Izaaryene Jean, Grange Rémi, Habouzit Vincent, Grange Sylvain, Orsini Bastien, Dassa Michael, Daidj Nassima, Thierry Louis, Ferre Marjorie, Phelip Jean Marc, Lelong Bernard, De Chaisemartin Cécile, Mitry Emmanuel, Piana Gilles
Interventional Radiology Department, Institut Paoli Calmettes, Aix Marseille University, 232 Boulevard Sainte Marguerite, 13009, Marseille, France.
Department of Interventional Radiology, University Hospital of Saint-Etienne, University Hospital of Saint-Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France.
Eur Radiol. 2025 Jun;35(6):3282-3293. doi: 10.1007/s00330-024-11153-0. Epub 2024 Nov 22.
To evaluate the oncological efficacy and complications of cryoablation (CA) in treating lung metastases from colorectal cancer (CRC) at the lung periphery.
The inclusion criteria for this bicenter retrospective study included patients with histologically confirmed CRC, with radiologically confirmed lung metastases at the periphery of the lung (distance of less than or equal to 2 cm from the costal, diaphragmatic, or cervical pleura) treated with CA between January 2017 and June 2022. Patients with intra-parenchymal metastases or metastases close to the mediastinal pleura and patients without follow-up were excluded.
Seventy-three patients were included (median age: 69 years, range 47.0-83.0; 38 males, 52.0%) with 113 metastases and 89 procedures. Technical success was achieved in all procedures. During follow-up (median 22 months), on a per metastasis basis, local recurrence occurred for 8/113 (7%) of the metastases in 7 patients at a median time of 19 months; 7 had concomitant distant recurrence. Local progression-free survival rates were 95% at 1 year and 89% at 2, 3, and 4 years. Distant progression occurred in 41/73 (56.2%) patients, significantly associated with a history of liver metastasis and synchronous lung metastasis (p < 0.05). The median chemotherapy-free survival was 14 (IQR (5.0-21.5)) months. Complications were predominantly mild or moderate, with a low incidence of severe complications.
CA demonstrates high rate of local control and appears well-tolerated in the treatment of peripheral lung metastases from CRC. The procedure offers a viable therapeutic option, allowing patients a significant period without chemotherapy.
Question Despite its advantages over surgery, data on cryoablation of metastases from colorectal cancer at the periphery of the lung are lacking. Findings Cryoablation enabled very good local control, with local progression-free survival rates of 95% at 1 year and 89% at 2, 3, and 4 years. Clinical relevance Cryoablation is an effective treatment for local tumor control of lung metastases from colorectal cancer at the periphery of the lung. The treatment is well tolerated and can provide patients with substantial relief from chemotherapy.
评估冷冻消融术（CA）治疗结直肠癌（CRC）肺外周转移瘤的肿瘤学疗效及并发症。
本双中心回顾性研究的纳入标准包括：组织学确诊为CRC，2017年1月至2022年6月期间接受CA治疗且经影像学确诊为肺外周转移瘤（距肋胸膜、膈胸膜或颈胸膜距离小于或等于2 cm）的患者。排除实质内转移瘤患者、靠近纵隔胸膜的转移瘤患者以及无随访资料的患者。
纳入73例患者（中位年龄：69岁，范围47.0 - 83.0岁；男性38例，占52.0%），共113处转移瘤，进行了89次手术。所有手术均取得技术成功。随访期间（中位时间22个月），以每处转移瘤计算，113处转移瘤中有8处（7%）在7例患者中出现局部复发，中位时间为19个月；7例伴有远处复发。1年、2年、3年和4年的局部无进展生存率分别为95%、89%、89%和89%。41/73（56.2%）例患者出现远处进展，与肝转移病史和同时性肺转移显著相关（p < 0.05）。无化疗生存的中位时间为14（IQR（5.0 - 21.5））个月。并发症多为轻、中度，严重并发症发生率低。
CA在治疗CRC肺外周转移瘤方面显示出较高的局部控制率，且耐受性良好。该手术提供了一种可行的治疗选择，使患者在相当长一段时间内无需化疗。
问题 尽管冷冻消融术相对于手术具有优势，但缺乏关于肺外周结直肠癌转移瘤冷冻消融的数据。发现 冷冻消融术实现了良好的局部控制，1年、2年、3年和4年的局部无进展生存率分别为95%、89%、89%和89%。临床意义 冷冻消融术是治疗肺外周结直肠癌肺转移瘤局部肿瘤控制的有效方法。该治疗耐受性良好，可为患者提供显著的化疗缓解。
