医学交流课件：经皮微波消融治进展期非小细胞肺癌临床研究现状

1、,经皮微波消融治进展期非小细胞肺癌临床研究现状 Clinical study on the percutaneousmicrowave/radiofrequency ablation ofadvanced non-small celllung cancer,硬膜外和鞘内止痛药 26,微波消融治疗肺癌发展,Dupuy DE et al, Am J Roentgenol. 2000 Jan;174(1):57-59,Eur J Radiol. 2011 Feb;77(2):346-57,Since the first reported use of thermal ablation for lun

2、g cancer in 2000 there has been an explosive use of the procedure,and by 2010 the number of procedures to treat thoracic malignancy is expected to exceed 150,000 per year.,欧美国家热消融治疗例数的估计 Estimation ofthe number of thermalablation patients in theEuropean and American,1736,Radiofrequency ablation lung

3、 cancer 807,Microwave ablation lung cancer 160,Cryoablation lung cancer 320,2016.12.15.,ablation lung cancer Laser 141,Lung Ablation Whats New? J Thorac Imaging 2016 Jul;31(4):228-37,The major advantage of RFA over other ablative techniques is experience. MWA has emerged as a potentially superior tr

4、eatment option to RFA due to a much broader energy deposition capable of producing a larger zone of active heating. MWA can produce higher intratumoral temperatures . Larger tumor ablation volumes with faster ablation times. Available MWA systems vessels adjacent to lung tumors . MWA is associated w

5、ith less procedural pain, perhaps from lack of electrical nerve stimulation associated with,Surg Oncol Clin N Am 2016； 25：553566,MWA is slowly replacing RFA for thermal ablation of lung tumors.,硬膜外和鞘内止痛药 26,USA (46,28.8%),China (35,21.8%),Other (37),Aus(8),Italy(8),Germany(8),France(6),Japan(6),160,

6、Microwave ablation lung cancer,Spain(2),18, 51.4%, 11.3%,35,2016.12.15.,硬膜外和鞘内止痛药 26,微波消融治疗进展期肺癌疗效,硬膜外和鞘内止痛药 26,CT Follow-up assessment * Disappearance * Cavitation * Fibrosis * Nodule * Atelectasis,Disappearance,Fibrosis,Nodule,Atelectasis,Cavitation,硬膜外和鞘内止痛药 26,中国肺癌杂志 2014;17(4):294-301.,泰山医学院硕士研

7、究生毕业论文答辩,16,RR:25-35%, PFS :4-6ms, MOS:8-10ms, 1ys:30-40%, 2ys:10-15%.,N Engl J Med. 2015 July 9; 373(2): 123135.,median os 9.2 months with nivolumab 6.0 months with docetaxel,1 y, OS :42% with nivolumab 24% with docetaxel.,N Engl J Med 2015;373:1627-39,median os 12.2 months with nivolumab 9.4 month

8、s with docetaxel,1 y, OS :51% with nivolumab 39% with docetaxel.,组合使用第一年约25万6千美元(人民币：1,780,000.00)，第二年单独使用Opdivo 约15万美元。 Opdivo 单价28.78美元/毫克（人民币189元），Yervoy 单价157.46美元/毫克（人民币1033元）。 这个单价是黄金价格的3800倍。 Keytruda （PD-1抗体）每年约15万美元。Tecentriq （PD-L1抗体）每年约15万美元。,硬膜外和鞘内止痛药 26,Nature. 2016 Sep 8;537(7619):S63.

