早期NSCLC的消融治疗问题与展望课件

1、 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AblationSBRTVATS-Open硬膜外和鞘内止痛药 26硬膜外和鞘内止痛药 26stage I ： median survival 13 msChest.2007 Jul;132(1):193-9. 1989 2003， 101,844 patients in Californiastage I ： 1, 3, 5-ys survival: 48%, 19%, 7%；硬膜外和鞘内止痛药 26 2013; 143(5)(Suppl):278S313SResected stage I and stage II NSCLC

2、5-year survival rates 60% to 80% for stage I 30% to 50% for stage II Thorac Surg Clin 26 (2016) 261269Cancer.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 (1

3、9%/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;2014:1520871-, 2-, 3-, 4-year 91.7%, 76.5%, 47.9%, 47.9%

4、,1-, 2-, 3-, 4-year 94.7%, 73.9%, 64.7%, 64.7%,28 pts, aged 75 years Median follow-up ：22.5 msMST： 35 ms Cancer-specific MST 41.9 msIndian Journal of Cancer 2015 （ 2）：52-5620002004200620082009201020112012201320142015LIVER8.50012.00016.00038.000126.000250.000370,000460,000520,000642,000722,000LUNG190

5、03,00016,00056,000135,000210,000330,000401,000504,000614,000KIDNEY1507001.50012.00042.00080.000130,000160,000192,000212,000292,000BONE1207001.5008.00011.00030.00045,00056,00064,00082,000102,000OTHERS1002001.00015.00019.00030.00070,000110,000182,000273,000379,000TOTAL8,87114,50023,00089,000254,000490

6、，000825,0001116，0001,359,0001,713,0002,109,000欧美国家热消融治疗例数的估计Estimation ofthe number of thermalablation patients in theEuropean and American AblationSBRTVATS-Open硬膜外和鞘内止痛药 26Eur Respir J.2015 Apr;45(4):1089-97. Stage I NSCLCRFA（62）wedge resection （59）p Median follow-up 42ms 36ms0.539local progression

7、23% 2%0.002 1-year OS93% (87%),100% (96%),OS/DFI2-year OS72% (63%), 96% (90%)5-year OS35% (55%)52% (76%)0.044 / 0.01硬膜外和鞘内止痛药 26J 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 26La

8、ncet Oncol 2015; 16: 63037张玉蛟 Joe Y Chang3y OS:96% : 79%3y RFS: 86% : 80%Int J Clin Oncol (2015) 20:499507RFA（47）SBRT（48）pdiameter2.00.8 （0.6-3.9） 2.10.9 （0.8-4.7）0.539local progression9.6% 7.0%, 0.7463-year OS86.4%,79.6%0.738Respiration. 2015;89(6):550-7 116 patients stage I NSCLC Sublobar resectio

9、n (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 26Transl 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-

10、year, 3- year, 5-year (css) 100%, 100%, 100%, 硬膜外和鞘内止痛药 2653 months after RFAFollow-up 5 yearsPatient with PacemakerSingle lung ablation消融后24hRepeat MWA2mon, 6mon, 29mon, 3mon, 19monRFA CryoablationMicrowaveLaser ablation 多种热消融治疗技术的应用现状 TOTAL: 1713Radiofrequency ablation lung cancer 795 Microwave ab

11、lation lung cancer 156Cryoablation lung cancer 3152016.9.2.ablation lung cancer Laser 138J 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 therm

12、al ablation of lung tumors. Microwave ablation equipmentAblation ProcedureUSA (44,28.5%)China (31,20.1%)Other (37)Aus(8)Italy(8)Germany(8)France(6)Japan(6)154Microwave ablation lung cancerSpain(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 26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, 20

13、12, 35: 247-254.硬膜外和鞘内止痛药 26 2013; 143(5)(Suppl):e278Se313SThe 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) peri

14、pheral NSCLC that are clinical stage I.Interventional procedure guidance Published: 6 February 2013 .uk/guidance/ipg 469硬膜外和鞘内止痛药 26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 26Thoracic Cancer 2015；6： 112121硬膜外和鞘内止痛药 26 热消融治疗肺癌并发症少硬膜外和鞘内止痛药 26J Vasc Interv Radiol

15、2015; 26:787791National (Nationwide) Inpatient Sample (NIS). 20072011， 3,344 patients硬膜外和鞘内止痛药 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%), B

16、ronchopleural 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 261.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

17、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标准；5.基础研究相对滞后，如复杂热场分布、对机体免疫的影响等等。6.专业刚刚兴起，治疗人员的专业化水平参差不齐，急需规范。硬膜外和鞘内止痛药 26Stage I NSCLCSurgerySBRTAblation（114）Professionals5-7 4-53-4Medical equipmentComplicatedVery complicatedRelatively simpleTreat-time/ hospitalization 4-5 h/ 7-10 d3-

18、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 pneumonitis PneumothoraxCost10,000-15,000 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;145:6