Interventional Oncology/Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
J Med Imaging Radiat Oncol. 2023 Dec;67(8):832-841. doi: 10.1111/1754-9485.13594. Epub 2023 Nov 9.
The presence of hepatic metastases indicates advanced disease and is associated with significant morbidity and mortality, especially when the hepatic disease is not amenable to locoregional treatments. The primary tumour of origin, the distribution and extent of metastatic disease, the underlying liver reserve, the patient performance status and the presence of comorbidities are factors that determine whether a patient will benefit from hepatectomy or local curative-intent treatments. For patients with metastatic colorectal cancer, the most common primary cancer that spreads to the liver, several studies have demonstrated a survival benefit for patients who can be treated with hepatectomy and/or percutaneous ablation, compared to those treated with chemotherapy alone. Despite advances in surgical techniques increasing the percentage of patients eligible for surgery, most patients have unresectable disease or are poor surgical candidates. Percutaneous ablation can be used to provide local disease control and prolong survival for both surgical and non-surgical candidates. This is typically offered to patients with small hepatic metastases that can be ablated with optimal (≥10 mm) or at least adequate minimum ablation margins (≥5 mm), as high local tumour control rates can be achieved for these patients which are comparable to surgical resection. This review summarizes available evidence and outcomes following percutaneous ablation of the most frequently encountered types of hepatic metastases in the clinical practice of interventional oncology. Patient selection, technical considerations, follow-up protocols and oncologic outcomes are presented and discussed.
肝转移的存在表明疾病已进入晚期，并与较高的发病率和死亡率相关，尤其是当肝脏疾病不能通过局部治疗来控制时。肿瘤的原发部位、转移灶的分布和范围、肝脏的潜在储备功能、患者的身体状况和合并症的存在，这些因素决定了患者是否能从肝切除术或局部治愈性治疗中获益。对于转移性结直肠癌患者（最常见的转移至肝脏的原发性癌症），多项研究表明，与单独化疗相比，能接受肝切除术和/或经皮消融治疗的患者有生存获益。尽管手术技术的进步提高了适合手术的患者比例，但大多数患者仍存在不可切除的疾病或不适合手术。经皮消融可用于为手术和非手术候选患者提供局部疾病控制并延长生存时间。对于那些肝脏转移灶较小（可以通过最佳消融范围（≥10 毫米）或至少足够的最小消融范围（≥5 毫米）进行消融）的患者，通常会采用这种方法，因为这些患者可以实现较高的局部肿瘤控制率，与手术切除的效果相当。本文综述了介入肿瘤学临床实践中最常见的几种肝转移瘤经皮消融的现有证据和结果。本文介绍并讨论了患者选择、技术考虑因素、随访方案和肿瘤学结果。
