使用射頻消融術可以治癒小肺腫瘤


  March 25, 2008 —不適合手術或其他緩解治療方式的肺腫瘤病患,使用射頻消融術(RFA)可延長存活 ;有些病患可以多存活兩年;不過,此技術之成功案例受限於腫瘤大小,腫瘤越小效果最好。
  
  華盛頓特區舉行的介入放射學會第33屆年度科學會議中,來自法國Gustave Roussy研究中心的Thierry de Baere醫師報告指出,大小3.7公分腫瘤的成功率超過90%;不過,當腫瘤大小增加到5公分時,成功率掉到約 70% ,當腫瘤更大,成功率不到50%。
  
  de Baere醫師報告了244名接受EFA的病患的一系列資料,這些病患有肺轉移(195名)或者原發非小細胞肺癌(NSCLC;49 人);追蹤顯示,這些病患有70%在兩年後仍存活(肺轉移者有72%,NSCLC者有64%)。
  
  de Baere醫師解釋,NSCLC病患約有三分之二不適合手術,一般都活不到12個月,通常他們只能接受緩解治療,例如化學治療或者放射線;他表示,這些不適合手術的病患有一些可以用RFA治療,可以治癒原發性腫瘤,因此,我的病患有70%的人可以多活兩年。
  
  以RFA治療的49名原發性NSCLC 病患中,影像檢查顯示,第一年時有85%的病患未出現成長中的腫瘤,第二年時有77%;de Baere醫師表示,這可以視為治癒;這些腫瘤都不到4公分,腫瘤若更小,效果會更好。
  
  de Baere醫師在會議中的記者會表示,他的團隊獲得的成功率和世界上其他研究團隊所報告的類似;他引述了澳洲的兩年存活率為64%、美國是78%、日本是 62%;這些比率相當接近手術的成功率,一篇回顧超過5,000個案例的研究顯示兩年存活率為70%;不過,他指出,這些回顧已經是八年前的資料,而目前不論是化療還是手術都有繼續進步,所以成功率可以更高。不過,RFA的成功率相當接近手術成功率,且有微創的優勢。
  
  普羅旺斯布朗大學Rhode Island醫院的Damian Dupuy醫師向Medscape腫瘤學提出建議表示, RFA已經廣泛用於肺癌,且是不適合手術病患的治療選項。
  
  在法國,RFA是在全身麻醉之下進行 ,但是在美國,通常是在清醒鎮靜之下進行,恢復迅速且大部分病患出院後無症狀;de Baere 醫師報告指出,他的244名病患中,66% 報告出院後無症狀,23%報告疼痛 (輕微的有4%、中度的有19%),5%報告有咳血、3%有肺部病變、0.5%有呼吸道功能不佳;他向與會聽眾表示,在他的機構中,RFA已經取代手術成為小腫瘤的治療方式,甚至可以禁得起手術的病患也選擇這個手術方式。
  
  介入放射學會第33屆年度科學會議:摘要106。發表於2008年3月17日。

Radiofrequency Ablation of Sma

By Zosia Chustecka
Medscape Medical News

March 25, 2008 — Radiofrequency ablation (RFA) of lung tumors in patients who are not candidates for surgery and would otherwise receive only palliative treatment can extend survival; some patients live an extra 2 years. But success with this technique is limited by the size of the tumor and works best for very small tumors.

Speaking at the Society of Interventional Radiology 33rd Annual Scientific Meeting, in Washington, DC, earlier this week, Thierry de Baere, MD, from the Institut Gustave Roussy, in Villejuif, France, reported a success rate of more than 90% for tumors up to 3.5 cm. However, the success rate falls to around 70% when the tumors are up to 5 cm in size and to less than 50% when the tumors are larger.

Dr. de Baere reported on a series of 244 patients who had undergone RFA for either lung metastases (195 patients) or primary non–small-cell lung cancer (NSCLC; 49 patients). Follow-up showed that 70% of these patients were still alive at 2 years (72% of those with lung metastases and 64% of those with NSCLC).

About two-thirds of patients diagnosed with NSCLC are ineligible for surgery and typically have less than 12 months to live, Dr. de Baere explained. Usually they are offered only palliative options, such as chemotherapy or radiation. "A subset of these patients ineligible for surgery can be treated with RFA with the intention of curing the primary tumor. Thus, 70% of my patients gained at least another 2 years," he said.

Among the 49 patients with primary NSCLC treated with RFA, imaging showed no viable lung tumor in 85% of patients at 1 year and no viable lung tumor in 77% at 2 years. This can be considered a cure, Dr. de Baere commented. These tumors were all smaller than 4 cm, he noted, and the results should be even better in tumors that are smaller.

The success rates from his group are similar to those reported by other groups in the world, Dr. de Baere commented at a press conference during the meeting. He cited 2-year survival rates of 64% in Australia, 78% in the United States, and 62% in Japan. These rates are "very close" to the success rate reported for surgery, he said, citing a review of more than 5000 cases that showed a 2-year survival rate of 70%. He noted, however, that that review was 8 years old, and there has been progress both in surgery and chemotherapy since then, so rates could now be higher. Nevertheless, RFA is "very close in success" to surgery and has the advantage of being very minimally invasive, he said.

Approached for comment, Damian Dupuy, MD, from Brown University Rhode Island Hospital, in Providence, told Medscape Oncology that RFA is already widely used for lung tumors and is an established treatment option for patients who are poor surgical candidates.

In France, RFA is carried out under general anesthetic, but in the United States it is often carried out under conscious sedation. Recovery is quick, and the majority of patients have no symptoms after discharge. Dr. de Baere reported that from his group's series of 244 patients, 66% reported no symptoms after discharge, 23% reported pain (mild in 4% and moderate in 19%), 5% reported hemoptysis, 3% reported pneumopathy, and 0.5% reported respiratory insufficiency. In his institution, RFA has already replaced surgery as the preferred treatment option for small tumors, and even patients who are able to withstand surgery opt to have this therapy instead, he told the meeting.

Society of Interventional Radiology (SIR) 33rd Annual Scientific Meeting: Abstract 106. Presented March 17, 2008.

    
相關報導
體適能較佳與某些癌症及死亡風險較低有關
2015/4/15 上午 10:28:31
終於有一種可以治療多數常見肺癌突變的療法
2012/6/20 下午 01:39:11
Afatinib使肺癌無惡化存活率加倍
2012/6/18 下午 05:19:27

上一頁
   1   2   3   4   5   6   7   8   9   10  




回上一頁