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热消融治疗肺癌的技术趋势

时间:2020-02-27 14:51来源:未知 作者:admin 点击:
Locally recurrent cancerLimited or low volume metastases



Chan et al. Percutaneous RFA of Lung Tumors: Evaluation of the Literature Using Evidence-based Techniques J Thorac Imaging 2011; 26:18-26



  • Original articles from 2002-2009
  • Evidence-based practice (EBP) 循证实践【1,2】 
  • Evidence level assignment 证据级别分配 【3】
  • 1° & 2° malignancies separately analyzed   
【1】Malone. Radiology 2007; 242:12-14. 
【2】Staunton. Radiology 2007; 242:23-31.
【3】The Centre for Evidence-based Medicine, Oxford University.
 

2° evidence = 1 review (26 observational studies 观察性研究)
1° evidence = 46 studies

Retrieved Studies on Percutaneous Radiofrequency Ablation for Pulmonary Malignancy


2,905 ablations in 1,584 patients
479 1° lung cancer

 
Practice Trends 技术趋势受影响的因素
 
  • Technical factors
  • Safety profile
  • Local recurrence rate
  • Survival rate
 Increase in conscious sedation over time for percutaneous RFA of lung lesions.
Trendline is for conscious sedation (other trendlines declined over time).
7 GA(全麻), 21 CS(清醒镇静), 1 Epi(硬膜外), 6 combination(联合)

Anesthesia: Sedation v. General Anesthesia
Sedation General Anesthesia
Advantages Advantages
  • Lower cost
  • Shorter procedure times
  • Patient comfort with less cooperation
  • Larger lesions
  • Airway control
  • Expert cardiopulmonary management
Disadvantages Disadvantages
  • Potential for patient discomfort and procedural pain
  • Higher cost
  • Logistical coordination with a 2nd service(需要协调)
  • Longer setup times
  • Higher potential for pneumothorax
  • Risk(s) specific to general anesthesia
5/7 = 71.5%【1】
2/7 = 28.5%【1】
 

趋势之一,选择清醒镇静的方式多






Anesthesia: Sedation v. General Anesthesia
Sedation
  1. General Anesthesia
  • Technical success 
  • Complication(s)
  • Hospitalization
  • Local tumor control     
  • No result reached statistical significance 
                 - Technical feasibility
                 - Results
                 - Complication rate
  • No need to do these interventions under general anesthesia

结论:
RFA of pulmonary tumors under GA or AS did not result in different tumor control and complication rates, respectively. Therefore, AS should be used except in anxious or agitated patients.



趋势之二:消融较小的肿瘤(Ablating smaller tumors)

 Mean lesion size over time for percutaneous RFA of lung lesions.


SIZE is the main determinant for better prognosis

Colorectal and Other Pulmonary Metastases
Survival: Significant Independent Factors
Size ≤ 3.0 cm
Extrapulmonary metastases
CEA
Disease-free interval
Response to treatment
Local Control: Significant Independent Factors
Size ≤ 1.0-3.5 cm
Contact w/ bronchus ≤ 2 mm 
Contact w/ vessels ≤ 3 mm

 

Non-small Cell Lung Carcinoma
Factors for Local Recurrence: 
  • Patient gender
  • Tumor location (potential for heat sink)
  • Radiation therapy (external beam or brachytherapy)
  • Tumor size
  • Clinical stage
Predictors for Local Recurrence
  • Tumor size (p = .02)
  • Clinical stage (p = .007)  

Beland et al. Primary non-small cell lung cancer: review of frequency, location, and time of recurrence after radiofrequency ablation. Radiology 2010; 254:301-307


趋势之三:用多电极射频消融针:Utilizing more multitined electrodes
 

Mean lesion size over time for percutaneous RFA of lung lesions.


 




趋势之四:PET/CT随访

 Increase in use of PET-CT over time for follow-up of pulmonary lesions after percutaneous RFA. Trendline was similar for CT and for PET-CT (CT and magnetic resonance imaging trendline showed a decline)


RFA Methods for Follow-up
 
  • Baseline chest CT (+ contrast nodule densitometry)
  • Chest CT with contrast nodule densitometry
  • Chest CT without contrast
 
  • Positron Emission Tomography (PET)
  • PET-CT
 




各种PET/CT随访计划




Summary of Follow-up, Overall Survival, and Cancer-specific Survival for Percutaneous Radiofrequency Ablation for Pulmonary Malignancy





















































循证实践(evidence-based practice, EBP)肇始于20世纪七、八十年代的循证医学。其字面意义为“遵循证据进行实践”,是实践者针对知识消费者(泛指实践者所服务的个人或群体,依据情境的不同,也可以将其称之为病人、顾客或来访者等)的具体问题,在消费者的主动配合下,根据研究者提供的最佳证据及管理者协调制定的实践指南、标准或证据数据库等所进行的实践。循证实践是新时代社会科学实践领域科学化、工程化的一种表现形式,体现了全球化时代求真、民主、高效、公正与共享等时代精神。(百度))


Evidence level assignment 

证据级别(和以往不同,最高证据级别可能是大数据支持的人工智能系统)





证据级别



观察性研究:是非随机化的研究,在自然状态下对研究对象的特征进行观查、记录,并对结果进行描述和对比分析的研究。实验性研究:就是人为地进行干预措施,而收集到结果的分析性研究。

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