目的:证明经皮不可逆电穿孔(IRE)治疗淋巴结转移的安全性和有效性。
方法:经IRB批准的,对胃肠道淋巴结转移患者进行单中心回顾性分析,和泌尿生殖系统原发性癌症。通过评估Clavien-Dindo分类的并发症来评估主要客观安全性。疗效由随访影像学的肿瘤反应和局部无进展生存期(LPFS)决定.次要结局指标为技术成功(充分消融边缘>5mm的完全消融),住院时间和远处无进展生存期(DPFS)。
结果:19例患者在2018年6月至2023年2月期间因淋巴结转移接受了经皮IRE,靠近关键结构,比如脉管系统,肠,或神经。在所有情况下都取得了技术成功。4例患者发生并发症(21.1%),包括两个自限性1级血肿,1级腹痛,和2级神经疼痛用药物治疗。17名病人过夜住院,一名病人住了两晚,另一名病人住了十四个晚上。中位随访时间为25.5个月。到局部进展的中位时间为24.1个月(95%CI:0-52.8),其中1-2-,5年LPFS为57.9%,57.9%和20.7%,分别。远端进展的中位时间为4.3个月(95%CI:0.3-8.3),其中1-2-,5年DPFS为31.6%,13.2%和13.2%,分别。
结论:IRE是一种安全有效的微创治疗淋巴结转移的方法,其中温度依赖性消融可能是禁忌的。在神经附近使用IRE时应小心。
OBJECTIVE: Demonstrating the safety and efficacy of percutaneous irreversible electroporation (IRE) for the treatment of lymph node metastases.
METHODS: An IRB-approved, single-center retrospective review was performed on patients with lymph node metastases gastrointestinal, and genitourinary primary cancers. Primary objective safety was evaluated by assessing complications graded according to the Clavien-Dindo Classification, and efficacy was determined by tumor response on follow-up imaging and local progression-free survival (LPFS). Secondary outcome measures were technical success (complete ablation with an adequate ablative margin > 5 mm), length of hospital stay and distant progression-free survival (DPFS).
RESULTS: Nineteen patients underwent percutaneous IRE between June 2018 and February 2023 for lymph node metastases, close to critical structures, such as vasculature, bowel, or nerves. The technical success was achieved in all cases. Complications occurred in four patients (21.1%), including two self-limiting grade 1 hematomas, a grade 1 abdominal pain, and grade 2 nerve pain treated with medication. Seventeen patients were hospitalized overnight, one patient stayed two nights and another patient stayed fourteen nights. Median follow-up was 25.5 months. Median time to local progression was 24.1 months (95% CI: 0-52.8) with 1-, 2-, and 5-year LPFS of 57.9%, 57.9% and 20.7%, respectively. Median time to distant progression was 4.3 months (95% CI: 0.3-8.3) with 1-, 2-, and 5-year DPFS of 31.6%, 13.2% and 13.2%, respectively.
CONCLUSIONS: IRE is a safe and effective minimally-invasive treatment for lymph node metastases in locations, where temperature dependent ablation may be contraindicated. Care should be taken when employing IRE near nerves.