Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
Department of Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
Eur Radiol. 2020 Feb;30(2):1221-1227. doi: 10.1007/s00330-019-06421-3. Epub 2019 Sep 6.
To evaluate the mid-term outcome of salvage radiofrequency ablation (RFA) treatment in patients who exhibited intrahepatic recurrence after major hepatectomy for colorectal liver metastases (CRCLM).
Observational study on 23 consecutive patients (mean age 59 ± 9 years; 14/9 male/female) who, after a single (11/23) or multiple rounds (12/23) of major hepatic surgery, developed recurrent CRCLM in the liver remnant. Patients with a maximum of three metastases measuring up to 3 cm, and without relevant extrahepatic disease, underwent CT-guided RFA. Using the Kaplan-Meier-method, median intrahepatic progression-free-survival (ihPFS) and overall survival (OS) times after salvage RFA were compared with the same patients' time between the respective last round of surgery and diagnosis of intrahepatic recurrence leading to RFA.
Median follow-up was 26 months (range 12-103 months). Median ihPFS time after RFA was 8 months (range 1-81 months). Median ihPFS time after the respective last round of surgery and RFA in the same patients had been 5 months (range 1-23 months), thus yielding similar ihPFS times after surgery vs. after salvage RFA (p = 0.238; Mood's median test). After RFA, 15/23 (65%) of patients developed new hepatic metastases within the first year post-RFA. Median OS was 37 months, with a 1-year OS rate of 100%, 3-year OS rate of 57%, and 5-year OS rate of 24%. No major complications were observed.
Patients who exhibit intrahepatic recurrence of CRCLM after major hepatectomy will experience intrahepatic recurrence after salvage RFA as well, and after similar time intervals. However, long-term ihPFS may still be achieved in some patients.
• Patients who exhibit intrahepatic recurrence of colorectal liver metastases after major hepatectomy will experience intrahepatic recurrence after salvage RFA as well, and after similar time intervals. • About two-thirds of all patients develop new metastases elsewhere in the liver within 1 year after RFA. • However, long-term intrahepatic progression-free survival may still be achieved in some patients.
评估射频消融（RFA）治疗在结直肠癌肝转移（CRCLM）患者行肝切除术（major hepatectomy）后出现肝内复发（intrahepatic recurrence）的中期疗效。
对 23 例连续患者（平均年龄 59±9 岁；14/9 男/女）进行观察性研究，这些患者在单次（11/23）或多次（12/23）行 major hepatic surgery 后，在肝残余部位出现 CRCLM 肝内复发。最大程度不超过 3cm 且无相关肝外疾病的 3 个转移灶患者，行 CT 引导下 RFA。采用 Kaplan-Meier 法比较挽救性 RFA 后患者的中位肝内无进展生存期（intrahepatic progression-free-survival，ihPFS）和总生存期（overall survival，OS）与相同患者各自最后一轮手术至导致 RFA 的肝内复发之间的时间。
中位随访时间为 26 个月（范围 12-103 个月）。RFA 后中位 ihPFS 时间为 8 个月（范围 1-81 个月）。相同患者各自最后一轮手术和 RFA 后的中位 ihPFS 时间为 5 个月（范围 1-23 个月），因此手术与挽救性 RFA 后的 ihPFS 时间相似（p=0.238；Mood 的中位数检验）。RFA 后，23 例中有 15 例（65%）患者在 RFA 后 1 年内出现新的肝转移。中位 OS 为 37 个月，1 年 OS 率为 100%，3 年 OS 率为 57%，5 年 OS 率为 24%。未观察到重大并发症。
行 major hepatectomy 治疗后出现 CRCLM 肝内复发的患者也会在挽救性 RFA 后出现肝内复发，且时间间隔相似。然而，一些患者仍可能获得长期的 ihPFS。
行 major hepatectomy 治疗后出现结直肠癌肝转移（CRCLM）肝内复发的患者也会在挽救性射频消融（RFA）后出现肝内复发，且时间间隔相似。
RFA 后 1 年内约 2/3 的患者会在肝脏其他部位出现新的转移灶。
然而，一些患者仍可能获得长期的肝内无进展生存期。
