Radiofrequency ablation of hepatic tumors: Increased tumor destruction with adjuvant liposomal doxorubicin therapy
Radiofrequency ablation of hepatic tumors: Increased tumor destruction with adjuvant liposomal doxorubicin therapy
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DOI：
10.2214/ajr.179.1.1790093
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发表时间：
2002-07-01
影响因子：
5
通讯作者：
Raptopoulos, V
中科院分区：
文献类型：
--
作者：
Goldberg, SN;Kamel, IR;Raptopoulos, V
OBJECTIVE.本研究的目的是确定在局灶性肝肿瘤中，射频消融前给予脂质体阿霉素是否比单独射频消融更能增加凝血。14个局灶性肝肿瘤（直径。10例患者（结直肠癌，n = 3例患者;肝细胞癌，n = 4例;神经内分泌肿瘤，n = 2例;乳腺癌，n = 1例）接受了内冷射频消融治疗。除了接受射频治疗外，5例患者（n = 7处病变）在消融前24小时被随机分配接受20 mg长循环隐形脂质体载体（Doxil）IV阿霉素治疗。射频消融术后即刻（30分钟内）（基线）和消融术后2-4周进行对比增强螺旋CT检查。通过三维重建技术测量诱导凝血体积，并将测量结果进行比较。对于单独使用射频治疗的肿瘤，消融后2-4周，热损伤体积减少了12- 2 - 4%（平均SD，初始体积的82.5% +/- 4.4%）。相比之下，在消融术后2-4周，观察到联合使用Doxil和射频治疗的所有病变的肿瘤破坏增加（p < 0.001）。6个病灶体积增加24-36%，结直肠小转移灶周围的凝血增加342%。在两名单独接受Doxil治疗的患者中，在四个未消融的对照病变中没有发现凝血。我们的初步临床研究表明，在各种局灶性肝肿瘤中，与单独的射频消融治疗相比，辅助Doxil化疗增加了肿瘤破坏。这种协同策略的优化可能最终改善临床疗效和结局。
OBJECTIVE. The purpose of this study was to determine whether the administration of liposomal doxorubicin before radiofrequency ablation increases coagulation more than radiofrequency alone in focal hepatic tumors.SUBJECTS AND METHODS. Fourteen focal hepatic tumors (diameter. mean +/- SD, 4.0 +/- 1.8 cm) in 10 patients (colorectal cancer, n = 3 patients; hepatocellular carcinoma, n = 4; neuroendocrine tumor, n = 2; breast cancer, n = 1) were treated with internally cooled radiofrequency ablation. In addition to undergoing radiofrequency, five patients (n = 7 lesions) were randomly assigned to receive 20 mg of IV doxorubicin in a long-circulating stealth liposome carrier (Doxil) 24 hr before ablation. Contrast-enhanced helical CT was performed immediately (within 30 min) after radiofrequency ablation (baseline) and 2-4 weeks after ablation. The volume of induced coagulation was measured by three-dimensional reconstruction techniques, and the measurements were compared.RESULTS. For tumors treated with radiofrequency alone, the volume of the thermal lesion had decreased 12-24% (mean SD, 82.5% +/- 4.4% of initial volume) at 2-4 weeks after ablation. By comparison, increased tumor destruction at 2-4 weeks after ablation was observed for all lesions treated with combined Doxil and radiofrequency (p < 0.001). Six lesions increased 24-36% in volume, and coagulation surrounding a small colorectal metastasis increased 342%. No coagulation was identified in four unablated control lesions in the two patients receiving Doxil alone.CONCLUSION. Our pilot clinical study suggests that adjuvant Doxil chemotherapy increases tumor destruction compared with radiofrequency ablation therapy alone in a variety of focal hepatic tumors. Optimization of this synergistic strategy may ultimately allow improved clinical efficacy and outcome.