微波消融治疗肝转移癌临床疗效及影响生存率的相关因素研究

目的 研究微波消融(MWA)治疗肝转移癌的临床疗效及影响生存率的相关因素.方法 收集经检查确诊为肝转移癌行MWA治疗的100例患者的病历资料,所有病例原发肿瘤均已控制.MWA 1个月后根据患者情况选行B超、超声造影、CT、MRI检查判断疗效.术后1个月后行B超、肝功能及肿瘤标志物检查,定期复查.定时进行电话或门诊随访.结果 不同肿瘤直径患者的完全消融率比较,差异有统计学意义(P﹤0.05);不同肿瘤直径患者的复发率比较,差异无统计学意义(P﹥0.05).原发肿瘤部位、肿瘤直径、肿瘤数目、分化程度与患者的生存率有关(P﹤0.05);性别、年龄、是否肝外转移与患者的生存率无关(P﹥0.05).多因素分析结果表明原发肿瘤部位与肿瘤数目均为肝转移癌患者预后的独立危险因素(P﹤0.05).结论 MWA对治疗肝转移癌的治疗效果良好,具有操作简单、耐受性好等优点;原发肿瘤部位与肿瘤数目均为肝转移癌患者预后的独立危险因素.     

Percutaneous thermal ablation for the treatment of colorectal liver metastases and hepatocellular carcinoma: a comparison of local therapeutic efficacy

Aim: This study aimed to compare the local therapeutic efficacy of percutaneous thermal ablation for colorectal liver metastases (CRLM) and hepatocellular carcinoma (HCC).

Methods: One hundred sixty-one CRLM nodules in 101 patients and 122 HCC nodules in 97 patients were treated with thermal ablation. Complications and local efficacy were retrospectively compared.

Results: Major complications were observed in two (2.0%) patients in the CRLM group and one (1.0%) in the HCC group (p?=?1.000). The complete ablation (CA) rate of lesions ≤?3?cm was lower in the CRLM group than in the HCC group (p?=?0.018). After a mean follow-up period of 21.1?±?20.7 months in the CRLM group and 22.1?±?17.6 months in the HCC group, the local tumour progression (LTP) rate of lesions >?3?cm was higher in the CRLM group than in the HCC group (p?=?0.036). The multivariate analysis revealed that only safety margin (≤?0.5?cm/>?0.5?cm) was a significant predictor of LTP in both CRLM and HCC.

Conclusions: To achieve better local tumour control, thermal ablation should be more aggressive for CRLM than for HCC, especially for large tumours in clinical.     

Surgical microwave ablation for multifocal non-resectable liver metastases: a single institution experience treating five or more liver lesions

BackgroundThermal ablation is an effective treatment for patients with metastatic colon and rectal cancer and allows surgeons to offer curative intent therapy to patients who are otherwise not candidates for resection. We aimed to report outcomes of a single institution experience using microwave ablation (MWA) with or without resection to treat five or more liver metastases.MethodsIn this retrospective cohort study, the University of Minnesota Division of Surgical Oncology liver surgery database was queried to identify all patients who underwent thermal ablation of five or more colorectal liver metastases (CRLM) between 2012–2018. We reviewed patient, disease, and tumor characteristics and measured local, intrahepatic, and extrahepatic recurrence (EHR) rates. We also calculated median overall survival (OS) and disease-free survival (DFS).ResultsTen patients identified had five or more (range, 5–18) tumors ablated with or without combined liver and bowel resection. Median age was 50, and most patients were male (70%) and Caucasian (90%). Four patients received ablation alone (5–12 lesions), while six had combined resection and ablation (5–18 lesions). Ablation was performed laparoscopically in six patients, and four had ablations without resection. All patients received pre- and post-operative chemotherapy. A median of 7 tumors were ablated per patient. Median follow-up was 2.3 years. Among 75 tumors ablated, ablation site recurrence (ASR) (within 1 cm of ablation site) was seen in three with a per-lesion recurrence rate of 4%. Intrahepatic recurrence (IHR) occurred in 6 (60%) patients and EHR in 1 (10%). Five patients underwent retreatment of IHR during follow-up. Median OS was 3 years and DFS was 7.1 months. At the time of last follow up, 6 patients were disease-free.ConclusionsThermal ablation can provide acceptable DFS and OS, even with high volume metastatic colorectal cancers. Future efforts should be focused on defining selection criteria for those most likely to benefit from this aggressive approach.     

