TAMPA (EGMN) –Radiofrequency ablation extended overall survival up to 3 years for 41% of patients with tumor recurrence in the liver following partial hepatectomy for colorectal cancer, according to results from a data review involving 209 patients.

Median overall survival of patients who received RFA was 31 months. Most of these patients (91%) were alive at 1 year, two-thirds were alive at 2 years, and 41% were alive at 3 years.

RFA “can significantly prolong the life of patients with limited treatment options,” said Dr. Constantinos T. Sofocleous of Memorial Sloan-Kettering Cancer Center, New York.

Dr. Sofocleous and his colleagues abstracted the data from a prospectively constructed ablation database of patients treated at Sloan-Kettering. The investigators identified 304 tumors in 209 patients who were treated during 2002-2008. Of these, 71 tumors were recurrent liver metastases in 56 patients who had already undergone partial hepatectomy for colorectal cancer, said Dr. Sofocleous at the annual meeting of the Society of Interventional Radiology.

All 56 patients received RFA as salvage treatment. These patients typically had their first follow-up with CT imaging at 4-6 weeks after ablation. “This is essentially to establish the effectiveness of the technique,” he said. This first image is used as the baseline for comparison with subsequent CT scans every 2-4 months.

Technical success – defined as an ablation region covering the entire tumor on the first follow-up CT scan – was achieved for 94% of lesions. The median follow-up period was 22 months.

Local tumor progression (LTP) following RFA occurred in 36 patients, and 10 patients underwent repeat RFA. Median primary and assisted (after repeat ablation) LTP-free survival were 10 and 25 months, respectively. Notably, 86% of recurrences were seen in the first year following ablation. More than half (52%) of recurrences were multifocal or extrahepatic.

“There is a high rate of tumor progression after a single ablation. This demonstrates how aggressive these tumors are,” said Dr. Sofocleous, an interventional radiologist at Sloan-Kettering.

The researchers also developed a modified clinical risk score, which included liver tumor size greater than 3 cm, disease-free interval less than 12 months, more than one liver tumor, and a positive-node primary tumor (each worth one point). Patients with a total score of 3 or 4 were considered to be high risk.

“There is a significant difference in survival between low-risk and high-risk patients,” Dr. Sofocleous said. Overall survival for low-risk patients was 35 months, compared with 21 months for high-risk patients.

In fact, the clinical risk score essentially was the only factor identified as a significant predictor of overall survival and progression, he said.

Dr. Sofocleous reported that he had no relevant financial relationships.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

坦帕(EGMN)——一项纳入209例患者数据的综述发现，对于因结直肠癌肝转移而行部分肝切除后肝肿瘤复发患者来说，射频消融(RFA)可将其中41%的总体生存时间延长至3年。

 

接受RFA治疗者的中位总体生存时间为31个月。大多数(91%)患者在1年时存活，2/3的患者在2年时存活，41%的患者在3年时存活。

 

纽约纪念Sloan-Kettering癌症中心的Constantinos T. Sofocleous博士说：“RFA可显著延长治疗选择有限患者的生存时间。”

 

Sofocleous博士及其同事抽取了对在Sloan-Kettering中心接受治疗的患者进行前瞻性构建的消融治疗数据库中的数据。Sofocleous博士在介入放射学会年会上表示，研究者们在209例2002~2008年收治的患者中确诊了304处肿瘤。其中，56例患者的71处肿瘤为复发性肝转移，并因结直肠癌肝转移而接受过部分肝切除术。

 

所有56例患者接受RFA作为挽救治疗。通常于RFA治疗后4~6周对这些患者进行CT检查随访。Sofocleous博士说：“这是确定这种方法有效性所必需的”。这次CT检查结果将被作为基线数据用来与随后每2~4个月的CT结果进行比较。

 

技术成功率为94%，即首次随访CT检查显示消融区域完全覆盖了整个肿瘤。中位随访时间为22个月。

 

RFA治疗后，36例患者发生了局部肿瘤进展(LTP)，其中10例接受了再次RFA治疗。中位初始和辅助(再次消融治疗后)无LTP生存时间分别为10个月和25个月。值得注意的是，86%的肿瘤复发发生在消融治疗后1年内。而超过半数(52%)的复发肿瘤是多灶性的或为肝外复发。

 

Sloan-Kettering中心的介入放射专家Sofocleous博士说：“单次消融治疗后肿瘤的进展率较高，就此可以看出这些肿瘤的侵袭性有多高。”

 

研究者们还开发了一种改良的临床风险评分系统，其包括肝肿瘤直径>3 cm、无病生存期<12个月、>1个肝肿瘤和原发肿瘤有淋巴结转移(每条分值为1分)。总评分为3分或4分的患者被归为高危。

 

Sofocleous博士说：“低危与高危患者的生存率之间具有显著差异。”低危患者的总体生存时间为35个月，而高危患者为21个月。

 

Sofocleous博士说，实际上，研究发现，仅临床风险评分为患者总体生存和疾病进展的显著预测因子。

 

Sofocleous博士表示无相关利益冲突声明。

 

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