Image-Guided Ablation for Colorectal Liver Metastasis: Principles, Current Evidence, and the Path Forward.
Image-Guided Ablation for Colorectal Liver Metastasis: Principles, Current Evidence, and the Path Forward.
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影像引导消融治疗结直肠癌肝转移：原则、现有证据和前进道路。
DOI：
10.3390/cancers13163926
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发表时间：
2021-08-04
期刊：
影响因子：
5.2
通讯作者：
Odisio BC
中科院分区：
文献类型：
--
作者：
Lin YM;Paolucci I;Brock KK;Odisio BC
结直肠癌是全球第四大常见癌症。大约20%的结直肠癌患者出现同步肝转移，高达60%的结直肠癌患者在病程中会发生异时转移。虽然肝切除术目前被认为是结肠直肠癌肝转移（CLM）的局部治疗选择，但在诊断为CLM时，只有不到三分之一的患者符合手术条件。对于小clm患者，消融术是一种完善的、侵入性较小的局部治疗方法，对于不可切除的clm患者，与适合手术治疗的患者相比，消融术显示出良好的肿瘤预后。随着对影响肿瘤预后因素的认识不断增加，可切除的小体积CLMs患者可以采用热消融治疗。成像和图像引导技术的不断发展促进了CLM治疗的范式转变。本文讨论了患者选择、患者因素、肿瘤因素、消融技术和临床应用的重要性。图像引导消融术可有效控制部分CLM患者的局部肿瘤。一项随机对照试验表明，与单独的全身化疗相比，射频消融联合全身化疗可使不可切除的CLM患者的生存获益。对于小肿瘤，有足够边缘的消融术可作为切除的替代方法。消融技术的改进可以治疗靠近主要血管结构或胆管的肿瘤，热消融模式的适用性具有挑战性。有几个因素影响消融的结果，包括但不限于肿瘤大小、数量、位置、最小消融边缘、RAS突变状态、既往肝切除术和肝外疾病。进一步了解肿瘤生物学和先进的成像指导对患者整体预后的影响可能有助于定制其应用，并改善图像引导消融的结果。
Colorectal cancer is the fourth most common type of cancer globally. Approximately 20% of patients with colorectal cancer present with synchronous liver metastases, and up to 60% will develop metachronous metastases during the course of the disease. Although liver resection is currently considered the local treatment of choice for colorectal liver metastasis (CLM), less than one-third of patients are eligible for surgery at the time of diagnosis of CLM. Ablation is a well-established, less invasive, locoregional therapy for patients with small CLMs, which has shown favorable oncological outcomes in patients with unresectable CLMs, comparable to those in patients eligible for surgery. The increasing knowledge of factors affecting oncological outcomes has allowed selected patients with resectable small volume CLMs to be treated with thermal ablation with curative intent. The continuous technological evolutions in imaging and image guidance have contributed to this paradigm shift in CLM treatment. The importance of patient selection, patient factors, tumor factors, ablation techniques, and clinical applications is discussed in this article. Image-guided ablation can provide effective local tumor control in selected patients with CLM. A randomized controlled trial suggested that radiofrequency ablation combined with systemic chemotherapy resulted in a survival benefit for patients with unresectable CLM, compared to systemic chemotherapy alone. For small tumors, ablation with adequate margins can be considered as an alternative to resection. The improvement of ablation technologies can allow the treatment of tumors close to major vascular structures or bile ducts, on which the applicability of thermal ablation modalities is challenging. Several factors affect the outcomes of ablation, including but not limited to tumor size, number, location, minimal ablation margin, RAS mutation status, prior hepatectomy, and extrahepatic disease. Further understanding of the impact of tumor biology and advanced imaging guidance on overall patient outcomes might help to tailor its application, and improve outcomes of image-guided ablation.
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影响因子：
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影响因子：
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