Impact of timing and cycles of systemic chemotherapy on survival outcome of colorectal liver metastases patients treated by percutaneous microwave ablation

Purpose: The aim of this retrospective study is to determine the optimal timing and number of cycles of systemic chemotherapy in patients with colorectal liver metastases (CLM) treated by ultrasound-guided percutaneous microwave ablation (PMWA).

Materials and methods: In total 199 patients with 318 CLM, median number of tumours one per patient and median maximum size of tumours 3.0?cm, treated by PMWA combined with or without systemic chemotherapy were included in our study. Chemotherapy was administered pre-ablatively in 148 of those patients (74.4%), and post-ablatively in 142 (73.6%). Chemotherapy regimens included FOLFOX/XELOX, FOLFIRI/XELIRI, and sequential monotherapy. Prognostic factors were evaluated by univariate and multivariate analyses, using log-rank test and Cox proportional hazards model, respectively.

Results: The estimated 5-year rates of progression free survival (PFS) and overall survival (OS) were 10.1% and 27.9%, respectively. The number of CLM (P?=?0.003), maximum size of CLM (P?<?0.001) and topography (P?=?0.030) were independent prognostic factors for PFS of patients with CLM while age (P?=?0.002), maximum size of CLM (P?=?0.006) and post-ablative chemotherapy (P?=?0.046) for OS. In further analysis, CLM patients receiving more than six cycles of post-ablative chemotherapy had significantly better OS (P?=?0.015) than those without post-ablative chemotherapy.

Conclusion: This study revealed chemotherapy administered after (more than six cycles) PMWA improved the OS of CLM patents. And, PMWA was a safe procedure in view of the absence of procedure-related death and low rate of major complications.     

局部微波消融联合髋臼球囊扩张骨水泥成形术治疗晚期髋臼转移瘤的临床疗效

目的 比较局部微波消融联合髋臼球囊扩张骨水泥成形术与传统髋臼球囊扩张骨水泥成形术治疗晚期髋臼转移瘤的临床疗效.方法 选取2015年12月至2020年1月就诊于广西医科大学附属肿瘤医院的晚期髋臼转移瘤的患者32例,患者行局部微波消融联合髋臼球囊扩张骨水泥成形术(观察组)或传统髋臼球囊扩张骨水泥成形手术治疗(对照组).通过...     

Local tumor progression after ultrasound-guided percutaneous microwave ablation of stage T1a renal cell carcinoma: risk factors analysis of 171 tumors

Purpose: To retrospectively review long-term oncologic outcomes after ultrasound (US)-guided percutaneous microwave ablation (MWA) of T1a renal cell carcinoma (RCC) and to identify the incidence and risk factors that predict local tumor progression (LTP) after MWA of RCC.

Materials and methods: The present study was approved by the institutional review board. A total of 162 patients with 171 RCC nodules (mean size, 2.6?±?0.8?cm; range, 0.6–4.0?cm) were treated by MWA between April 2006 and January 2017. The influence of eight factors (age; sex; longest tumor diameter; tumor number, location and pathology type; ablation power and time) affecting the risk of LTP was assessed. Univariate Kaplan–Meier and Cox proportional hazard models were used for statistical analysis.

Results: LTP occurred in five patients (5 tumors) after US-guided percutaneous MWA of stage T1a RCC. The overall occurrence of LTP was 2.9% per tumor and 3.0% per patient with a median follow-up of 45.5?months. Among the 162 patients, there were no instances of LTP-related deaths; however, 20 patients died of other diseases. All patients with LTP survived through follow-up. The survival rate of LTP-free patients at 1, 3 and 5?years were 98.7%, 89.5% and 82.1%, respectively (p?=?.38). Univariate and multivariate analysis identified tumor location to be the only independent predictor of LTP.

Conclusions: US-guided percutaneous MWA for T1a RCC achieved a relatively low LTP incidence rate. Tumors adjacent to the renal pelvis or bowel increased the potential of LTP occurrence.     

