Huashan Hospital Radiofrequency Treatment Center was established in November 2007 and started treating the first patient on December 18, 2007. Among them, 65% are neurological tumors and 35% are body tumors. Among the body tumors, lung cancer takes the first place, liver tumor and spinal vertebral tumor are tied for the second place. Huashan Hospital Radiofrequency Knife Treatment Center is the center with the largest number of radiofrequency knives in China.
Radio wave knife is a kind of radiation therapy equipment, it is not a universal machine, and treatment must be carried out according to the indications in order to achieve the ideal effect. The treatment effect of the radio wave knife does not depend entirely on the machine, but more importantly on the doctors, physiotherapists and treatment technicians who master the machine. Lars Leksell, Swedish professor of neurosurgery, inventor of the Gamma Knife, said: A fool uses a tool (machine) or a fool. Responsible, conscientious doctors who are committed to treatment excellence and a good treatment team are necessary to achieve good treatment results. The following is the experience of Huashan Hospital’s Radiofrequency Knife Treatment Center in treating lung cancer, with the aim of benefiting more lung cancer patients who are suitable for Radiofrequency Knife treatment.
In the early stage of radio wave knife treatment, we selected some patients with advanced cancer and some patients whom we are very sure of for radio wave knife treatment, and these patients with advanced cancer got the effect of symptom improvement and life quality improvement, and we have accumulated treatment experience.
Incidence of lung cancer: According to the statistical results of cancer incidence in large cities in China, the incidence and death rate of lung cancer rank first among malignant tumors in Shanghai, Beijing, Tianjin, Wuhan, Harbin and other cities. Lung cancer is divided into nine categories according to pathological histological characteristics.
1.1 Squamous carcinoma
1.2 Small cell carcinoma
1.3 Adenocarcinoma.
1.4 Large-cell carcinoma.
1.5 Adenosquamous carcinoma
1.6 Carcinoma with pleomorphic/sarcomatoid/sarcomatous component
1.7 Carcinoid tumor
1.8 Salivary gland type carcinoma
1.9 Carcinoma that cannot be classified
Clinically, lung cancer is simply classified into small cell lung cancer and non-small cell lung cancer (including adenocarcinoma, squamous carcinoma and large cell carcinoma, etc.).
History of lung cancer treatment with radiofrequency knife.
In 2003, Stanford University first reported the treatment of lung cancer with a single 15 Gy irradiation of the radio wave knife. 2006, Italy reported the introduction of lung cancer treatment using the radio wave knife breath-tracking technique, and in the same year, Dutch scholars reported the experience of lung cancer treatment with the radio wave knife, and Stanford University reported the results of a study of lung cancer treatment with a single 25 Gy irradiation ( In 2007, the University of Florida (USA) reported the follow-up results of stage I non-small cell lung cancer treated with the radiofrequency knife, with a tumor control rate of 93.2% at 1 year and 85.8% at 4.5 years after treatment. According to foreign reports, the 2-year control of stage I peripheral type non-small cell lung cancer is around 95%.
Most of the lung cancer patients treated at Huashan Hospital’s Radiofrequency Knife Treatment Center are elderly patients and some advanced lung cancer patients, but we have achieved satisfactory treatment results by formulating individualized treatment plans according to the patients’ conditions, with a total of 300 lung cancer cases treated in 5 years. The treatment regimen we adopt is slightly different from the 3-treatment regimen reported abroad; we usually use a regimen of 4 or 5 treatments, and a few patients are treated 6 or even 7-8 times. We found that irradiation with the radio wave knife for 4 or 5 times with moderately lower dose for each irradiation and increasing the number of irradiation, the total dose of treatment remains the same, the side effects after treatment are mild and the tumor control is good.
Indications for radiofrequency knife treatment of non-small cell lung cancer (adenocarcinoma, squamous carcinoma, large cell carcinoma, adenosquamous carcinoma):
1.Small stage I peripheral lung cancer with tumor diameter less than 3cm: the best indication for radiofrequency knife treatment
2.Senior patients with peripheral lung cancer, the tumor diameter can be relaxed to 5cm: it is a good indication for radiofrequency knife treatment.
3.Patients with small central lung cancer, where the tumor does not invade the trachea or bronchi heavily and surgical resection is difficult, can choose radiofrequency knife treatment combined with chemotherapy (or targeted therapy)
4.Patients with superior vena cava syndrome caused by tumor compression of superior vena cava; or patients with mediastinal lymph node metastasis compressing trachea or superior vena cava; radio wave knife can be used as a palliative treatment to improve symptoms and enhance life quality.
Radio wave knife treatment is a kind of local radiotherapy. After radio wave knife treatment, if the patient is in good health, he still needs to combine chemotherapy or targeted therapy and other comprehensive management.