9、,NEJM 2016; 375;13:1289-1294,硬膜外和鞘内止痛药 26,Heon Lee ,et al. Cardiovasc Intervent Radiol 2012 Apr;35(2):343-50.,1 y, OS :100% RA+CT 77.8% CT.,硬膜外和鞘内止痛药 26,Cardiovasc Intervent Radiol (2015) 38:135142,M PFS：8.7 ms,MOS ：21.3 ms,39pts,硬膜外和鞘内止痛药 26,Med Oncol (2015) 32:13 DOI 10.1007/s12032-014-0464-z,PFS

10、（ median） MWA/chem ： 10.9 ms Chemotherapy ：4.8 ms,46pts:28pts,m PFS: 8.3 months OS :27.2 months,Eur Radiol. 2016 Jul 19. Epub ahead of print,硬膜外和鞘内止痛药 26,P = 0.297,Med Oncol. 2015 Sep;32(9):227.,硬膜外和鞘内止痛药 26,Ming Zhao ,et al. AJR 2013; 201:13621367,Median PFS2: 16 wks,硬膜外和鞘内止痛药 26,OncoTargets and Th

11、erapy 2015:8 32273235,35 patients Median follow-up of 17.7 ms Median PFS： 11.8 months OS： 17.7 months.,神经阻断、姑息手术 15,女, 51岁, 中分化腺癌,2.2cm- 2011.2.,24ms,48ms,24ms,48ms,12ms,36ms,顺铂+多烯紫杉醇，4 cycles,硬膜外和鞘内止痛药 26,神经阻断、姑息手术 15,1 week,24ms,36ms,60ms,12ms,6ms,男，63,中分化鳞癌 ，顺铂+吉西他滨 4周期 消融,2011-10-17,2014-11-18,2

12、012-6-15,2015-10-22,2016-8-26,15ms,25ms,36ms,57ms,M,52y, Adenocarcinoma 6.7cm,9 ms,6月,12月,硬膜外和鞘内止痛药 26,神经阻断、姑息手术 15,Nature 2001, 414 : 106-111,硬膜外和鞘内止痛药 26,NCT02455843,硬膜外和鞘内止痛药 26,神经阻断、姑息手术 15,Time to Progression after local therapy,Overall survival after local therapy,J Thorac Oncol. 2013 March ;

13、8(3): 346351.,mPFS2 :8.8 vs. 5.8 ms,mOS: 27.7 vs. 20.0 ms,54 NSCLC patients with EGFR mutations who showed a clinical benefit from initial EGFR-TKI . MWA group (n=28) Chemotherapy group (n=26) m PFS1 12.6 vs. 12.9 ms,Medicine (Baltimore). 2016 Jun;95(25):e3998.,M，62ys，metastasis（5.5cm），pre-ablation

14、VAS 8,35,M，69ys，bone metastasis（6.5cm），pre-ablation VAS 8,硬膜外和鞘内止痛药 26,F，76ys，Bone metastasis after radiotherapy（3.5cm），pre-ablation VAS 7,硬膜外和鞘内止痛药 26,M，59ys，bone metastasis pre-ablation VAS 8,M ，49ys, extraspinal bone metastases , pre-MWA combined with osteoplasty ,VAS 7.,M ，52ys, extraspinal bone

15、 metastases , pre-MWA combined with osteoplasty ,VAS 8.,硬膜外和鞘内止痛药 26,26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty.,Skeletal Radiol. 2015 Oct;44(10):1485-90,硬膜外和鞘内止痛药 26,Median overall survival timewas 12 months. The 1-year o

16、verall survival rate was 44.3%. Median local tumor progression-free survival time was 9 months.,Korean J Radiol 2016;17(6):1-7,硬膜外和鞘内止痛药 26,热消融治疗肺癌并发症多吗？ Major complications,硬膜外和鞘内止痛药 26,J Vasc Interv Radiol 2015; 26:787791,National (Nationwide) Inpatient Sample (NIS). 20072011， 3,344 patients,硬膜外和鞘

17、内止痛药 26,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

18、 Surg 2014;98:2438,Int J Hyperthermia. 2014 Sep;30(6):412-7,Anticancer Res.2015 May;35(5):2823-6.,热消融治疗肺癌的有关指南 Guidance for microwave/ radiofrequency ablation for treating lung malignant,Philippe L, Pereira, Masala Salvatore. Standards of Practice: Guidelines for Thermal Ablation of Primary and Secondary Lung Tumors.,Cardiovasc Intervent Ra