经皮微波消融治疗鼻咽癌局限肝转移的疗效分析

背景与目的：局限性肝转移瘤由于数目、大小可控,局部微创治疗可以有效提高患者的生存期,微波消融已经成为肝转移瘤的重要治疗手段。该研究旨在探讨经皮肝穿刺微波消融治疗局限性鼻咽癌肝转移瘤的应用价值。方法：收集湖南省肿瘤医院自2011年9月—2014年10月共26例晚期放化疗失败的鼻咽癌肝脏转移患者的临床资料。患者肿瘤病灶数目小于等于3个,直径小于等于5 cm,且无其他远处转移病灶。在B超引导下行经皮肝穿刺微波消融治疗,26例患者共完成43次消融治疗,术后1个月复查肝功能、增强CT或者MRI,在mRECIST标准评价肿瘤治疗疗效。观察患者术后并发症,统计患者无疾病进展时间(progression-free survival,PFS)及总生存期(overall survival,OS)。结果：26例患者共53个病灶,其中完全消融(complete ablation,CA)20例(20/26,77.0%),部分消融(part ablation,PA)3例(3/26,11.5%),整体有效率(CA+PA)为88.5%,无严重并发症出现,26例患者0.5、1和2年生存率分别为96.1%、65.3%和23.0%,PFS为11.4个月,中位生存期(median survival time,MST)为17.8个月,OS为23.7个月。结论：经皮肝穿刺微波消融治疗局限性鼻咽癌肝转移瘤是微创、安全、有效的治疗方法。     

Systematic review and meta-analysis of local ablative therapies for resectable colorectal liver metastases

IntroductionLocal ablative therapies (LAT) have shown positive but heterogenous outcomes in the treatment of colorectal liver metastases (CRLM). The aim of this systematic review is to evaluate LAT and compare them with surgical resection.MethodsIn accordance with PRISMA guidelines, Medline, EMBASE, Cochrane and Web of Science databases were searched for reports published before January 2019. We included papers assessing radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CA) and electroporation (IRE) treating resectable CRLM with curative intention. We evaluated LAT related complications and oncological outcomes as tumour progression (LTP), disease-free survival (DFS) and overall survival (OS).ResultsThe literature search yielded 6767 records; 20 papers (860 patients) were included. No included studies related mortality with LAT. Median adverse events percentage was 7%: (8% RFA;7% MWA). Median 3y-DFS was 32% (24% RFA; 60% MWA); 5y-DFS was 27%: (18% RFA; 38.5% MWA). Median 3y-OS was 59% (60% RFA; 70% MWA; 34% CA), 5y-OS was 44.5% (43% RFA; 55% MWA; 20% CA).Surgical resection showed decreased LTP, improved DFS and OS than those reported with LAT, with RFA accounting for reduced 1y-DFS (RR 0.83, 95%CI 0.71–0.98), 3y-DFS (RR 0.5, 95%CI 0.33–0.76), 5y-DFS (RR 0.53, 95%CI 0.28–0.98) and 5y-OS (RR 0.76, 95%CI 0.58–0.98) in comparison with surgical resection.ConclusionsLow quality evidence suggests that both RFA and MWA seem superior to CA. MWA presents similar adverse events when compared to RFA with a possible increase in DFS and OS. Surgical resection still seems to provide superior DFS and OS in comparison with LAT.     

A prognostic nomogram for colorectal cancer liver metastases after percutaneous thermal ablation

Purpose: To assess the efficacy of percutaneous thermal ablation in treating colorectal cancer liver metastases (CRCLM), and to propose a prognostic nomogram for overall survival (OS).

Materials and methods: Seventy-one patients with CRCLM undergoing thermal ablation at our institute from 2009 to 2013 were identified and analysed to formulate a prognostic nomogram. The concordance index (C-index) and calibration curve were calculated to evaluate the predictive accuracy of the nomogram. The nomogram was compared with two current prognostic nomograms for patients with CRCLM who had undergone hepatectomy (Kattan) and selective internal radiation therapy (Fendler). Predictive validity was assessed in the validation cohort of 25 patients who had undergone thermal ablation from 2014 to 2016.

