肝转移癌射频消融的疗效

消融相关结直肠癌转移的自然病史（Natural history of CRC metastases in relation to ablation）

关于局部治疗的生存期报告

1. 外科治疗是结直肠癌肝转移的局部治疗也是射频消融治疗的一面镜子

外科作为肝转移癌传统治疗的方法，结果如何呢？下列Meta分析

外科：结直肠癌肝转移的局部治疗【1】，46个研究，9934例患者，随访范围17~99个月。

39项研究为肝切除（N=8485），7项研究为根治性肿瘤消融（伴或不伴肝切除）N=1449例

中位生存期：28-59月

5年整体生存（42篇文献涉及）：7~58%（med=36，24个研究）

1-3个结节，25.9~50%（中位39%）-19篇文献
≥4个结节，0%~53%（中位17.1%）-25篇文献
单纯根治性射频7%~33%（中位16%~33%
切除或/和射频，≤3结节显著好于≥4结节，但没有统计意义的差别单纯射频消融。

2. 局部治疗可以改善患者的生存期吗？【2】Local ablative treatment improves survival?


4-year OS；Chemotherapy: 9%；RFA : 22%	AbdallaEK, Ann Surg2004

Local ablative treatment improves survival?

Comparison Between Local Ablative Therapy and Chemotherapy for Non-Resectable Colorectal Liver Metastases: A Prospective Study


	RuersT, Ann Surg Oncol 2007【3】

Reporting survival of local therapies ：Surgery/ RFA predictive factors【4】

Resection Versus Laparoscopic Radiofrequency Thermal Ablation Of Solitary Colorectal Liver Metastasis

在临床上，罕有单独外科切除或根治性消融而不进行全身化疗。化疗结果如何呢？

Colorectal cancer metastases：1 year OS* after systemic chemotherapy

bilobar disease	5%
unilobar disease	27%
solitary metastasis	60%(<3% @ 5 years)

在发现结直肠癌肝转移的时候，化疗通常总是开始在最前面。

【5】

100pts with 507 CRC mets【5】

	中位生存期
100pts with 507 CRC mets	28 mths
RFA before any chemotherapy	48 mths
RFA after chemotherapy (residual or progressive)	22 mths

Reporting/comparing survival

Timing of RFA within the disease history

(Machi J, Cancer J, 2006; 12 : 318-326)

Evaluate results according to "treatmentline"

Avoidto treatprogressive patients100ptswith507CRCmetsMedianOverallsurvival:28mthsRFAbeforeanychemotherapy(medOS:48mths)RFAafterchemotherapy(residualorprogressive):(medOS:22mths)Natural historyof CRC metastasesin relation toablationTobecomparedwith1stlinechemotherapy?

即使是不能手术的病人，RCT证据表明消融+化疗超过单纯化疗的疗效。


无进展生存期 RFA+化疗 VS. 化疗	整体生存期 RFA+化疗 VS. 化疗

Ruers ASCO 2010 CLOCC trial

1. Smith MD, McCall JL. Systematic review of tumour number and outcome after radical treatment of colorectal liver metastases. Br J Surg. 2009 Oct; 96(10):1101-13.

.2. Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, Hess K, Curley SA. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004 Jun;239(6):818-25; discussion 825-7.

3. Ruers TJ, Joosten JJ, Wiering B, Langenhoff BS, Dekker HM, Wobbes T, Oyen WJ, Krabbe PF, Punt CJ. Comparison between local ablative therapy and chemotherapy for non-resectable colorectal liver metastases: a prospective study Ann Surg Oncol. 2007 Mar;14(3):1161-9. Epub 2006 Dec 31.

4. .Berber E, Tsinberg M, Tellioglu G, Simpfendorfer CH, Siperstein AE. Resection versus laparoscopic radiofrequency thermal ablation of solitary colorectal liver metastasis. J Gastrointest Surg. 2008 Nov;12(11):1967-72.

5. Machi J, Oishi AJ, Sumida K, Sakamoto K, Furumoto NL, Oishi RH, Kylstra JW. Long-term outcome of radiofrequency ablation for unresectable liver metastases from colorectal cancer: evaluation of prognostic factors and effectiveness in first- and second-line management. Cancer J. 2006 Jul-Aug;12(4):318-26.

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肝转移癌射频消融的疗效