- 期刊
肝癌的經皮射頻燒灼治療
Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma
摘要
自從1993年射頻燒灼療法(RFA)被用來治療人類的肝腫瘤以來，許多的研究結果顯示RFA可以有效的治療肝細胞癌或肝轉移性癌，在小型肝癌的局部消融治療中，RFA的療效優於酒精注射，此乃因為RFA的消融範圍較能臆測、治療的次數較少、腫瘤的完全消融率較高及局部復發率較低、以及存活率較高；對於中大型的肝癌，RFA合併酒精注射或肝動脈化學栓塞治療，比單獨使用RFA有效；RFA與微波熱凝治療(microwave coagulation therapy)比較，兩者的腫瘤的完全消融率與局部復發率相當，但是因為設計不同，RFA所需的燒灼次數較少。RFA與肝癌切除治療比較，Hong SN等的回顧性研究與Chen MS等所作的隨機對照研究結果顯示，兩者的三年或四年總存活率相當；對於高危險位置的肝癌，單獨以RFA治療可能會傷及附近的器官，若在RFA術前注入人工腹水或人工胸水，一則可以避免傷及附近的器官，二則可以使肝癌的在超音波下的影像更清楚。至於RFA的最新進展，因為時下的射頻探針只能有效的消融3公分以下的腫瘤，因此近期的發展主要在以更快的速度消融更大的腫瘤，如Burdio F及Clasen S等的各別研究結果顯示，使用雙極(bipolar)探針或2至3支單極探針同時放進腫瘤再加上具有switching controller的射頻發射器(RF generator)，可以在短時間燒灼腫瘤達5至8公分。結論：對於大多數的小型肝癌，RFA為局部消融治療法中最優先的選擇。對於較大的肝癌，RFA合併酒精注射或肝動脈栓塞治療比RFA單獨治療效果佳；對於高危險位置的肝癌，RFA術前注入人工腹水或胸水可以避免傷及臨近的器官，也可以增加RFA的療效。依據最新的進展，使用雙極(bipolar)RFA探針能夠更快的消融更大的腫瘤。
並列摘要
Radiofrequency ablation (RFA) has been employed for treatment of malignant liver tumor since 1993. Growing evidences have shown that RFA is superior to percutaneous ethanol injection in terms of fewer treatment sessions, more predictable ablation extent, lower local tumor progression, higher overall survival and cancer-free survival for small hepatocellular carcinoma (HCC). RFA was comparable to microwave coagulation therapy in local tumor progression but a fewer ablation sessions were required by RFA. For larger (＞3cm) HCC, combine ethanol injection or chemoembolization with RFA is superior to RFA alone. Comparing with resection, RFA is equivalent to resection in terms of 3 or 4-year overall survival in a retrospective study by Hong SN et al and a randomized controlled trial by Chen MS et al. In HCC with high-risk location, the operators can improve the visibility of the tumor, improve ablation effects and reduce the complications by creation of artificial ascites or pleural effusion immediately before RFA. Recent advances in RFA are aimed to enlarge the ablation zone in a shorter time by utilizing the higher power RF generators or bipolar RF electrodes. In summary, RFA is the choice of local ablations for small HCC. For larger HCC, combine RFA and ethanol injection or chemoembolization is superior to RFA alone. The 3 or 4-year overall survival was nearly comparable between RFA and resection in small HCC. In HCC with high-risk location, creation of artificial ascites or pleural effusion would reduce the complication and improved the ablation effect. In the near future, larger ablation in a shorter period by using bipolar electrode or switching controller is the challenging and advances of RFA.