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稳定转移性乳腺癌患者乳腺肿瘤的经皮冷冻消融:安全性、可行性和疗效

Percutaneous cryoablation of breast tumours in patients with stable metastatic breast cancer: safety, feasibility and efficacy.

作者信息

Beji Hédi, Pilleul Frank, Picard Raphaelle, Tredan Olivier, Bouhamama Amine, Peix Marie, Mavrovi Erti, Mastier Charles

机构信息

1 Department of Radiologie, Centre Léon Bérard , Lyon , France.

2 Department of Gynécologie, Hôpital Edouard Herriot , Lyon , France.

出版信息

Br J Radiol. 2018 Feb;91(1083):20170500. doi: 10.1259/bjr.20170500. Epub 2018 Jan 12.

Abstract

PURPOSE

To evaluate safety, feasibility and efficacy of percutaneous cryoablation of breast tumours in patients with clinically stable metastatic breast cancer, and to compare the findings with reports on alternative procedures, namely surgery and local radiotherapy.

METHODS

17 female patients (average age of 54.8 years ± 10.8; range 37-72) with primary breast tumour not surgically treated because of metastatic disease were included. Patients were treated for their primary lesion by percutaneous cryotherapy in period of stable disease. This minimally intervention was performed using ultrasound or CT scan guidance. All patients had clinical and breast-MRI evaluation before and at 1, 3, 6 and 12 months after the procedure.

RESULTS

All procedures were performed under local anaesthesia and technically successful. The mean largest diameter of the primary lesions was 16 ± 12 mm (size range 5-45 mm). In 15 patients, we obtained a complete regression of the primary breast lesion without recurrence during the follow-up period. Two patients with lesions measured at 40 and 45 mm had recurrence in follow up period. A second session of cryotherapy was performed for these 2 patients, not included in this study. Five patients had painful masses before cryotherapy. All were immediately relieved after the intervention and durably during all follow-up.

CONCLUSION

These results show that the cryoablation of primary breast lesions seems to be well suited to the palliative care of metastatic patients, particularly because of its good tolerance, low complication rate and ability to provide local or analgesic control. Advances in knowledge: Therapies are limited for these symptomatic patients at metastatic state of primary breast tumour. This study shows that cryoablation in palliative care is achievable in common practice, is effective in local control of the tumour and can provide immediate and long-term analgesic control.

摘要

目的

评估经皮冷冻消融治疗临床病情稳定的转移性乳腺癌患者乳腺肿瘤的安全性、可行性和疗效,并将结果与其他替代治疗方法(即手术和局部放疗)的报告进行比较。

方法

纳入17例女性患者(平均年龄54.8岁±10.8岁;范围37 - 72岁),这些患者因转移性疾病未接受原发性乳腺肿瘤的手术治疗。在疾病稳定期,对患者的原发性病灶进行经皮冷冻治疗。这种微创干预在超声或CT扫描引导下进行。所有患者在治疗前以及治疗后1、3、6和12个月均进行了临床和乳腺MRI评估。

结果

所有手术均在局部麻醉下进行且技术成功。原发性病灶的平均最大直径为16±12毫米(大小范围5 - 45毫米)。15例患者在随访期间原发性乳腺病灶完全消退且无复发。2例病灶直径分别为40毫米和45毫米的患者在随访期间出现复发。对这2例患者进行了第二次冷冻治疗,本研究未纳入。5例患者在冷冻治疗前有疼痛性肿块。干预后所有患者的疼痛立即缓解,且在整个随访期间持续缓解。

结论

这些结果表明,原发性乳腺病灶的冷冻消融似乎非常适合转移性患者的姑息治疗,特别是因其耐受性良好、并发症发生率低以及能够提供局部或止痛控制。知识进展:对于处于原发性乳腺肿瘤转移状态的这些有症状患者,治疗方法有限。本研究表明,姑息治疗中的冷冻消融在常规实践中是可行的,对肿瘤的局部控制有效,并且可以提供即时和长期的止痛控制。

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