tumor progression (LTP) rate with that in previous studies of RF ablation alone. MATERIALS AND METHODS: After institutional review board approval and informed consent, 17 patients with primary and metastatic lung cancer were enrolled in this prospective study. Between January 2008 and February 2011, 20 nodules (median diameter, 3.0 cm; range, 2.0-5.0 cm) were treated during 19 sessions. Antineoplastic agents loaded on 50-100-µm microspheres were selectively infused into specific pulmonary arteries. Percutaneous computed tomography (CT)-guided RF ablation of lung nodules was performed 48 hours after SPACE. Follow-up consisted of enhanced CT 48 hours after combination treatment was completed, after 30 days, and every 3 months thereafter. Fluorine 18 fluorodeoxyglucose positron emission tomography was performed 3 months after combination therapy and then every 6 months. The t test was used to compare groups. RESULTS: Technical success was achieved in 100% of cases. Ventilation-lung single photon emission computed tomography showed a wide area without ventilation in the lung parenchyma treated with SPACE. The LTP rate was 21% (three of 14 nodules) in 3-5-cm-diameter tumors and 0% (zero of six nodules) in tumors of 3 cm or smaller in diameter. Complete response was achieved in 65% (11 of 17) of patients at minimum follow-up of 6 months. Overall, treatment was well tolerated. Major complications were pneumothorax in five of 19 sessions (26%) and one bronchopleural fistula (one of 19, 5%). No treatment-related changes in general lung function were noted. CONCLUSION: Combination therapy with RF ablation after SPACE to treat unresectable lung tumors is technically feasible, safe, and effective and may represent an advantage over RF ablation alone.
Asunto(s)
Antineoplásicos/administración & dosificación , Ablación por Catéter/métodos , Quimioembolización Terapéutica/métodos , Cisplatino/administración & dosificación , Doxorrubicina/administración & dosificación , Neoplasias Pulmonares/terapia , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Progresión de la Enfermedad , Estudios de Factibilidad , Femenino , Fluorodesoxiglucosa F18 , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Microesferas , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Estudios Prospectivos , Radiofármacos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Radiofrequency thermal ablation (RFA) has been demonstrated to be useful for the treatment of liver neoplasms. The study aimed to evaluate the feasibility and safety of the combination of transarterial chemoembolization (TACE) and RFA, performed simultaneously to treat primary and secondary liver neoplasms. PATIENTS AND METHODS: From July 2006 to October 2007, 34 patients (21 with HCC and 13 with liver metastases) underwent 37 sessions of treatment. The schedule consisted of: induction TACE (with epirubicin, mitomycin C and lipiodol, or with doxorubicin/irinotecan loaded on microspheres), percutaneous RFA and second TACE. Monopolar RFA was used on 52 nodules, whereas the bipolar multiprobe technique was used in 6 cases. RESULTS: The treatment was well tolerated, with moderate hepatic and hematological toxicity. In total 51 nodules were evaluable for response, with technical success in 45/51 cases (88%). CONCLUSION: Combined TACE plus RFA is feasible and safe; the preliminary data make it a promising procedure with regard to efficacy and support further investigation.
Asunto(s)
Carcinoma Hepatocelular/terapia , Ablación por Catéter , Quimioembolización Terapéutica , Neoplasias Hepáticas/terapia , Anciano , Anciano de 80 o más Años , Camptotecina/administración & dosificación , Camptotecina/análogos & derivados , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/cirugía , Terapia Combinada , Doxorrubicina/administración & dosificación , Epirrubicina/administración & dosificación , Femenino , Humanos , Aceite Yodado/administración & dosificación , Irinotecán , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Mitomicina/administración & dosificación , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
OBJECTIVE: Radiofrequency thermal ablation is a minimally invasive treatment widely used for treatment of liver neoplasms and has also been tested on other types of tumor. Few studies have been published regarding the use of radiofrequency thermal ablation in the treatment of lung neoplasms. This study was performed to evaluate the technical feasibility, the safety, and the efficacy of lung radiofrequency thermal ablation. SUBJECTS AND METHODS: Between February 2002 and March 2003, 18 subjects with unresectable lung neoplasms, four of whom had primary neoplasms and 14 of whom had metastatic neoplasms, underwent lung radiofrequency ablation. The technique was performed percutaneously using a monopolar cooled-tip electrode needle under CT guidance with the patient under general anesthesia. Patients had no more than three nodules with a total diameter of 10 cm and no evidence of extrathoracic disease. A total of 40 nodules were treated in 24 therapeutic sessions. After treatment, patients underwent follow-up every 3 months by CT and nuclear MRI with gadolinium for a median time of 8 months (range, 2-14 months). RESULTS: No evidence of local relapse was discovered in 94.4% of subjects. The treatment was safe and well tolerated. Complications encountered included massive pneumothorax, which occurred in one subject, requiring pleural drainage. Other complications were moderate pneumothorax (also requiring pleural drainage), cough, fever, slight dyspnea, and pain, but these complications were short in duration and successfully treated. CONCLUSION: Radiofrequency thermal ablation is a promising technique in the treatment of patients with lung neoplasms and has been found to be both safe and technically feasible.