The following is a brief introduction of lung cancer cases treated by radio wave knife in Huashan Hospital
Case 1: The patient was 70 years old and her right lung cancer was found during physical examination. Due to some medical diseases that could not tolerate surgery, she chose radio wave knife treatment. This peripheral type small lung cancer is the best indication for radio wave knife treatment, with good effect and mild side effects. The patient felt tired and fatigue within 2-3 weeks after treatment, and the fatigue symptoms basically disappeared after 1 month. The tumor disappears 1 year after treatment. The following are the CT images of the patient at the time of radiofrequency knife treatment and the CT images of the patient’s re-examination 2 years and 2 months after treatment.
Case 2, the patient was 78 years old with peripheral type lung cancer (non-small cell lung cancer) with a tumor diameter greater than 5 cm and a large volume of tumor (89 cm3). This larger peripheral type of lung cancer is a good indication for radio-wave knife treatment. We adopt a staged treatment plan. The first irradiation was 4 times with 9Gy dose each time, and the tumor shrank after one year and was treated with radio wave knife again. The patient had no uncomfortable symptoms after the radio wave knife treatment, and although the repeat lung CT showed that the tumor lesion was still there, it did not develop for a long time, which could be due to radiation damage of the lung or fibrosis after tumor necrosis, and the patient has been living normally for 4 years and is in very good health.
Left peripheral lung cancer with a large tumor. a and b: CT at the time of the first radio wave knife treatment, tumor maximum diameter 68 mm. c and d: tumor shrinkage 1 year after radio wave knife treatment and radio wave knife treatment again. The colored curves on the figure are the isodose curves at the time of radio wave knife treatment.
The lung CT was reviewed after the radio-wave knife treatment. E and F: 1.5 years after the first radio-wave knife treatment (6 months after the second treatment), the left lung cancer shrank. G and K: 4 years after the radio-wave knife treatment, the tumor still remained in the shrunken state with large pulmonary alveoli around the tumor, but the patient had no uncomfortable symptoms and had a high quality of life without discomfort for 4 years.
Case 3: The patient was 75 years old and was found to have right-sided lung cancer (central type, non-small cell lung cancer) due to coughing lung CT examination, and the tumor was adjacent to the large bronchus. Due to the weakness of the patient’s system, he could not be treated surgically, so he opted for radio wave knife treatment. After the radio wave knife treatment, no treatment was done due to the weakness of the patient’s body that could not tolerate chemotherapy. The patient recovered well after the radio wave knife treatment without any uncomfortable symptoms and had a high quality of life. However, PET-CT was repeated 1 year later and the treated lung cancer disappeared and a new tumor appeared in the left lung (as shown in Figure 5 and Figure 6).
A repeat PET-CT 1 year after radio-wave knife treatment showed that the right central lung cancer disappeared without metabolic activity, but a new tumor appeared in the left lung. There was no chemotherapy after radio wave knife treatment because the patient’s general condition could not receive chemotherapy, but the patient had no uncomfortable symptoms and was as normal. Again radio wave knife treatment for left lung cancer.
Case 4: The patient was 74 years old, 3.5 years after surgery for peripheral lung cancer, and recently developed edema of the left face and left shoulder in January. Radiofrequency knife irradiated the mediastinal lymph node metastasis in small doses and several times. The patient’s symptoms began to improve 2 weeks after treatment and returned to normal after 1 month. A repeat lung CT showed that the mediastinal metastases had disappeared.
Radiofrequency knife treatment of mediastinal lymph node metastases. a, b and c: images at the time of radiofrequency knife treatment, the color curves on the graph are isodose curves with fractionated radiofrequency knife treatment. d, e and f: review of enhanced chest CT 1 month after radiofrequency knife treatment showed disappearance of mediastinal lymph node metastases.
Case 5: Postoperative chemotherapy for lung cancer with pericardial metastasis (images to be uploaded later). The patient had an open-chest attempt to surgically remove the metastasis on the pericardium, but failed to do so and was then treated with radio-wave knife. After radio-wave knife treatment, the patient went to work normally, the metastases were significantly reduced, and PET–CT showed reduced metabolism.
Case 6: An elderly patient with left-sided central lung cancer was found to be inoperable due to poor lung function. We treated the patient with radio-wave knife, and the patient’s symptoms improved after treatment. 1 year later, PET-CT was repeated and found that the tumor treated with radio-wave knife shrank and had no metabolic activity, and a new tumor appeared in the right lung, which was treated with radio-wave knife again.
Left central lung cancer, changes before and after radio-wave knife treatment. a: before radio-wave knife treatment (yellow colored part is tumor); b: 1 year after radio-wave knife treatment tumor shrank significantly, PET-CT showed no metabolic activity of tumor. There was radiological lung injury around the tumor, but the patient was asymptomatic.
1 year after radio wave knife treatment, a new tumor appeared in the right side of the lung and was treated with radio wave knife again. Due to the patient’s advanced age and general weakness, the patient refused systemic chemotherapy.