早期NSCLC的消融治療問題與展望課件

1、 經(jīng)皮熱消融治療早期非小細(xì)胞肺癌：現(xiàn)狀與展望早期NSCLC治療現(xiàn)狀A(yù)blationSBRTVATS-Open硬膜外和鞘內(nèi)止痛藥 26硬膜外和鞘內(nèi)止痛藥 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%；硬膜外和鞘內(nèi)止痛藥 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歐美國家熱消融治療例數(shù)的估計(jì)Estimation ofthe number of thermalablation patients in theEuropean and American AblationSBRTVATS-Open硬膜外和鞘內(nèi)止痛藥 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硬膜外和鞘內(nèi)止痛藥 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硬膜外和鞘內(nèi)止痛藥 26La

8、ncet Oncol 2015; 16: 63037張玉蛟 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 硬膜外和鞘內(nèi)止痛藥 26Transl Lung Cancer Res 2015;4(4):438-447熱消融治療肺癌的優(yōu)勢1. 創(chuàng)傷小2.特殊情況下的唯一選擇3.可反復(fù)多次應(yīng)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%, 硬膜外和鞘內(nèi)止痛藥 2653 months after RFAFollow-up 5 yearsPatient with PacemakerSingle lung ablation消融后24hRepeat MWA2mon, 6mon, 29mon, 3mon, 19monRFA CryoablationMicrowaveLaser ablation 多種熱消融治療技術(shù)的應(yīng)用現(xiàn)狀 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熱消融治療肺癌規(guī)范硬膜外和鞘內(nèi)止痛藥 26自2012年至今，熱消融作為外科手術(shù)以外的局部治療方法進(jìn)入NCCN指南Cardiovasc Intervent Radiol, 20

13、12, 35: 247-254.硬膜外和鞘內(nèi)止痛藥 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硬膜外和鞘內(nèi)止痛藥 26心肺功能等機(jī)體狀況經(jīng)評估無法接受手術(shù)的 I 期和期的 NSCLC 患者，可選擇根治性放射治療、射頻消融治療和藥物治療等。 硬膜外和鞘內(nèi)止痛藥 26Thoracic Cancer 2015；6： 112121硬膜外和鞘內(nèi)止痛藥 26 熱消融治療肺癌并發(fā)癥少硬膜外和鞘內(nèi)止痛藥 26J Vasc Interv Radiol

15、2015; 26:787791National (Nationwide) Inpatient Sample (NIS). 20072011， 3,344 patients硬膜外和鞘內(nèi)止痛藥 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 熱消融治療肺癌：問題與展望硬膜外和鞘內(nèi)止痛藥 261.熱消融技術(shù)對于早期周圍型肺癌患者有可能成為首選之一，但是尚缺乏大規(guī)模、多中心、隨機(jī)、前瞻性的臨床比較研究；2. 缺乏與其他傳統(tǒng)治療手段（如放射治療）的前瞻性、多中

17、心臨床比較研究；3.如何提高局部完全消融率，降低復(fù)發(fā)，是今后工作的方向之一；4.缺乏公認(rèn)的、符合熱消融技術(shù)自身規(guī)律的療效判斷標(biāo)準(zhǔn)；5.基礎(chǔ)研究相對滯后，如復(fù)雜熱場分布、對機(jī)體免疫的影響等等。6.專業(yè)剛剛興起，治療人員的專業(yè)化水平參差不齊，急需規(guī)范。硬膜外和鞘內(nèi)止痛藥 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