Results: The median OS in the primary cohort was 26.4?months, whereas the 1-, 3- and 5-year OS rates were 72.2%, 37.2% and 17%, respectively. The median progression-free survival was 4.2?months. After univariate and multivariate analysis, a prognostic nomogram was formulated based on four predictors, including the number of tumours, maximum diameter of the tumour, CA19–9 level and ablation margin. The C-index of the nomogram was 0.815. Based on the patients of this study, the C-index was significantly higher than that of the Fendler nomogram (C-index, 0.698) and Kattan nomogram (C-index, 0.514, p?Conclusions: Thermal ablation was an effective therapy for CRCLM. Moreover, the nomogram was effective and simple for CRCLM patients undergoing thermal ablation.     

Combined microwave ablation and systemic chemotherapy for liver metastases from oesophageal cancer: Preliminary results and literature review

Purpose: Oesophageal cancer is a highly aggressive disease with about 50% of patients presenting with advanced or metastatic disease at initial diagnosis. In this study we assessed combined microwave ablation (MWA) and systemic chemotherapy in the treatment of liver metastases arising from oesophageal squamous cell carcinoma (OSCC). Materials and methods: Between February 2009 and June 2014, OSCC patients who underwent percutaneous MWA?+?concurrent systemic chemotherapy and systemic chemotherapy alone for liver metastases were enrolled in this study. Overall survival (OS) and progression-free survival (PFS) were recorded and compared between groups. Results: In total 15 patients with 25 liver metastases who underwent ultrasound-guided percutaneous MWA and chemotherapy were enrolled in this study. Technical success was achieved in 96% (24/25) of metastatic liver tumours. No major or minor complications associated with MWA procedures were observed. The median OS and PFS from initial MWA were 13 months and 4 months. The 1-, 2-, 3-, 4-year OS rates after MWA were 53.3%, 26.7%, 13.3%, and 13.3%, respectively. The 1- and 2-year PFS rates after MWA were 26.7% and 13.3%. The OS and PFS of the MWA?+?systemic chemotherapy group were superior than those of patients who received systemic chemotherapy alone (P?=?0.011 and 0.030, respectively). Conclusions: Combined MWA with systemic chemotherapy is a feasible, safe and effective treatment for liver metastases from OSCC.     

The value of KRAS gene status in predicting local tumor progression of colorectal liver metastases following radiofrequency ablation

Purpose: We investigated the relationships between KRAS gene status and local tumor progression (LTP) of colorectal liver metastases (CLMs) after treatment with percutaneous ultrasound-guided radiofrequency ablation (RFA).

Materials and methods: Clinical and imaging data from 76 patients (154 lesions) with CLM who underwent percutaneous ultrasound-guided RFA and had KRAS gene test results between January 2012 and June 2016 were analyzed. The average lesion size was 2.3?±?1.0?cm (range 0.9–5.7?cm); 38 cases (82 lesions) had wild-type KRAS, and 38 cases (72 lesions) had KRAS mutations.

Results: The technique effectiveness was 98.1% (151/154), and the LTP rate was 18.2% (28/154) after RFA, which was performed between January 2012 and November 2017. The mean and median follow-up were 32.7?±?2.5 and 32.0?±?2.6 months (range 1–70 months), respectively. Cumulative LTP rates at 6 months and 1, 2 and 3 years post-RFA for all patients were 7.4, 14.5, 17.8 and 19.2%, respectively. The LTP rate for patients with mutant KRAS (27.8% [20/72]) was significantly higher than that in patients with wild-type KRAS (9.8% [8/82]; p?=?.004). The cumulative LTP rates at 6 months and 1, 2 and 3 years post-RFA were 4.0, 11.1, 11.1 and 11.1%, respectively, for patients with wild-type KRAS and 11.2, 18.4, 25.2 and 36.2%, respectively, for patient with mutant KRAS (p?=?.011). Univariate (p?=?.011) and multivariate analyses (p?=?.005) showed that KRAS genotype in liver metastases was predictive of LTP. Multivariate analysis also showed that ablation margin size (p< .001) and modified clinical risk score (CRS; p?=?.033) were independent prognostic factors for LTP.

Conclusions: KRAS gene status of liver metastatic lesions was associated with LTP rates after RFA of CLM. Ablation margin size and modified CRS were also independent prognostic factors for LTP.     

