热消融治疗寡转移性肝病的结直肠癌患者
Thermal Ablation in the Management of Colorectal Cancer Patients with Oligometastatic Liver Disease.
作者信息
Petre Elena Nadia, Sofocleous Constantinos
机构信息
Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
出版信息
Visc Med. 2017 Mar;33(1):62-68. doi: 10.1159/000454697. Epub 2017 Feb 3.
BACKGROUND
Surgical resection of limited colorectal liver disease improves long-term survival and can be curative in a subset of selected cases. Image-guided percutaneous ablation therapies have emerged as safe and effective alternative options for selected patients with unresectable colorectal liver metastases (CLM) that can be ablated with margins. Ablation causes focal destruction of tissue and has increasingly been shown to provide durable eradication of tumors.
METHODS
A selective review of literature was conducted in PubMed, focusing on recent studies reporting on the safety, efficacy, and long-term outcomes of percutaneous ablation modalities in the treatment of CLM. The present work gives an overview of the different ablation techniques, their current clinical indications, and reported outcomes from most recently published studies. The 'test of time' concept for using ablation as a first local therapy is also described.
RESULTS
There are several thermal ablative tools currently available, including radiofrequency ablation (RFA), microwave ablation, and cryoablation. Most data to date originated from the application of RFA. Adjuvant thermal ablation in the treatment of oligometastatic colon cancer liver disease offers improved oncologic outcomes. The ideal CLM amenable to percutaneous ablation is a solitary tumor with the largest diameter up to 3 cm that can be completely ablated with a sufficient margin. 5-year overall survival rates up to 70% after ablation of unresectable CLM have been reported. Pathologic confirmation of complete tumor necrosis with margins over 5 mm provides best long-term local tumor control by thermal ablation.
CONCLUSION
Current evidence suggests that percutaneous ablation as adjuvant to chemotherapy improves oncologic outcomes of patients with CLM. For small tumors that can be ablated completely with clear margins, percutaneous ablation may offer outcomes similar to those of surgery.
背景
对局限性结直肠癌肝转移灶进行手术切除可提高长期生存率，并且在部分特定病例中可实现治愈。对于部分无法切除但可在边缘进行消融的结直肠癌肝转移（CLM）患者，图像引导下经皮消融治疗已成为安全有效的替代选择。消融可导致组织局部破坏，并且越来越多地显示出能持久根除肿瘤。
方法
在PubMed上进行了文献的选择性回顾，重点关注近期报道经皮消融方式治疗CLM的安全性、有效性和长期结局的研究。本研究概述了不同的消融技术、其当前的临床适应证以及最近发表研究报道的结局。还描述了将消融作为首选局部治疗的“时间考验”概念。
结果
目前有几种热消融工具可用，包括射频消融（RFA）、微波消融和冷冻消融。迄今为止，大多数数据来自RFA的应用。辅助热消融治疗寡转移性结肠癌肝转移可改善肿瘤学结局。适合经皮消融的理想CLM是最大直径达3 cm的孤立肿瘤，可在有足够边缘的情况下完全消融。据报道，不可切除CLM消融后5年总生存率高达70%。病理证实肿瘤完全坏死且边缘超过5 mm可通过热消融提供最佳的长期局部肿瘤控制。
结论
目前的证据表明，经皮消融作为化疗的辅助手段可改善CLM患者的肿瘤学结局。对于可在有清晰边缘的情况下完全消融的小肿瘤，经皮消融可能提供与手术相似的结局。
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