Veltri Andrea, Sacchetto Paola, Tosetti Irene, Pagano Eva, Fava Cesare, Gandini Giovanni
Department of Clinical and Biological Sciences, Institute of Radiology, University of Torino, Regione Gonzole 10, 10043, Orbassano, TO, Italy.
Cardiovasc Intervent Radiol. 2008 Sep-Oct;31(5):948-56. doi: 10.1007/s00270-008-9362-0. Epub 2008 May 28.
The objective of this study was to analyze long-term results of radiofrequency thermal ablation (RFA) for colorectal metastases (MTS), in order to evaluate predictors for adverse events, technique effectiveness, and survival. One hundred ninety-nine nonresectable MTS (0.5-8 cm; mean, 2.9 cm) in 122 patients underwent a total of 166 RFA sessions, percutaneously or during surgery. The technique was "simple" or "combined" with vascular occlusion. The mean follow-up time was 24.2 months. Complications, technique effectiveness, and survival rates were statistically analyzed. Adverse events occurred in 8.1% of lesions (major complication rate: 1.1%), 7.1% with simple and 16.7% with combined technique (p = 0.15). Early complete response was obtained in 151 lesions (81.2%), but 49 lesions (26.3%) recurred locally after a mean of 10.4 months. Sustained complete ablation was achieved in 66.7% of lesions < or = 3 cm versus 33.3% of lesions > 3 cm (p < 0.0001). Survival rates at 1, 3, and 5 years were 91%, 54%, and 33%, respectively, from the diagnosis of MTS and 79%, 38%, and 22%, respectively, from RFA. Mean survival time from RFA was 31.5 months, 36.2 in patients with main MTS < or = 3 cm and 23.2 in those with at least one lesion > 3 cm (p = 0.006). We conclude that "simple" RFA is safe and successful for MTS < or = 3 cm, contributing to prolong survival when patients can be completely treated.
本研究的目的是分析射频热消融（RFA）治疗结直肠癌转移灶（MTS）的长期结果，以评估不良事件的预测因素、技术有效性和生存率。122例患者的199个不可切除的MTS（直径0.5 - 8 cm；平均2.9 cm）接受了总共166次RFA治疗，治疗途径为经皮或术中治疗。该技术为“单纯”或“联合”血管闭塞。平均随访时间为24.2个月。对并发症、技术有效性和生存率进行了统计学分析。8.1%的病灶发生不良事件（主要并发症发生率：1.1%），单纯技术组为7.1%，联合技术组为16.7%（p = 0.15）。151个病灶（81.2%）获得早期完全缓解，但49个病灶（26.3%）在平均10.4个月后局部复发。直径≤3 cm的病灶有66.7%实现持续完全消融，而直径>3 cm的病灶为33.3%（p < 0.0001）。从MTS诊断起，1年、3年和5年的生存率分别为91%、54%和33%，从RFA治疗起分别为79%、38%和22%。RFA后的平均生存时间为31.5个月，主要MTS≤3 cm的患者为36.2个月，至少有一个病灶>3 cm的患者为23.2个月（p = 0.006）。我们得出结论，“单纯”RFA对于≤3 cm的MTS是安全且成功的，当患者能够得到完全治疗时有助于延长生存期。
