CT guided percutaneous radiofrequency ablation in treatment of patients with inoperable lung cancer / 肿瘤研究与临床

Surgical resection remains the cornerstone of therapy for early stage lung cancer. Five-year survival rates are reported as high as 92% for stage Ⅰ non-small cell lung cancer (NSCLC). However, many patients presenting with resectable early stage disease are unable to tolerate pulmonary resection, even sublobular resection, because of compromised cardiopulmonary functions or other comorbidities. Traditionally,patients deemed medically inoperable have been treated by external-beam radiation. But the results were poor with a mean survival of 20 months and a 5-years survival rate of 12%. In this scenario, we need to develop other non-surgical local therapies. One of these was image-guided percutaneous radiofrequency ablation(RFA).Many clinical trials show that RFA for lung tumors is a minimally invasive, feasible and safe technique with minor mortality and morbidity. Moreover, its efficacy seems to be promising, even in the long-term follow-up.Further experiences and comparison with other emerging minimally invasive local treatments are required to determine its rote in the treatment of medically inoperable early stage NSCLC.

Application of a puncture guidance supporter in CT intervention / 中国介入影像与治疗学

Objective To evaluate the application of a puncture guidance supporter in CT guided biopsy and interventional therapy. Methods Totally 468 patients underwent CT interventional biopsy (n=110) or treatment (n=358) using a puncture guidance supporter. The size of lesions was 2-15 cm. CT scanning was performed to determine the entry point, data of bi-directional needle angle α, θ and depth d before operation. After local anesthesia, the needle was punctured into skin through the puncture guidance supporter, the needle overlap CT positioning laser line in tilt angle (α) was adjusted and the puncture direction at angle θ. After CT scanning confirmed the needle aiming at target lesion, punctures were performed with the needle into the depth to hit the target. Results The total puncture hit rate was 100%, and one step hit rate was 96.79%. The average time from location scanning to hit the target was 8.4 min. The incidence of pneumothorax occurred in thorax management was 1.56%. Conclusion The application of puncture guidance supporter in CT interventional diagnosis and treatment makes operation more accurate, safe and convenient.

Radio frequency ablation combined with transcatherterarterial chemo embolization and ethanol injection for hepatic carcinoma / 肿瘤研究与临床

Objective To explore the effect of radio frequency ablation (RFA) combined with transcatherterarterial chemo embolization (TACE) and percutaneous puncture hydrochloric acid injection(PHI) for hepatic tumors unable to resection. Methods The clinical data of 40 cases of patients with unable resection liver cancer (URLC) treated by RFA combined with TACE and PEI were analyzed retrospectively.Results There were 30 cases of primary hepatic tumor(PHT) and 10 cases of metastasis hepatic tumor(MPT) , in this series. Examination of ultrasound, CT and MRI showed the tumors shrink or steady in 39 patients.Among 30 patients with damage by ethanol, 18 cases were AFP positive before treatment and 16 cases of them AFP decreased to normal level after operation. No severe complication was seen in the series. Conclusion RFA combined with TACE and PEI is a safe, well tolerable and effective method for hepatic cancer, and may improve the treatment efficacy of URLC.

Destructive effect of percutaneous hydrochloric acid injection therapy for liver cancer--a preliminary experimental and clinical study.

