Clinical Application Of MR-guided Minimally Invasive Treatment For Mid-advanced Non-small Cell Lung Cancer

ObjectiveTo study the clinical efficacy, safety and feasibility of integrated therapy of chemotherapy with125I radioactive particles implantation or cryoablation under MR guidance for non-small cell lung cancer in mid-advanced stage, and investigate the individualized treatment.MethodsJune2012-December2013, a total of23cases of mid-advanced non-small cell lung cancer patients approved by pathology, including:8cases with squamous cell carcinoma,14cases with adenocarcinoma,1case with poorly differentiated carcinoma; Ⅲa7cases, Ⅲb10cases, IV6cases. Under the guidance of0.23T open-configuration MR scanner (Marconi, Philips) mounted with optical tracking system (iPath200, Philips Medical System), all patients were undergone percutaneous lung biopsy and integrated therapy of chemotherapy with125I radioactive particles implantation or cryosurgery. Followed-up1-6months after operation regularly, the Karnofsky score, biological parameters of oncology, imaging changes, and survival rate were tested to evaluate curative effect.ResultAll cases of operation were successfully performed. There were six cases being undergone percutaneous interstitial radioactive125I particles implantation; seven cases were undergone cryoablation; and ten cases were undergone percutaneous cryoablation combined with125I particles implantation. The prescription dose(PD) of I25I seed implantation were110-140Gy; the planning target volume(PTV) included clinical target volume(CTV) plus5-10mm margin; the radioactivity quantum were 0.7～0.9mCi. Two or eight cryoprobes were used during the procedure in every case;95%of tumor size had been ablated for each procedure. Two, four and six months after the treatment favorable improvement was seen in52.17%、56.52%and60.87%of patients respectively, with the total effective rate of73.91%、86.95%and91.30%respectively. The six months survival rate was100%. The Karnofsky score in one month after operation improved from71.74±8.34to84.35±8.96. The biological parameters of oncology were tested pre and post operation. About83.33%(16/18) decreased in six months to a greater or lesser extent. Three patients (13.04%) had pneumothorax recovering after closed drainage. Five patients (21.74%) had fever, cough and other adverse reactions, but when receiving symptomatic treatment they were back to normal in about a week. The chemotherapy adverse reaction(I-II acute myelosuppression, Ⅰ-Ⅱ gastrointestinal reaction, mild trichomadesis).Conclusion1.0.23T open MRI-guided percutaneous interventional diagnosis and treatment is safe, feasible, and minimally invasive.2. Percutaneous lung biopsy and integrated therapy of chemotherapy with125I radioactive particles implantation or cryoablation under MRI guidance for non-small cell lung cancer in mid-advanced stage present a significant clinical short-term curative efficacy and improve the survival qualities of patients.