Chemotherapy plus percutaneous radiofrequency ablation in patients with inoperable colorectal liver metastases

AIM:To access the efficacy of chemotherapy plus radiofrequency ablation(RFA)as one line of treatment in inoperable colorectal liver metastases.METHODS:Eligible patients were included in three PhaseⅡstudies.In the first study percutaneous RFA was used first followed by 6 cycles of 5-fluorouracil,leucovorin and irinotecan combination(FOLFIRI)(adjunctive chemotherapy trial).In the other two,chemotherapy(FOLFIRI or 5-fluorouracil,leucovorin and oxaliplatin combination)up to 12 cycles was used first with percutaneous RFA offered to responding patients (primary chemotherapy trials).RESULTS:Thirteen patients were included in the adjunctive chemotherapy trial and 17 in the other two.At inclusion they had 1-4 liver metastases(up to 6.5 cm in size).Two patients died during chemotherapy.All patients in the adjunctive chemotherapy trial and 44%in the primary chemotherapy studies had their metastases ablated.Median PFS and overall survival in the adjunctive study were 13 and 24 mo respectively while in the primary chemotherapy studies they were 10 and 21 mo respectively.Eighty one percent of the patients had tumour relapse in at least one previously ablated lesion.CONCLUSION:Chemotherapy plus RFA in patients with low volume inoperable colorectal liver metastases seems safe and relatively effective.The high local recurrence rate is of concern.     

Contrast-enhanced ultrasound-guided percutaneous microwave ablation of renal cell carcinoma that is inconspicuous on conventional ultrasound

Purpose: This study was designed to determine the safety, effectiveness and feasibility of contrast-enhanced ultrasound (CEUS)-guided percutaneous microwave ablation (MWA) of renal cell carcinoma (RCC) that is inconspicuous on conventional ultrasound (US).

Materials and methods: A total of 32 RCC nodules in 29 patients (23 men and 6 women) were treated with CEUS-guided percutaneous MWA between January 2010 and September 2014. The median maximum diameter of the nodules was 2.4?cm (interquartile range: 1.8–2.9?cm). The US contrast agent was SonoVue, a second-generation contrast agent. CEUS was applied before the needle was inserted into the tumour, and percutaneous MWA was performed under CEUS-guidance.

Results: In total 31 tumours were successfully visualised via CEUS using 1–2 (1.0–2.0?mL) contrast agent injections, and percutaneous MWA was performed under CEUS-guidance. The technical success rate of CEUS-guided percutaneous MWA of RCC was 96.9% (31/32). The mean number of sessions of CEUS-guided percutaneous MWA for each tumour was 1.2?±?0.4. The mean duration of energy application for each tumour was 7.3?±?2.7?min. All patients were followed up for 3–71 months (median 17 months) to observe the therapeutic effects and complications. The therapeutic effects were assessed at follow-up with computed tomography (CT) or magnetic resonance imaging (MRI) and CEUS. There was no local tumour progression and the technique effectiveness rate was 100% (31/31). The complications rate was 6.5% and the major complications rate was 3.2%. We observed one case of pleural effusion and one case of renal subcapsular haemorrhage after the percutaneous MWA procedures.

Conclusion: CEUS-guided percutaneous MWA is a safe, efficient and feasible therapy for patients with RCCs inconspicuous on conventional US.     

