Maastricht University, Faculty of Health, Medicine and Life Sciences, School of Medicine, Maastricht, The Netherlands; Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
Cancer Treat Rev. 2014 Feb;40(1):60-7. doi: 10.1016/j.ctrv.2013.05.004. Epub 2013 Jun 13.
Long-term survival can be obtained with local treatment of lung metastases from colorectal cancer. However, it is unclear as to what the optimal local therapy is: surgery, radiofrequency ablation (RFA) or stereotactic radiotherapy (SBRT).
A systematic review included 27 studies matching with the a priori selection criteria, the most important being ≥50 patients and a follow-up period of ≥24months. No SBRT studies were eligible. The review was therefore conducted on 4 RFA and 23 surgical series.
Four of the surgical studies were prospective, all others were retrospective. No randomized trial was found. The reporting of data differed between the studies, which led to difficulties in the analyses. Treatment-related mortality rates for RFA and surgery were 0% and 1.4-2.4%, respectively, whereas morbidity rates were reported inconsistently but seemed the lowest for surgery.
Due to the lack of phase III trials, no firm conclusions can be drawn, although most evidence supports surgery as the most effective treatment option. High-quality trials comparing currently used treatment modalities such as SBRT, RFA and surgery are needed to inform treatment decisions.
通过局部治疗结直肠癌肺转移，可获得长期生存。然而，尚不清楚最佳的局部治疗方法是手术、射频消融（RFA）还是立体定向放疗（SBRT）。
系统评价纳入了 27 项符合预设选择标准的研究，最重要的标准是至少有 50 例患者和 24 个月以上的随访期。没有符合条件的 SBRT 研究。因此，本研究仅对 4 项 RFA 和 23 项手术系列进行了分析。
4 项手术研究为前瞻性研究，其余均为回顾性研究。未发现随机试验。研究之间的数据报告存在差异，这导致分析存在困难。RFA 和手术的治疗相关死亡率分别为 0%和 1.4%-2.4%，而发病率的报告不一致，但手术似乎发病率最低。
由于缺乏 III 期试验，因此无法得出明确结论，尽管大多数证据支持手术是最有效的治疗选择。需要高质量的试验来比较目前使用的治疗方法，如 SBRT、RFA 和手术，以指导治疗决策。
