Radiotherapy and Radiosurgery, Humanitas Clinical and Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy.
Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy.
J Cancer Res Clin Oncol. 2018 Sep;144(9):1777-1783. doi: 10.1007/s00432-018-2692-7. Epub 2018 Jun 22.
The study aim was to compare the disease control in two groups of patients affected by liver metastases from CRC treated with microwave ablation (MWA) or stereotactic body radiation therapy (SBRT).
We extracted data of patients treated between 2009 and 2016. Inclusion criteria were: (1) maximum diameter of the liver lesions less than 4 cm; (2) no more than three liver lesions; (3) no evidence of progressive or untreated gross disease outside the liver; (4) adequate liver function; (5) no concurrent chemotherapy; (6) minimum age of 18. Tumour response was classified according to EORTC-RECIST criteria. Aim of the present study was to evaluate freedom from local progression (FFLP). To reduce indication bias, an inverse probability of treatment weighting was used to estimate treatment effect.
A total of 135 patients with 214 lesions were included in the analysis. Median follow-up time was 24.5 months (range 2.4-95.8). The 1-year freedom from local progression (FFLP) was 88% (95%CI 80-92). In the SBRT group, FFLP was statistically longer than MWA group (p = 0.0214); the 1-year FFLP was 91% (95% CI 81-95) in SBRT group and 84% (95% CI 0.72-0.91) in MWA group. Patients treated with SBRT showed a reduce risk of local relapse compared to MWA (adjusted HR 0.31; 95%CI 0.13-0.70, p = 0.005). As expected, analogous result obtained in the inverse probability weighting analysis (HR 0.38; 95%CI 0.18-0.80; p = 0.011).
In conclusion, there seems to be an advantage of SBRT compared to MWA in treating CRC liver metastases, particularly for lesions bigger than 30 mm.
本研究旨在比较两组接受微波消融（MWA）或立体定向体部放射治疗（SBRT）治疗结直肠癌肝转移患者的疾病控制情况。
我们提取了 2009 年至 2016 年期间接受治疗的患者数据。纳入标准为：（1）肝脏病变的最大直径小于 4cm；（2）不超过 3 个肝脏病变；（3）无肝外进展或未治疗的大体疾病证据；（4）肝功能充足；（5）无同期化疗；（6）年龄最小 18 岁。根据 EORTC-RECIST 标准对肿瘤反应进行分类。本研究的目的是评估无局部进展（FFLP）。为了减少治疗选择偏差，我们使用逆概率治疗加权法来估计治疗效果。
共纳入 135 例 214 个病灶的患者进行分析。中位随访时间为 24.5 个月（范围 2.4-95.8）。1 年无局部进展（FFLP）率为 88%（95%CI 80-92）。在 SBRT 组中，FFLP 明显长于 MWA 组（p=0.0214）；SBRT 组 1 年 FFLP 为 91%（95%CI 81-95），MWA 组为 84%（95%CI 0.72-0.91）。与 MWA 相比，接受 SBRT 治疗的患者局部复发风险降低（调整 HR 0.31；95%CI 0.13-0.70，p=0.005）。正如预期的那样，在逆概率加权分析中也得到了类似的结果（HR 0.38；95%CI 0.18-0.80；p=0.011）。
总之，SBRT 在治疗结直肠癌肝转移方面似乎优于 MWA，尤其是对于大于 30mm 的病灶。
