早期NSCLC的消融治疗问题与展望课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,经皮热消融治疗早期非小细胞肺癌：,现状与展望,早期,NSCLC,治疗现状,硬膜外和鞘内止痛药,2,6,硬膜外和鞘内止痛药,2,6,stage I,：,median survival 13 ms,Chest.,2007 Jul;132(1):193-9.,1989 2003,，,101,844 patients in California,stage I,：,1,3,5-ys survival:48%,19%,7%,；,硬膜外和鞘内止痛药,2,6,2013;143(5)(Suppl):278S313S,Resected stage I and stage II NSCLC,5-year survival rates,60%to 80%for stage I,30%to 50%for stage II,Thorac Surg Clin 26(2016)261269,Cancer.,2015;121(23):4222-30.,In total,3147 patients,SBRT,：,258 patients(8.2%),No treatment,：,2889 patients(91.8%),Median overall survival:,SBRT:29 ms(48%/3y;28%/5y),No treatment,：,10.1 ms(19%/3y,6%/5y),(P .001),OS rates,1 2 3 5-year,78%-100%,53%-86%,36%-88%,25%-61%.,cancer-specific survival rates,1 2 3,-year,89%-100%,92%-93%,59%-88%.,The median survival time ranged from 29-67months.,BioMed Research International 2014;2014:152087,1-,2-,3-,4-year,91.7%,76.5%,47.9%,47.9%,1-,2-,3-,4-year,94.7%,73.9%,64.7%,64.7%,28 pts,aged 75 years,Median follow-up,：,22.5 ms,MST,：,35 ms,Cancer-specific MST 41.9 ms,Indian Journal of Cancer 2015,（,2,）：,52-56,2000,2004,2006,2008,2009,2010,2011,2012,2013,2014,2015,LIVER,8.500,12.000,16.000,38.000,126.000,250.000,370,000,460,000,520,000,642,000,722,000,LUNG,1,900,3,000,16,000,56,000,135,000,210,000,330,000,401,000,504,000,614,000,KIDNEY,150,700,1.500,12.000,42.000,80.000,130,000,160,000,192,000,212,000,292,000,BONE,120,700,1.500,8.000,11.000,30.000,45,000,56,000,64,000,82,000,102,000,OTHERS,100,200,1.000,15.000,19.000,30.000,70,000,110,000,182,000,273,000,379,000,TOTAL,8,871,14,500,23,000,89,000,254,000,490,，,000,825,000,1116,，,000,1,359,000,1,713,000,2,109,000,欧美国家热消融治疗例数的估计,Estimation ofthe number of thermalablation,patients in theEuropean and American,硬膜外和鞘内止痛药,2,6,Eur Respir J.,2015 Apr;45(4):1089-97.,Stage I NSCLC,RFA,（,62,）,wedge resection,（,59,）,p,Median follow-up,42ms,36ms,0.539,local progression,23%,2%,0.002,1-year OS,93%(87%),100%(96%),OS/DFI,2-year OS,72%(63%),96%(90%),5-year OS,35%(55%),52%(76%),0.044/0.01,硬膜外和鞘内止痛药,2,6,J Vasc Interv Radiol 2013;24:476482,OS:,1-,2-,3-y,Surgery:100%,95%,83%,RF:91%,73%,55%,The median cost per month lived,Surgery:$1,195.92,RF:$620.74,硬膜外和鞘内止痛药,2,6,Lancet Oncol,2015;16:63037,张玉蛟,Joe Y Chang,3y OS:96%:79%,3y RFS:86%:80%,Int J Clin Oncol(2015)20:499507,RFA,（,47,）,SBRT,（,48,）,p,diameter,2.00.8,（,0.6-3.9,）,2.10.9,（,0.8-4.7,）,0.539,local