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I和II期高危NSCLC治疗比较

时间:2020-02-28 22:05来源:未知 作者:admin
RF Ablation Results: Comparative Therapies High-risk stage 1 and 2 NSCLC Modality 1-year 2-year 3-year 5-year LC DM Zemlyaketal SLR(25) 87.1% 12% 12% 3-ycancer-specific 90.6%,87.5%,90.2% 3-ycancer-free(p0.05) 60.8%,50%,45.6% RFA(12) 87.5%
RF Ablation Results: Comparative Therapies

High-risk stage 1 and 2 NSCLC

 

 		 Modality 1-year 2-year 3-year 5-year LC DM
 
Zemlyak et al SLR (25)
 
 		 87.1%
 		 12% 12% 3-y cancer-specific 

90.6%, 87.5%, 90.2%

3-y cancer-free (p > 0.05)

60.8%, 50%, 45.6%
RFA (12)
 
 		 87.5%
 		 33% 25%
PCT (27)
 
 		 77.0%
 		 11% 7.4%
Kim et al Surgery (14) 93% 77%
 		 67% 28.6% 42.9% p = 0.054

Stage 1
RFA (8) 88% 50%
 		 25% 50% 37.5
Lee et al Surgery (13) 85.7% 70.1%
 		 0%
 
 		 p = 0.426

Stage 1 and 2
RFA (16) 100% 76.9%
 		 18.7%
 
 


























 

 		 Modality 1-year 2-year 3-year 5-year LC DM
 
Zemlyak et al SLR (25)
 
 		 87.1%
 		 12% 12% 3-y cancer-specific 

90.6%, 87.5%, 90.2%

3-y cancer-free (p > 0.05)

60.8%, 50%, 45.6%
RFA (12)
 
 		 87.5%
 		 33% 25%
PCT (27)
 
 		 77.0%
 		 11% 7.4%
Kim et al Surgery (14) 93% 77%
 		 67% 28.6% 42.9% p = 0.054

Stage 1
RFA (8) 88% 50%
 		 25% 50% 37.5
Lee et al Surgery (13) 85.7% 70.1%
 		 0%
 
 		 p = 0.426

Stage 1 and 2
RFA (16) 100% 76.9%
 		 18.7%
 
 
























 
Standard Therapies for Stage I NSCLC

  • Lobar resection – “gold standard” 主要应用于低风险的病人
                 - Open / VATS approaches （电视辅助胸腔镜手术 video-assisted thoracic surgery, VATS）
  • Sub-lobar resections
                - Segmental / wedge resections 
                - Currently viewed as a compromise operation for high-risk patients（被视为高风险病人的有希望的方法）
  • RFA：射频消融被夹在外科手术（低危患者）和外照射（高危患者之间），究竟扮演什么角色？
  • 外照射，传统应用于高风险病人
  •  
  • Lobar resection – “gold standard” 主要应用于低风险的病人
                 - Open / VATS approaches （电视辅助胸腔镜手术 video-assisted thoracic surgery, VATS）
  • Sub-lobar resections
                - Segmental / wedge resections 
                - Currently viewed as a compromise operation for high-risk patients（被视为高风险病人的有希望的方法）
  • RFA：射频消融被夹在外科手术（低危患者）和外照射（高危患者之间），究竟扮演什么角色？
  • 外照射，传统应用于高风险病人

Zemlyak et al. J Am Coll Surg 2010; 21168-72.
Kim et al. Eur J Radiol 2011; Feb 8 epub ahead of print.
Lee et al. Cardiovasc Intervent Radiol 2011; May 28 epub ahead of print.


RFA Considerations

  • Good (low) risk patients
  • Intermediate risk patients
射频消融不适合高风险的病人？

Good (low) risk patients
  - ? 1 cm ground glass opacity (GGO)
  • Probably bronchoalveolar carcinoma
  • Multiple
  • Unlikelihood of lymph node metastasis
  • Limited resection justified1
1Asamura et al. Ann Thorac Surg 2003; 76:1016-1022.
 
      - Intermediate risk patients
  • ? cancers where lobectomy would be the only resection option
  • Middle 1/3 or central cancers not abutting the mediastinum
  • ? 75 years or older with peripheral NSCLC ≤ 1 cm 
  • Incidence of lymph node metastases ~5-7%1
  • Same survival with sub-lobar versus lobar resection2 
1Miller et al. Ann Thorac Surg 2002; 73:1545-1550.
2Mery et al. Chest 2005; 128:237-245.
 

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