Radiofrequency Ablation as First-Line Treatment in Patients With Early Colorectal Liver Metastases Amenable to Surgery
Radiofrequency Ablation as First-Line Treatment in Patients With Early Colorectal Liver Metastases Amenable to Surgery
复制标题
DOI：
10.1097/sla.0b013e3181bc9fae
复制
发表时间：
2010-05-01
影响因子：
9
通讯作者：
Pitton, Michael Bernhard
中科院分区：
文献类型：
--
作者：
Otto, Gerd;Dueber, Christoph;Pitton, Michael Bernhard
目的：为了避免徒劳的手术，我们测试了射频消融（RFA）是否可以作为结直肠手术后第一年内发生的结直肠转移（CRLM）患者的一线治疗。背景数据摘要：手术切除是 CRLM 患者的标准治疗。主要回顾性分析已确定结直肠手术与 CRLM 发生之间的时间间隔对于预后具有重要意义。迄今为止，尚不清楚如果将 RFA 作为一线治疗是否会影响各个患者的生存。 方法：根据临床路径，我们优先采用 RFA 治疗结直肠手术后第一年内检测到的 CRLM 患者（n = 28）。由于转移病灶的数量、大小或位置而被认为不适合 RFA 的患者进行了切除术 (n = 82)。各组之间病变的直径不同。患者和病变的所有其他特征都是可比的。局部复发和新出现的肝脏病灶尽可能采用重复射频消融或手术治疗。结果：射频消融或切除后的患者中，分别有32%和4%（P < 0.001）出现消融或切除部位局部复发，50%和34%（P = 0.179）出现除既往治疗部位以外的新转移，32%和37%（P = 0.820）的患者出现全身复发。分别进行手术。主要接受 RFA 治疗的患者的进展时间显着缩短（203 天与 416 天；P = 0.017）。初步治疗后，9 名 RFA 患者和 8 名手术患者接受了重复 RFA 或重复手术，两个治疗组的无病患者率和 3 年总生存率相同：分别为 67% 和 60%； P = 0.93。 结论：尽管局部肿瘤复发和进展时间较短，但早期 CRLM 患者的生存率并不取决于主要肝脏治疗的模式。
Objective: Aiming at avoidance of futile surgery, we have tested whether radiofrequency ablation (RFA) may be used as first-line treatment in patients with colorectal metastases (CRLM) occurring within the first year after colorectal surgery.Summary Background Data: Surgical resection is the standard treatment in patients with CRLM. Major retrospective analyses have identified the interval between colorectal surgery and the occurrence of CRLM to be of prognostic importance. So far, it is unknown whether survival of the respective patients is hampered if RFA is used as first-line treatment.Methods: According to a clinical pathway, we have treated patients with CRLM detected within the first year after colorectal surgery preferentially by RFA (n = 28). Resection (n = 82) was performed in patients who were deemed not amenable to RFA due to number, size, or location of metastatic lesions. The diameter of lesions differed between the groups. All other characteristics of patients and lesions were comparable. Local recurrence and new hepatic lesions were treated with repeated RFA or surgery whenever possible.Results: Local recurrence at the site of ablation or resection occurred in 32% and 4% (P < 0.001), new metastases apart from the site of previous treatment in 50% and 34% (P = 0.179), and systemic recurrence in 32% and 37% (P = 0.820) of the patients after RFA and surgery, respectively. Time to progression was significantly shorter in patients primarily treated with RFA (203 vs. 416 days; P = 0.017). After primary treatment, 9 RFA patients and 8 surgery patients were amenable to repeated RFA or repeated surgery resulting in identical rates of disease-free patients and identical 3-year overall survival in both treatment groups: 67% and 60%, respectively; P = 0.93.Conclusions: Despite striking differences in local tumor recurrence and shorter time to progression, survival in patients with early CRLM does not depend on the mode of primary hepatic treatment.