Bortolotto C, Macchi S, Veronese L, Dore R, Draghi F, Rossi S
Institute of Radiology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy.
J Ultrasound. 2012 Sep;15(3):199-205. doi: 10.1016/j.jus.2012.06.007. Epub 2012 Jun 27.
Breast cancer (BC) is the most common malignancy in women. Various studies [5,6] have shown that surgical resection of single liver or lung metastases in patients with metastases from BC increases survival. Radiofrequency ablation (RFA) can be an alternative to resection in some patients when resection is not feasible.
From January 2002 to December 2008, 491 patients with liver metastases underwent US-guided percutaneous RFA. Of these patients 5 (5/491; 1%) had BC. In the same period, 32 patients with pulmonary metastases underwent CT-guided RFA. Of these patients 3 (3/32; 9%) had BC. Mean age was 61.3 years. All patients were postmenopausal and receiving polychemotherapy according to international guidelines. Inclusion criteria for RFA treatment of metastases from BC applied are identical or in some cases more restrictive than those reported in the literature.
There were no deaths or severe complications and no treatment failures. Disease free and overall median survival were respectively 7.65 and 25.7 months after US-guided RFA and 13.4 and 34.8 months after CT-guided RFA. During follow-up (mean follow-up 26 months, range 4-63 months) 5/8 (62.5%) patients exhibited recurrence: 3/5 (60%) had local recurrence and 2/5 (40%) had non-local recurrence; 4/5 patients with recurrence were re-treated.
The authors' experience confirms that RFA is an effective, safe and repeatable technique in the treatment of metastases from BC. Metastatic recurrence rate confirms that metastatic BC is a disease which requires a multidisciplinary approach and that the role of chemotherapy is indisputable. Effects on survival are promising but further confirmation is needed through prospective randomized studies.
乳腺癌(BC)是女性中最常见的恶性肿瘤。各种研究[5,6]表明,对发生BC转移的患者进行单发性肝或肺转移灶的手术切除可提高生存率。当切除不可行时,射频消融(RFA)可作为某些患者切除的替代方法。
2002年1月至2008年12月,491例肝转移患者接受了超声引导下经皮RFA。其中5例(5/491;1%)患有BC。同期,32例肺转移患者接受了CT引导下RFA。其中3例(3/32;9%)患有BC。平均年龄为61.3岁。所有患者均为绝经后患者,并根据国际指南接受多药化疗。应用于BC转移灶RFA治疗的纳入标准与文献报道相同或在某些情况下更严格。
无死亡或严重并发症,也无治疗失败情况。超声引导下RFA后无病生存期和总生存期的中位数分别为7.65个月和25.7个月,CT引导下RFA后分别为13.4个月和34.8个月。在随访期间(平均随访26个月,范围4 - 63个月),8例患者中有5例(62.5%)出现复发:5例中有3例(60%)为局部复发,2例(40%)为非局部复发;5例复发患者中有4例接受了再次治疗。
作者的经验证实,RFA是治疗BC转移灶的一种有效、安全且可重复的技术。转移复发率证实转移性BC是一种需要多学科方法治疗的疾病,化疗的作用是无可争议的。对生存的影响很有前景,但需要通过前瞻性随机研究进一步证实。