Department of Gastroenterology, Endocrinology, Metabolism and Infectiology, University Hospital Marburg, Marburg, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Marburg, Germany.
J Neuroendocrinol. 2023 Jun;35(6):e13289. doi: 10.1111/jne.13289. Epub 2023 Jun 15.
In progression of multifocal liver metastases of gastroenteropancreatic neuroendocrine tumors (GEP-NET) escalation of systemic therapy is indicated. The aim of this retrospective study was to investigate the potential of local thermal ablation in hepatic oligoprogression and otherwise stable disease in GEP-NET. Patients with hepatic oligoprogression and otherwise stable disease, who underwent radiofrequency ablation (RFA) or microwave ablation (MWA) for local control, were included in the study. Thermal ablation was performed while maintaining the ongoing systemic therapy or without addition of a systemic therapy. The effectiveness of this therapeutic approach was evaluated by determination of local treatment success, improvement of progression-free survival (PFS) and the safety. Seventeen thermal ablation procedures were performed in 13 patients with well differentiated NET including seven ileum NET, four pancreatic NET, one appendix NET and one rectum NET. RFA and MWA of liver metastases were well tolerated without major complications. Thermal ablation resulted in an estimated median PFS of 62.6 weeks (mean 50.5 weeks; range 10.1-78.9 weeks) per procedure. In four patients, two ablation procedures were performed throughout the course of their disease resulting in an estimated median PFS of 69.1 weeks (mean 71.6 weeks; range 10.1-123.1 weeks) per patient. Start or change of systemic therapy could be delayed up to 123.1 weeks by using thermal ablations for isolated progression of single liver metastases. 88% of thermal ablations prolonged PFS. Thermal ablation of liver metastases in a non-curative intent has the potential to provide focal growth control and to prolong PFS in GEP-NET patients with hepatic oligoprogression.
在胃肠胰神经内分泌肿瘤（GEP-NET）的多灶性肝转移进展中，建议进行全身治疗升级。本回顾性研究的目的是探讨局部热消融在 GEP-NET 肝寡进展和其他稳定疾病中的潜在作用。本研究纳入了接受射频消融（RFA）或微波消融（MWA）局部控制的肝寡进展和其他稳定疾病的患者。在维持正在进行的全身治疗或不添加全身治疗的情况下进行热消融。通过确定局部治疗的成功率、无进展生存期（PFS）的改善和安全性来评估这种治疗方法的有效性。13 名高分化 NET 患者（包括 7 名回肠 NET、4 名胰腺 NET、1 名阑尾 NET 和 1 名直肠 NET）共进行了 17 次热消融手术。肝转移的 RFA 和 MWA 耐受性良好，无重大并发症。热消融导致估计中位 PFS 为 62.6 周（平均 50.5 周；范围 10.1-78.9 周）/次。在 4 名患者中，在疾病过程中进行了两次消融手术，导致估计中位 PFS 为 69.1 周（平均 71.6 周；范围 10.1-123.1 周）/患者。通过对单个肝转移灶的孤立进展进行热消融，可以将全身治疗的开始或改变延迟长达 123.1 周。88%的热消融延长了 PFS。在 GEP-NET 患者中，以非治愈为目的的肝转移热消融具有提供局部生长控制和延长 PFS 的潜力。
