Department of Specialist Imaging, University College Hospital, London, UK.
Clin Oncol (R Coll Radiol). 2010 Nov;22(9):781-4. doi: 10.1016/j.clon.2010.08.004. Epub 2010 Sep 9.
Minimally invasive, image-guided thermal ablation is gaining acceptance for the treatment of solid tumour deposits and its use is increasing. This overview discusses one method of thermal ablation in one palliative setting; the local control of breast cancer liver metastases (BCLM) using radiofrequency ablation. Breast cancer is common and over half of all women diagnosed with metastatic disease develop BCLM. The mainstay of therapy remains chemotherapy and supportive care, which may prolong survival to a median of 18-24 months. Despite breast cancer being considered a systemic disease, surgical series of metastectomy for BCLM have shown a survival advantage. Despite this, surgery for BCLM is rarely practiced due to the associated morbidity for a relatively meagre survival benefit. Similarly, radiofrequency ablation has been used for local control of BCLM; the reported series show a median survival of between 30 and 60 months, with no treatment-related deaths and only three serious treatment-related adverse events in 164 patients reported. Despite this, scepticism remains over the efficacy of BCLM ablation due to the heterogeneity of patient inclusion and selective nature of reporting. Randomised trials are needed to formulate robust evidence-based recommendations and direct the necessary allocation of health care resources. Whether or not local ablative treatment of BCLM conveys a survival advantage is an important consideration. However, in this non-curative setting, it is essential that other outcome measures are carefully evaluated in conjunction with survival, including symptoms (local and constitutional), quality of life and psychological morbidity. To these ends, a randomised, multicentre trial to assess best medical therapy alone versus best medical therapy plus radiofrequency ablation in patients presenting with newly diagnosed BCLM with or without the presence of stable extra-hepatic disease will shortly be underway.
微创、影像引导的热消融技术因其在治疗实体肿瘤方面的有效性而逐渐被接受，其应用也在不断增加。本篇综述讨论了热消融技术在一个姑息治疗环境中的应用，即使用射频消融治疗乳腺癌肝转移（BCLM）。乳腺癌较为常见，超过一半被诊断为转移性疾病的女性会发生 BCLM。目前的主要治疗方法仍然是化疗和支持性治疗，这可以将中位生存期延长至 18-24 个月。尽管乳腺癌被认为是一种全身性疾病，但乳腺癌切除术治疗 BCLM 的手术系列研究显示出了生存优势。尽管如此，由于相关的发病率较高，而生存获益相对较低，因此很少有患者选择手术治疗 BCLM。同样，射频消融也被用于 BCLM 的局部控制，报告的系列研究显示，中位生存期为 30 至 60 个月，164 例患者中无治疗相关死亡，仅报告了 3 例严重的与治疗相关的不良事件。尽管如此，由于患者纳入的异质性和报告的选择性，BCLM 消融的疗效仍然存在争议。需要进行随机试验来制定强有力的循证建议，并指导必要的医疗资源分配。局部消融治疗 BCLM 是否能带来生存优势是一个重要的考虑因素。然而，在这种非治愈性的治疗环境中，除了生存时间，还必须仔细评估其他结果指标，包括症状（局部和全身）、生活质量和心理发病率。为此，一项旨在评估新诊断的 BCLM 患者（伴或不伴稳定的肝外疾病）单独接受最佳药物治疗与最佳药物治疗联合射频消融治疗的效果的随机、多中心试验即将开始。
