早期肺癌热消融技术的临床应用进展课件

早期肺癌早期肺癌热热消融技消融技术术 的的临临床床应应用用进进展展XXXXXX XXXX大学大学XXXX医院医院XXXX市市XXXX防治研究所防治研究所 XXXX大学大学XXXX医院国医院国际诊疗际诊疗中心中心早期肺癌热消融技术 的临床应用进展XXX XX大学XX医院1热热消融技消融技术术原理原理射射频频消融消融（radiofrequency ablation,RFA）利用375-500kHz的高频交变电流在肿瘤组织内引 起的离子相互磨擦、碰撞而产生的热生物学效应，局 部温度可达60-120，当肿瘤组织被加热至60以 上时，可引起细胞凝固性坏死。微波消融微波消融（microwave ablation,MWA）一般采用915MHz或2450MHz两种频率。在微波 电磁场的作用下，肿瘤组织内的水分子、蛋白质分 子等极性分子产生极高速振动，造成分子之间的相互 碰撞、摩擦，在短时间内产生高达60-150的高温，从而导致细胞凝固性坏死。其他消融方式其他消融方式（激光、高（激光、高强强度聚焦超声、冷度聚焦超声、冷冻冻.）热消融技术原理射频消融（radiofrequency abl2Dupuy DE et al,Am J Roentgenol.2000;174(1):57-59.冯威健,等.中中华肿华肿瘤瘤杂杂志志2002;24(4).热热消融消融历历史史Dupuy DE et al,Am J Roentgen3Diagnostic and Interventional Imaging 2016;97:1019-1024.疗疗效效：RFADiagnostic and Interventional 4The major advantage of RFA over other ablative techniques is experience.MWA has emerged as a potentially superior treatment option to RFAdue to a much broader energy deposition capable of producing a larger zone of active heating.1.MWA can produce higher intratumoral temperatures.2.Larger tumor ablation volumes with faster ablation times.3.Available MWA systems vessels adjacent to lung tumors.4.MWA is associated with less procedural pain,perhaps from lack of electrical nerve stimulation associated withJ Thorac Imaging 2016;31(4):228-237.疗疗效效：WMA Vs.RFAThe major advantage of RFA ove5中国肺癌中国肺癌杂杂志志 2018;21(2):76-88.中国中国专专家共家共识识：射：射频频消融消融中国肺癌杂志 2018;21(2):76-88.中国专家6中国肺癌中国肺癌杂杂志志 2017;20(7):433-445.中国中国专专家共家共识识：热热消融消融中国肺癌杂志 2017;20(7):433-445.中国7中国中国专专家共家共识识：英文版：英文版J Can Res Ther2018;14:730-744.中国专家共识：英文版J Can Res Ther2018;8Stage I NSCLCRFA（62）wedge resection（59）pMedian follow-up42ms36ms0.539local progression23%2%0.0021-year OS93%(87%),100%(96%),2-year OS72%(63%),96%(90%)5-year OS35%(55%)52%(76%)0.044/0.01RFA can be considered an option for inoperable patients,especially for those with stage T1N0M0.Eur Respir J 2015;45(4):1089-1097.疗疗效比效比较较：RFA VS.手手术术Stage I NSCLCRFA（62）wedge rese9Int J Clin Oncol 2015;20:499507.diameterRFA（47）2.0 0.8（0.6-3.9）SBRT（48）2.1 0.9（0.8-4.7）p 0.539local progression9.6%7.0%,0.7463-year OS86.4%,79.6%0.738疗疗效比效比较较：RFA VS.SBRTInt J Clin Oncol 2015;20:49910Respiration 2015;89(6):550-557.