射频消融术联合肝动脉化疗栓塞及西妥昔单抗治疗结直肠癌肝转移的疗效评价
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摘要
目的探究射频消融术(RFA)联合肝动脉栓塞化疗术(TACE)及西妥昔单抗(cetuximab)治疗结直肠癌肝转移的临床疗效。方法回顾性分析2010年1月—2014年1月49例结直肠癌肝转移患者,分为治疗组(RFA+TACE+cetuximab)23例和对照组(TACE+cetuximab)26例,观察两组患者治疗后实体瘤疗效、1年总生存率(OS)、1年无进展生存率(PFS)及不良反应的情况。结果治疗组的完全缓解率达到73.9%(17/23),明显优于对照组的26.9%(7/26),差异有统计学意义(P<0.05)。治疗组及对照组的OS差异无统计学意义(P>0.05);但治疗组的1年PFS为52.2%,优于对照组的23.1%,差异有统计学意义(P<0.05)。结论对于无法手术的结直肠癌肝转移患者,RFA联合TACE及西妥昔单抗治疗的近期疗效及1年PFS优于单纯TACE联合西妥昔单抗治疗,具有肿瘤完全坏死率高、肝内复发率低的优点。
Objective To evaluate the clinical efficacy of radiofrequency ablation(RFA) therapy combined with transcatheter artery chemoembolization(TACE) and cetuximab for hepatic metastases from colorectal carcinoma. Methods The clinical data of 49 cases with hepatic metastasis from colorectal carcinoma, who were admitted to authors' hospital during the period from January 2010 to January 2014,were retrospectively analyzed. Based on the therapeutic scheme the patients were divided into the treatment group(using RFA +TACE +cetuximab) and the control group(TACE +cetuximab). The therapeutic effect of solid tumor, one-year overall survival(OS), one-year progression free survival(PFS) and adverse reactions of the two groups were recorded, and the results were compared between the two groups. Results The complete remission rate of the treatment group was 73.9%, which was obviously higher than 26.9% of the control group; the difference was statistically significant(P <0.05). No statistically significant difference in one-year OS existed between the two groups(P >0.05); one-year PFS of the treatment group was 52.2%,which was obviously better than 23.1% of the control group, and the difference was statistically significant(P <0.05). Conclusion For the treatment of inoperable hepatic metastases from colorectal carcinoma,RFA combined with TACE and cetuximab is superior to TACE plus cetuximab in aspects of short-term effect and one-year PFS, besides, this therapy carries higher complete tumor necrosis rate and lower intrahepatic recurrence rate.
Objective To evaluate the clinical efficacy of radiofrequency ablation(RFA) therapy combined with transcatheter artery chemoembolization(TACE) and cetuximab for hepatic metastases from colorectal carcinoma. Methods The clinical data of 49 cases with hepatic metastasis from colorectal carcinoma, who were admitted to authors' hospital during the period from January 2010 to January 2014,were retrospectively analyzed. Based on the therapeutic scheme the patients were divided into the treatment group(using RFA +TACE +cetuximab) and the control group(TACE +cetuximab). The therapeutic effect of solid tumor, one-year overall survival(OS), one-year progression free survival(PFS) and adverse reactions of the two groups were recorded, and the results were compared between the two groups. Results The complete remission rate of the treatment group was 73.9%, which was obviously higher than 26.9% of the control group; the difference was statistically significant(P <0.05). No statistically significant difference in one-year OS existed between the two groups(P >0.05); one-year PFS of the treatment group was 52.2%,which was obviously better than 23.1% of the control group, and the difference was statistically significant(P <0.05). Conclusion For the treatment of inoperable hepatic metastases from colorectal carcinoma,RFA combined with TACE and cetuximab is superior to TACE plus cetuximab in aspects of short-term effect and one-year PFS, besides, this therapy carries higher complete tumor necrosis rate and lower intrahepatic recurrence rate.
引文
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[11]Ruers T,Coevorden F van,Pierie J,et al.Radiofrequency ablation(RFA)combined with chemotherapy for unresectable colorectal liver metastases(CRC LM):interim results of a randomised phaseⅡstudy of the EORTC-NCRI CCSG-ALM Intergroup 40004(CLOCC)[J].J Clin Oncol(Meeting Abstracts),2008,26:4012.
[12]赵明,王健鹏,吴沛宏,等.射频消融治疗结直肠癌肝转移及其预后因素分析[J].中华医学杂志,2010,90:1587-1592.
[13]Di Bartolomeo M,Maggi C,Ricchini F,et al.Bevacizumab treatment in the elderly patient with metastatic colorectal cancer[J].Clin Interv Aging,2015,10:127-133.
[14]Heinemann V,Von Weikersthal LF,Decker T,et al.FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer(FIRE-3):a randomised,open-label,phase 3 trial[J].Lancet Oncol,2014,15:1065-1075.
[2]Lencioni R,Llovet JM.Modified RECIST(m RECIST)assessment for hepatocellular carcinoma[J].Semin Liver Dis,2010,30:52-60.
[3]Sotelo MJ,Garcia-Paredes B,Aguado C,et al.Role of cetuximab in first-line treatment of metastatic colorectal cancer[J].World J Gastroenterol,2014,20:4208-4219.
[4]全毅,何柱光,李祥厦.TACE治疗化疗后进展期结直肠癌肝转移的临床研究[J].重庆医学,2012,41:859-860.
[5]Fiorentini G,Aliberti C,Mulazzani LA,et al.Chemoembolization in colorectal liver metastases:the rebirth[J].Anticancer Res,2014,34:575-584.
[6]范卫君,张亮,顾仰葵,等.大肠癌肝转移的射频消融治疗[J].介入放射学杂志,2006,15:75-77.
[7]王建华,王小林.腹部介入放射学[M].上海:上海医科大学出版社,1998.
[8]邵子力,吴健,陈敏山,等.射频消融与手术切除治疗结直肠癌肝转移的疗效比较[J].广东医学,2012,33:1410-1413.
[9]孙崇启,赵静.射频消融技术临床应用现状[J].介入放射学杂志,2007,16:502-504.
[10]Ruers T,Punt C,Van Coevorden F,et al.Radiofrequency ablation combined with systemic treatment versus systemic treatment alone in patients with non-resectable colorectal liver metastases:a randomized EORTC Intergroup phaseⅡstudy(EORTC 40004)[J].Ann Oncol,2012,23:2619-2626.
[11]Ruers T,Coevorden F van,Pierie J,et al.Radiofrequency ablation(RFA)combined with chemotherapy for unresectable colorectal liver metastases(CRC LM):interim results of a randomised phaseⅡstudy of the EORTC-NCRI CCSG-ALM Intergroup 40004(CLOCC)[J].J Clin Oncol(Meeting Abstracts),2008,26:4012.
[12]赵明,王健鹏,吴沛宏,等.射频消融治疗结直肠癌肝转移及其预后因素分析[J].中华医学杂志,2010,90:1587-1592.
[13]Di Bartolomeo M,Maggi C,Ricchini F,et al.Bevacizumab treatment in the elderly patient with metastatic colorectal cancer[J].Clin Interv Aging,2015,10:127-133.
[14]Heinemann V,Von Weikersthal LF,Decker T,et al.FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer(FIRE-3):a randomised,open-label,phase 3 trial[J].Lancet Oncol,2014,15:1065-1075.