微波原位灭活技术治疗髋臼周围骨转移癌

目的回顾性的分析了应用微波原位灭活技术治疗髋臼周围转移癌的手术方法,观察手术疗效,从而评估微波灭活的安全性及有效性。方法2006年10月至2012年9月,15例髋臼周围转移癌的患者在我院接受微波原位灭活手术治疗。其中男8例,女7例,年龄36～66岁,中位年龄50岁。原发肿瘤肺癌5例,肝癌、肾癌、乳癌及前列腺癌各2例,甲状腺癌及直肠癌各1例。全部病例均得到明确的术后病理学证实,其中4例以髋臼周围肿瘤为首发表现的病例进行了术前活检。肿瘤累及 I～III 区的病例6例, II 区4例,II＋III 区3例,I＋II 区2例。髋臼周围转移癌原位微波灭活手术适应证为：临床疼痛症状明显（ VAS ＞7分）且保守治疗无效的病例,或肿瘤累及髋臼顶部负重区存在病理骨折风险的病例,且临床评估预期生存期＞6个月者。应用自体骨、异体骨或骨水泥重建骨缺损,骨盆重建钢板固定。结果手术时间平均3.2 h,术中出血平均800 ml。91.7%患者术后疼痛得到满意的缓解。术后 MSTS 功能评分平均为25分。13例病例得到随访,随访时间6～49个月,平均随访21个月,其中1例肾癌及1例肝癌病例分别在术后8个月及13个月局部复发;5例术后7～22个月死于原发疾病,但没有髋臼周围肿瘤复发;其余6例患者至今存活且没有髋臼周围肿瘤局部复发的证据。无伤口并发症及深部感染的发生,无骨折发生。结论将微波原位灭活技术应用到髋臼周围转移癌的治疗,既可以达到比较满意的肿瘤局部控制,又可以减少手术损伤,保留髋关节功能,是一种值得采用的治疗方法。     

Radiofrequency versus microwave ablation for intraoperative treatment of colorectal liver metastases

IntroductionIntraoperative radiofrequency ablation (RFA) and the newer technique of microwave ablation (MWA) can both be of additional value in parenchyma preserving surgical treatment of colorectal liver metastases (CRLM). MWA is less influenced by the heat-sink effect of surrounding vessels and can generate more heat in less time but RFA is still widely used. True comparing studies are scarce.MethodsThis single centre retrospective cohort study analyzed patients who underwent ultrasound guided intraoperative ablation as a part of the surgical treatment of CRLM between 2013 and 2018. In September 2015, MWA was substituted for RFA. Outcomes included unsuccessful ablation rates at 1-year postoperative, 30-days major complication rates, progression free survival (PFS) and overall survival (OS). Logistic regression models were used for univariable and multivariable analyses to identify predictors of unsuccessful ablation.ResultsForty-one patients underwent RFA of 98 lesions (median 2) and 79 patients underwent MWA of 193 lesions (median 2). The median diameter of the ablated lesions was 9 mm for both RFA and MWA. Unsuccessful ablation was observed in 7 metastases (7.1%) after RFA and 14 metastases (7.3%) after MWA (p = 1.000). Complications requiring re-intervention were observed after 8 procedures, 2 complications in the RFA group (4.9%) versus 6 complications in the MWA group (7.6%, p = 0.714), of which 6 were liver-related. Ninety-day mortality did not occur. Ablation technique was not associated with unsuccessful ablations. CRLM size was associated with unsuccessful ablation in the per lesion analysis (p < 0.001).ConclusionIntraoperative RFA and MWA were equally effective for treatment of small CRLM.     

Feasible temperature of percutaneous microwave ablation of dog liver abutting the bowel

Purpose: This study used a dog model to determine the optimal temperature of percutaneous microwave ablation that causes complete necrosis of liver but not the adjacent bowel, supporting the use of this method to specifically and effectively treat liver tumour abutting the bowel.

Materials and methods: Ultrasound-guided percutaneous microwave ablation of liver abutting the bowel was performed on healthy adult dogs. Temperature of the ablation margin was monitored and controlled through inserted thermal monitoring needles. Dogs were divided into three groups and received microwave ablation at 75–95°C, 65–75°C, or 55–65°C. Imaging and histological examination were used to evaluate the damage of the bowel adjacent to the ablated liver.

Results: Within one hour of treatment, the bowel adjacent to the ablated liver was seriously burned in the group receiving 75–95°C microwave ablation. Inflammation and congestion were found in the submucosa of the bowel in the group receiving 65–75°C microwave ablation. Minor inflammation was found in the mucosa of the bowel in the group receiving 55–65°C microwave ablation. Moreover, in the group receiving 55–65°C microwave ablation, ablated liver areas were covered with omenta, and histological examination revealed inflammatory reaction of the omenta 28 days after ablation.

Conclusions: Microwave ablation at 55–65°C for 6?min is preferred for ablation of liver tissue abutting the bowel in dogs. These findings may provide some valuable reference for percutaneous microwave ablation of human liver tumour adjacent to the bowel.