手手术术 VS.RFA VS.SBRTRespiration 2015;89(6):550-511Stage I NSCLCSurgerySBRTAblationHistory180019002000Professionals5-74-53-4Medical equipmentComplicatedVery complicatedRelatively simpleTreat-time/hospitalization4-5 h/7-10 d2-4 weeks/0-1d1-1.5 h/1-3dIn-hospital/3ms mortality2.8-5.5%/5.0-7.5%0.6-0.9%/1.5-3.2%0.5-1.3%/0.8-1.5%ComplicationsAnesthesia，infection，HemorrhageRadiation pneumonitisPneumothoraxCost10,000-15,000 12,000-21,000 3,5006,0005-year survival rates55-75%35-60%25-61%1.J Thorac Oncol.2015 Jun;10(6):960-4.2.Respir Investig.2014 Jul;52(4):221-6.3.Biomed Res Int.2014;2014:152087.4.Thorac Surg Clin.2007 May;17(2):251-9.5.Lancet Oncol.2013 Jan;14(1):e28-37.6.Chest 2013;143(5)(Suppl):278S313S 7.J Vasc Interv Radiol 2013;24:476482 8.J Thorac Cardiovasc Surg 2013;145:692-99 9.Eur Respir J.2015 Apr;45(4):1089-97 10.J Vasc Interv Radiol.2015 Jun;26(6):787-91.11.J Oncol Pract.2014 May;10(3):e130-6.12.Int J Radiat Oncol Biol Phys.2011 Nov 15;81(4):964-73.13.J Thorac Oncol.2015 Dec;10(12):1776-84.手手术术 VS.AB VS.SBRTCost-Effectiveness Analysis Comparing Surgery SBRT&AblationStage I NSCLCSurgerySBRTAblati12指南推荐（指南推荐（NCCN）多发单发指南推荐（NCCN）多发单发13Ann Oncol 2014;25(8):1462-1474.指南推荐指南推荐（ESMO）Ann Oncol 2014;25(8):1462-1414The role of ablative therapies in the treatment of high-risk patients with stage I NSCLC is evolving.RF ablation,the most studied of the ablative modalities,has been used effectively in medically inoperable patients with small(3 cm)peripheral NSCLC that are clinical stage I.Chest 2013;143(5)(Suppl):278-313.指南推荐（指南推荐（CHEST）The role of ablative therapies152支修益,等.中中华肿华肿瘤瘤杂杂志志 2015;37(1).指南推荐（中国指南推荐（中国诊疗规诊疗规范）范）2支修益,等.中华肿瘤杂志 2015;37(1).指南推16Fortschr Rntgenstr 2017;189:828-843.消融：消融：较较好的非手好的非手术术干干预选择预选择Fortschr Rntgenstr2017;189:17左肺上叶腺癌左肺上叶腺癌，T1aN0M0，90岁岁微波消融后随微波消融后随访访：瘢痕形成，逐：瘢痕形成，逐渐缩渐缩小小病例一：高病例一：高龄龄患者患者左肺上叶腺癌，T1aN0M0，90岁微波消融后随访：瘢痕形成18右肺上叶肉瘤右肺上叶肉瘤，T1bN0M0，肺肺纤维纤维化化微波消融后随微波消融后随访访：结节缩结节缩小小病例二：心肺功能差病例二：心肺功能差右肺上叶肉瘤，T1bN0M0，肺纤维化微波消融后随访：结节缩19右肺上叶、右肺下叶腺癌右肺上叶、右肺下叶腺癌，T1a(2)N0M0微波消融后随微波消融后随访访：瘢痕形成，逐：瘢痕形成，逐渐缩渐缩小小病例三：多原病例三：多原发发肺癌肺癌右肺上叶、右肺下叶腺癌，T1a(2)N0M0微波消融后随访：20左肺上叶腺癌左肺上叶腺癌（ROSE），），T1bN0M0病理病理现场现场确确认认后即刻行微波消融后即刻行微波消融病例四：活病例四：活检检后即刻消融后即刻消融左肺上叶腺癌（ROSE），T1bN0M0病理现场确认后即刻行21左肺上叶腺癌左肺上叶腺癌，T1aN0M0，消融后即刻活消融后即刻活检检微波消融后随微波消融后随访访：瘢痕形成：瘢痕形成病例五：消融后即刻活病例五：消融后即刻活检检左肺上叶腺癌，T1aN0M0，消融后即刻活检微波消融后随访：22左肺上叶腺癌，薄左肺上叶腺癌，薄层层CT显显示内部示内部实实性成分性成分为为血管血管“No Touch”夹夹持消融，消融后即刻活持消融，消融后即刻活检检病例六：消融后即刻活病例六：消融后即刻活检检左肺上叶腺癌，薄层CT显示内部实性成分为血管“No Touc23右肺下叶腺癌，（固化）消融后即刻活右肺下叶腺癌，（固化）消融后即刻活检检活活检检后影像：活后影像：活检侧检侧固化效固化效应应明明显显，未出血，未出血病例七：消融后即刻活病例七：消融后即刻活检检右肺下叶腺癌，（固化）消融后即刻活检活检后影像：活检侧固化效24Dr Graham:I believe that one day,the human for lung cancer will have a more safe and effective than surgical removal of the way.我我们还们还在路上在路上.Dr Graham:我们还在路上.25介入介入交叉融合交叉融合 成就彼此成就彼此外科外科 放放疗疗科科介入交叉融合 成就彼此外科 放疗科26THANK YOU!THANK YOU!27