肝静脉汇合处肿瘤的立体定向射频消融。

Stereotactic radiofrequency ablation of tumors at the hepatic venous confluence.

机构信息

Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.

Department of Radiology, The Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK.

出版信息

HPB (Oxford). 2022 Jul;24(7):1044-1054. doi: 10.1016/j.hpb.2021.11.010. Epub 2021 Nov 24.

DOI:10.1016/j.hpb.2021.11.010

PMID:34887174

Abstract

BACKGROUND

Radiofrequency ablation (RFA) is subject to "heat-sink" effects, particularly for treatment of tumors adjacent to major vessels.

METHODS

In this retrospective study, 104 patients with 137 tumors (40 HCC, 10 ICC and 54 metastatic liver tumors) close to (≤1 cm from) the hepatic venous confluence underwent stereotactic RFA (SRFA) between June 2003 and June 2018. Median tumor size was 3.7 cm (1.4-8.5) for HCC, 6.4 cm (0.5-11) for ICC and 3.8 cm (0.5-13) for metastases. Endpoints comprised safety, local tumor control, overall and disease-free survival.

RESULTS

The overall major complication rate was 16.0% (20/125 ablations), where 8 (40%) were successfully treated by the interventional radiologist in the same anesthetic session and did not prolong hospital stay. 134/137 (97.8%) tumors were successfully ablated at initial SRFA. Local recurrence (LR) developed in 19/137 tumors (13.9%). The median and overall survival (OS) rates at 1-, 3-, and 5- years from the date of the first SRFA were 51.5 months, 73.5%, 67.0%, and 49.7% for HCC, 14.6 months, 60.0%, 32.0% and 32.0% for ICC and 38.1 months, 91.4%, 56.5% and 27.9% for metastatic disease, respectively.

CONCLUSION

SRFA represents a viable alternative to hepatic resection for challenging tumors at the hepatic venous confluence.

摘要

背景

射频消融（RFA）受到“热沉”效应的影响，特别是在治疗靠近大血管的肿瘤时。

方法

在这项回顾性研究中，我们对 104 名 137 个肿瘤（40 个 HCC、10 个 ICC 和 54 个转移性肝肿瘤）靠近（≤1cm 距离）肝静脉汇流处的患者进行了立体定向射频消融（SRFA）治疗，这些患者接受治疗的时间为 2003 年 6 月至 2018 年 6 月。HCC 的肿瘤中位大小为 3.7cm（1.4-8.5），ICC 为 6.4cm（0.5-11），转移性肿瘤为 3.8cm（0.5-13）。终点包括安全性、局部肿瘤控制、总体和无病生存率。

结果

总的主要并发症发生率为 16.0%（20/125 个消融），其中 8 例（40%）在同一次麻醉中由介入放射科医生成功治疗，并未延长住院时间。137 个肿瘤中有 134 个（97.8%）在首次 SRFA 时成功消融。19 个肿瘤（13.9%）出现局部复发（LR）。从首次 SRFA 日期起，1 年、3 年和 5 年的中位及总体生存率（OS）分别为 HCC 为 51.5 个月、73.5%、67.0%和 49.7%，ICC 为 14.6 个月、60.0%、32.0%和 32.0%，转移性疾病为 38.1 个月、91.4%、56.5%和 27.9%。