OBJECTIVES: To evaluate the tissue coagulation and anticancer effects of hydrochloric acid compared with ethanol and acetic acid. To assess the in situ destructive effects and safety of CT mediated percutaneous hydrochloric acid injection therapy (PHAIT). METHODS: IC50 of gastric juice and 10% diluted hydrochloric acid against cancer cell lines in vitro were determined. Coagulated necrotic area of hydrochloric acid was observed in vitro and in vivo using pig liver. The coagulated effects of 6 mol/l hydrochloric acid solution (HAS6) on pig liver and muscle were compared with 50% acetic acid and anhydrous alcohol. Thirty patients with 38 lesions of liver cancer were treated by the CT mediated intratumor injection of HAS6. The in situ destructive rate, CT evaluation, PET, histopathology, survival and side effects were observed. RESULTS: The IC50 of gastric juice and 10% diluted hydrochloric acid against cancer cell lines were as similar as approximately 0.05-0.07% in concentration. Coagulated area of liver tissue by 1 ml of 1.5-12 mol/l hydrochloric acid was 18.3-53.4 mm in diameter. The globular hoariness coagulation area with a clear-cut borderline separated from normal tissue was produced. The 6.0 mol/l hydrochloric acid shows a larger coagulation dimension with a clear boundary, 15 times of anhydrous alcohol and 5 times of 50% acetic acid. No toxicities in the routine local injection dosages were found. Clinically, the patients received 73 sessions of PHAIT; CT scan shows a low density area with gas that did not enhance by CT scan shown 24 hrs later. A good necrosis and destruction rate of cancer was obtained by PET, biopsy and AFP measurement. One year, 2-year and 3-year survival rates were 100, 90 and 85%, respectively. Nine cases survived more than 3 years, and 2 cases for more than 4 years. No change in the heart, liver and kidney functions were found. Main side effects were slight pain, lower fever, etc. CONCLUSIONS: The 6 mol/l hydrochloric acid is an effective endogenetic protein coagulator; the cancer tissue coagulated effect of HAS6 was superior to 50% acetic acid and anhydrous alcohol. CT mediated percutaneous hydrochloric acid injection therapy showed good destructive effects; it would be used as a new minimum invasive treatment for percutaneous treatment of liver cancer, instead of acetic acid and anhydrous alcohol with its safety, controllability and no poisonous effects.

Percutaneous microwave coagulation therapy for lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the clinical effect, CT image changes and side-effects of percutaneous microwave coagulation therapy for lung cancer.</p><p><b>METHODS</b>CT-guided percutaneous puncture was performed using a needle mono-pole microwave antenna with 65W, 2 450 MHz microwave delivered in 60 seconds to 20 peripheral lung cancer patients, including 8 suffering from primary lung cancer and 12 metastatic lung cancer (totally 28 lesions).</p><p><b>RESULTS</b>Sixteen patients were alive after having been followed-up for 3 approximately 24 months. All patients showed nodules decreased in size. Diminution of over 50% was observed in 13 nodules and 3, completely disappeared. The overall response rate was 57.1%. Ellipsoid shadow 3.5 cm x 2.5 cm across was observed by CT in lesions immediately after coagulation. Gasification within the coagulated area was observed in a week with a high density in the peripheral region. Consolidation was observed in 3 months and the lesion disappeared 1 year later. Complete tumor necrosis was proved by biopsy. No side-effects or complications were observed.</p><p><b>CONCLUSION</b>Percutaneous microwave coagulation therapy is a new safe treatment for lung cancer, giving marked effect but minimum trauma.</p>

Combined Chemotherapy of HCPT,MTX,Leucovorin and 5-Fu for Metastatic Breast Cancer / 中国肿瘤临床

Objective:The therapeutic efficacy and side effects of combined chemotherapy of HCPT,MTX,LV and 5-Fu for metastatic or recurrent breast cancer were evaluated in our study.Methods:A total of 43 cases of advanced metastatic or recurrent breast cancer were treated with chemotherapy regimen consisting of HCPT 10mg/m2 iv gtt for dl～5,MTX 100mg iv dl,Leucovorin 150mg/m2 iv gtt for d2～4,5-Fu 500mg/m2 iv gtt for dl～5.The cycle was repeated every 4 weeks,and 2 cycles were given as one course.Results:The overall CR+PR was 47%.One year survival rate was 54% and the median survival interval was 19 months.The main side effects were bone marrow suppression and gastrointestinal reaction.Conclusion:The combined chemotherapy regimen consisting of HCPT etc is beneficial for metastatic breast cancer.