医学交流课件：微波消融与射频消融在治疗实体肿瘤中的比较研究

Complete Respon
268
86.2
se
ParEal Response
43
13.8
Responses According the the Distance of the Lesions from the Vessels
N tot=12 9
Lesions Close to
Vessels Lesions Far from
- no interferences with
pacemakers & metallic ..
- higher cost of devices - learning curve - few clinical results yet
微波消融治疗肿瘤问世的时间仅十余年， 尚有许多问题有待解决
• 由于肿瘤的大小、形状、位置等病灶条件的不同，技术难度和临床疗效 也有差别，尤其肿瘤过大、形态欠规整、浸润性强或靠近重要脏器时给 治疗带来困难，效果也较差
CR : Disappearance of any intratumoral arterial enhancement in all lesions PR : At least a 30% decrease in the sum of diameters of viable tissue
CR= 92
> 2 ≤ 3cm B 107
99
8
(92.5%) (7,5 %)
> 3 ≤ 4cm
C 67
60
7
(89.5%) (10.5%)
> 4 ≤ 5cm > 5cm
D 27 E 19
16 (61%)
9 (47%)
11 (39%)
10 (53%)
Type of Respon No. of Lesions
%
se
• 国内外的研究已证实，微波消融治疗肿瘤在使之原位灭活的同时，机体 外周血和局部的免疫功能也会增强，这是其区别于手术治疗的特色，这 也有利于杀灭残存的癌细胞，但如何长期增强机体的细胞免疫，巩固疗 效，是临床上面临的实际问题
• 如何进一步增强微波消融的疗效，如微波消融联合生物治疗、微波消融 联合 TACE（肝动脉化疗栓塞）、微波消融联合超抗原等方法还需研究
微波消融与射频消融在治疗 实体肿瘤中的比较研究
New Ablation Device: Key ??
• What can it do ? • Is it safe ? • Is it better than other alternatives ?
Technical success
mRECIST for HCC
Possible “chimney effect”
PRE -
POST-
CONCLUSIONS PROs
MWA
CONs
- faster
- larger (fewer insertions)
- less heat sink - lower LTP rate
- no circulating current - equal major complications
Liver abscess and pleural ቤተ መጻሕፍቲ ባይዱmpyema
HCC 20 mm IV segm
60W - 10 min CT at 1 month
MR 3 months after LMWH
MWA: Conduction of Steam
T=6 minutes; P=100 watts Microsulis 5.7 mm antenna
Major complication rates
• Liang P, Radiology 2009:
• 2.6% in 1136 pts (single Center) (no correlation with size)
• Livraghi T, CVIR 2012:
• 2.9% in 736 pts (multicenter Italian Study)
PR= 8%
Stratification according to TUMOR SIZE
Size < 3 cm Size 3-4 cm Size 4-5 cm Size > 5 cm
CR 96% CR 93% CR 82% CR 62%
PR 4% 1 cm «gained»?
PR 7% PR 18% PR 38%
Tutti i diritti riservati di proprietàdegli autori. Èvietata la riproduzione anche parziale.
Resection Ablation
Ablation
Tutti i diritti riservati di proprietàdegli autori. È vietata la riproduzione anche parziale
• 2013 Italian Multicenter Study: 0.6% in 178 pts. with CRC mets
Data on 670 pts - 14 major complications reported (2 %)
14. One procedure related death (0.12%)
Italian Multicenter Study (14 Centers, 312 mets in 178 pts)
Responses According to the Lesion Size
Size
N° CR, n PR, n
lesions
(%)
(%)
≤ 2 cm
A 91 89
2
(97,5%) (2,5%)
展望
➢ 影像引导下微波消融治疗恶性肿瘤以其肿瘤完全坏死率高，疗效 好，并发症少，且能增强机体免疫功能 等优点为肝癌的治疗开辟 了新的途径
➢ 可以相信随 着消融技术的研究和影像学的发展，肿瘤微波消融 存 在的问题和不足会逐步解决，消融范围更大、更彻 底，复发率和 转移率也会降低
Vessels
CR
N (%)
58 (82.8%)
PR
N (%)
12 (17.2%)
45
14
(76.3%) (23.7%)
New Ablation Device: Key ??
• What can it do ? • Is it safe ? • Is it better than other alternatives ?