Vogl Thomas J, Farshid Parviz, Naguib Nagy N N, Darvishi Abbas, Bazrafshan Babak, Mbalisike Emmanuel, Burkhard Thorsten, Zangos Stephan
Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany,
Radiol Med. 2014 Jul;119(7):451-61. doi: 10.1007/s11547-014-0415-y. Epub 2014 Jun 4.
Surgery is currently considered the treatment of choice for patients with colorectal cancer liver metastases (CRLM) when resectable. The majority of these patients can also benefit from systemic chemotherapy. Recently, local or regional therapies such as thermal ablations have been used with acceptable outcomes. We searched the medical literature to identify studies and reviews relevant to radiofrequency (RF) ablation, microwave (MW) ablation and laser-induced thermotherapy (LITT) in terms of local progression, survival indexes and major complications in patients with CRLM. Reviewed literature showed a local progression rate between 2.8 and 29.7 % of RF-ablated liver lesions at 12-49 months follow-up, 2.7-12.5 % of MW ablated lesions at 5-19 months follow-up and 5.2 % of lesions treated with LITT at 6-month follow-up. Major complications were observed in 4-33 % of patients treated with RF ablation, 0-19 % of patients treated with MW ablation and 0.1-3.5 % of lesions treated with LITT. Although not significantly different, the mean of 1-, 3- and 5-year survival rates for RF-, MW- and laser ablated lesions was (92.6, 44.7, 31.1 %), (79, 38.6, 21 %) and (94.2, 61.5, 29.2 %), respectively. The median survival in these methods was 33.2, 29.5 and 33.7 months, respectively. Thermal ablation may be an appropriate alternative in patients with CRLM who have inoperable liver lesions or have operable lesions as an adjunct to resection. However, further competitive evaluation should clarify the efficacy and priority of these therapies in patients with colorectal cancer liver metastases.
对于可切除的结直肠癌肝转移（CRLM）患者，手术目前被视为首选治疗方法。这些患者中的大多数也可从全身化疗中获益。最近，诸如热消融等局部或区域治疗方法已被应用且取得了可接受的效果。我们检索了医学文献，以确定与射频（RF）消融、微波（MW）消融和激光诱导热疗（LITT）在CRLM患者的局部进展、生存指标和主要并发症方面相关的研究及综述。综述文献显示，在12 - 49个月的随访中，RF消融肝病灶的局部进展率为2.8%至29.7%，在5 - 19个月的随访中，MW消融病灶的局部进展率为2.7%至12.5%，在6个月的随访中，LITT治疗病灶的局部进展率为5.2%。接受RF消融治疗的患者中有4%至33%出现主要并发症，接受MW消融治疗的患者中有0%至19%出现主要并发症，接受LITT治疗的病灶中有0.1%至3.5%出现主要并发症。尽管无显著差异，但RF、MW和激光消融病灶的1年、3年和5年生存率平均值分别为（92.6%，44.7%，31.1%）、（79%，38.6%，21%）和（94.2%，61.5%，29.2%）。这些方法的中位生存期分别为33.2个月、29.5个月和33.7个月。对于有不可切除肝病灶或有可切除病灶作为切除辅助手段的CRLM患者，热消融可能是一种合适的替代方法。然而，进一步的对比评估应明确这些治疗方法在结直肠癌肝转移患者中的疗效和优先顺序。