progression,9.6%,7.0%,0.746,3-year OS,86.4%,79.6%,0.738,Respiration.2015;89(6):550-7,116 patients stage I NSCLC,Sublobar resection(42)Radiofrequency ablation(25)Radiotherapy(49),1-2-year OS,94 85%SLR,86 74%RFA,93 69%RT,硬膜外和鞘内止痛药,2,6,Transl Lung Cancer Res 2015;4(4):438-447,热消融治疗肺癌的优势,1.,创伤小,2.,特殊情况下的唯一选择,3.,可反复多次,应用,J Vasc Interv Radiol 2014;25:333339,（,33 consecutive patients,）,1-year,3-year,5-year (OS),100%,96.4%,96.4%,1-year,3-year,5-year (css),100%,100%,100%,硬膜外和鞘内止痛药,2,6,53 months after RFA,Follow-up 5 years,Patient with Pacemaker,Single lung ablation,消融后,24h,Repeat MWA,2mon,6mon,29mon,3mon,19mon,RFA,Cryoablation,Microwave,Laser ablation,多种热消融治疗技术的应用现状,TOTAL:1713,Radiofrequency ablation lung cancer,795,Microwave ablation lung cancer,156,Cryoablation lung cancer,31,5,2016.9.2.,ablation lung cancer Laser,138,J Thorac Imaging 2016 Jul;31(4):228-37,MWA over others,1.Higher intratumoral temperatures.,2.Minimal heat sink effect.,3.Larger ablation volumes.,4.Faster ablation times.,MWA is slowly replacing RFA for thermal ablation of lung tumors.,Microwave ablation equipment,Ablation Procedure,USA (44,28.5%),China(31,20.1%),Other(37),Aus(8),Italy(8),Germany(8),France(6),Japan(6),154,Microwave ablation lung cancer,Spain(2),15,48.4%,9.7%,31,热消融治疗肺癌规范,硬膜外和鞘内止痛药,2,6,自,2012,年至今，热消融作为外科手术以外的局部治疗方法进入,NCCN,指南,Cardiovasc Intervent Radiol,2012,35:247-254,.,硬膜外和鞘内止痛药,2,6,2013;143(5)(Suppl):e278Se313S,The 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.,Interventional procedure guidance Published:6 February 2013 nice.org.uk/guidance/ipg 469,硬膜外和鞘内止痛药,2,6,心肺功能等机体状况经评估无法接受手术的,I,期和,期的,NSCLC,患者，可选择根治性放射治疗、射频消融治疗和药物治疗等。,硬膜外和鞘内止痛药,2,6,Thoracic Cancer 2015,；,6,：,112121,硬膜外和鞘内止痛药,2,6,热,消融治疗,肺癌,并发症少,硬膜外和鞘内止痛药,2,6,J Vasc Interv Radiol 2015;26:787791,National(Nationwide)Inpatient Sample (NIS).,20072011,，,3,344 patients,硬膜外和鞘内止痛药,2,6,Major complications:20.6%,Pneumothorax:32 cases(15.7%,requiring chest tube).,Pleural effusions:6 cases(2.9%,requiring chest tube),Pneumonia:6 cases(2.9%),Pulmonary abscess:1 case (0.5%),Bronchopleural fistula:1 case (0.5%),Death related ablation:1 session(0.5%).,Ann Thorac Surg 2014;98:2438,消融后,14,天,消融后,32,天,消融后,32,天,Bronchopleural fistula(1),Int J Hyperthermia.2014 Sep;30(6):412-7,热,消融治疗肺癌：,问题与展望,硬膜外和鞘内止痛药,2,6,1.,热消融技术对于早期周围型肺癌患者有可能成为,首选之一,，但是尚,缺乏大规模、,多,中心、随机、,前瞻性的临床比较研究；,2.,缺乏与其他传统治疗手段（如放射治疗）的,前瞻性、,多,中心临床,比较研究；,3.,如何提高局部完全消融率，降低复发，是今后工作的方向之一；,4,.,缺乏公认,的、符合热消融技术自身规律的疗效判断