Kurilova I, Gonzalez-Aguirre A, Beets-Tan R G, Erinjeri J, Petre E N, Gonen M, Bains M, Kemeny N E, Solomon S B, Sofocleous C T
Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Cardiovasc Intervent Radiol. 2018 Oct;41(10):1530-1544. doi: 10.1007/s00270-018-2000-6. Epub 2018 May 29.
To review outcomes following microwave ablation (MWA) of colorectal cancer pulmonary metastases and assess predictors of oncologic outcomes.
Technical success, primary and secondary technique efficacy rates were evaluated for 50 patients with 90 colorectal cancer pulmonary metastases at immediate, 4-8 weeks post-MWA and subsequent follow-up CT and/or F-FDG PET/CT. Local tumor progression (LTP) rate, LTP-free survival (LTPFS), cancer-specific and overall survivals were assessed. Complications were recorded according to SIR classification.
Median follow-up was 25.6 months. Median tumor size was 1 cm (0.3-3.2 cm). Technical success, primary and secondary technique efficacy rates were 99, 90 and 92%, respectively. LTP rate was 10%. One-, 2- and 3-year LTPFS were: 93, 86 and 86%, respectively, with median LTPFS not reached. Median overall survival was 58.6 months, and median cancer-specific survival (CSS) was not reached. One-, 2- and 3-year overall and CSS were 94% and 98, 82 and 90%, 61 and 70%, respectively. On univariate analysis, minimal ablation margin (p < 0.001) and tumor size (p = 0.001) predicted LTPFS, with no LTP for minimal margin ≥ 5 mm and/or tumor size < 1 cm. Pleural-based metastases were associated with increased LTP risk (p = 0.002, SHR = 7.7). Pre-MWA CEA level > 10 ng/ml (p = 0.046) and ≥ 3 prior chemotherapy lines predicted decreased CSS (p = 0.02). There was no 90-day death. Major complications rate was 13%.
MWA with minimal ablation margin ≥ 5 mm is essential for local control of colorectal cancer pulmonary metastases. Pleural-based metastases and larger tumor size were associated with higher risk of LTP. CEA level and pre-MWA chemotherapy impacted CSS.
回顾结直肠癌肺转移灶微波消融（MWA）后的结局，并评估肿瘤学结局的预测因素。
对50例患者的90个结直肠癌肺转移灶在MWA后即刻、4 - 8周以及随后的随访CT和/或F - FDG PET/CT检查时评估技术成功率、一次和二次技术有效率。评估局部肿瘤进展（LTP）率、无LTP生存期（LTPFS）、癌症特异性生存率和总生存率。根据SIR分类记录并发症。
中位随访时间为25.6个月。中位肿瘤大小为1 cm（0.3 - 3.2 cm）。技术成功率、一次和二次技术有效率分别为99%、90%和92%。LTP率为10%。1年、2年和3年的LTPFS分别为93%、86%和86%，未达到中位LTPFS。中位总生存期为58.6个月，中位癌症特异性生存期（CSS）未达到。1年、2年和3年的总生存率和CSS分别为94%和98%、82%和90%、61%和70%。单因素分析显示，最小消融边缘（p < 0.001）和肿瘤大小（p = 0.001）可预测LTPFS，最小边缘≥5 mm和/或肿瘤大小<1 cm时无LTP。基于胸膜的转移灶与LTP风险增加相关（p = 0.002，SHR = 7.7）。MWA前CEA水平>10 ng/ml（p = 0.046）和≥3线既往化疗可预测CSS降低（p = 0.02）。无90天死亡病例。主要并发症发生率为13%。
最小消融边缘≥5 mm的MWA对于结直肠癌肺转移灶的局部控制至关重要。基于胸膜的转移灶和较大肿瘤大小与LTP风险较高相关。CEA水平和MWA前化疗影响CSS。
