腹腔鏡RFA可安全有效的減除異常肝腫瘤


  April 18, 2005 - 在佛州羅德岱堡舉行的美國胃腸道與內視鏡外科醫學會2005年會議中,一項先期性研究結果指出,對於非大腸直腸及非神經內分泌性的癌症,腹腔鏡放射頻燒灼術(RFA)對於完全肝移轉的患者而言,是一項安全有效的減積手術;異常肝腫瘤的患者,在使用其他方法無效後,可以藉由RFA而獲益。
  
  克里夫蘭臨床基金會的外科駐院醫師Eren Berber醫師向Medscape表示,最近的10年裡,對於無法切除的肝腫瘤,放射頻燒灼術被視為一項新的選擇療法;雖然切除手術被尊為黃金標準,但是90%的患者卻無法進行這項手術,因為這些患者的肝臟疾病過度嚴重,或治療的條件無法允許手術的進行;因為化療效果不彰,因此這些患者的治療選擇很有限。
  
  本研究的主研究員為克里夫蘭臨床基金會的Alan E. Siperstein醫師。
  
  Berber醫師指出,RFA證實可以延長一些患者的存活期,含大腸直腸癌及非內分泌性癌症所造成的肝轉移、原發性肝腫瘤等;但是對於其他癌症所造成的肝轉移,目前並沒有文件紀錄RFA的治療效果。
  
  在1996年1月至2005年5月間,517位患者進行了腹腔鏡RFA治療,一共處理了1500個原發性及移轉性肝腫瘤,都無法以手術切除;這些患者中,有53位(約10%)有著192個腫瘤屬於非大腸直腸或非神經內分泌性癌症,這些包含肉瘤(18)、乳癌(10)、食道癌(4)、肺癌(3)、黑色素瘤(4)、卵巢癌(2)、胰臟癌(2)、不明腫瘤(2)、膽管脈瘤(2)、直腸鱗狀細胞瘤(2)、腎臟癌(2)、血管內皮細胞瘤(1)。
  
  所有的患者在術前造影檢查上,都顯示出了完全的肝疾,並且都無法以化療達到效果。
  
  Berber特別提到,選擇患者的標準是最重要的考量因素,相對於其他三組會因本疾惡化而死亡的患者(原發性肝腫瘤,或大腸直腸/神經內分泌移轉性肝腫瘤),本研究所選擇的患者則會因全身性的擴散而死亡;一般不建議對這些移轉性的異常腫瘤作處理。
  
  在這53位患者中,有8位(15%)需要再度治療,平均的住院期為1天,無人在30天內死亡;副作用包含1位手術後出血、1位膿瘡、1位創傷性感染。
  
  在平均24個月的追蹤期中,有19個腫瘤處出現復發的現象;RFA治療後,整體的平均存活期為33個月,乳癌及黑色素瘤的患者則分別為51及25個月。
  
  Berber醫師表示,以RFA治療後,各種腫瘤的局部復發率及患者發病率皆相似,含大腸直腸與神經內分泌肝移轉腫瘤、原發性肝細胞癌。
  
  Berber醫師總結指出,之所以會選擇不同類別的患者,是因為這些患者都在肝臟處顯現出完全的病狀;根據文獻,腹腔鏡RFA可以提供與傳統腫瘤治療相同的局部控制及效果,這些效果的指標包含發病率及死亡率的控制。

Laparoscopic RFA Safe, Effecti

By Yael Waknine
Medscape Medical News

April 18, 2005 — Laparoscopic radiofrequency ablation (RFA) is safe and effective for the cytoreduction of exclusively hepatic metastases from noncolorectal and nonneuroendocrine primary cancers, according to the results of a prospective study presented at the 2005 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons in Fort Lauderdale, Florida. Patients with these unusual hepatic tumors may benefit from RFA when other treatment methods have failed.

"Radiofrequency ablation has been introduced in the last decade as a new treatment option for liver tumors that are not resectable," coauthor Eren Berber, MD, chief surgical resident at the Cleveland Clinic Foundation in Ohio, told Medscape. "Although resection is the gold standard, 90% of patients are not eligible due to extensive liver disease or because of medical conditions precluding the operation. For these patients, treatment options are limited because chemotherapy is not so effective."

The lead investigator of the study was Alan E. Siperstein, MD, from the Cleveland Clinic Foundation in Ohio.

Although RFA has been shown to prolong survival in patients with hepatic metastases from colorectal and neuroendocrine cancer, and in patients with primary liver tumors, its benefits have not been documented in patients with hepatic metastases from other cancers, Dr. Berber said.

Between January 1996 and March 2005, 517 patients underwent laparoscopic RFA for 1,500 unresectable primary and metastatic liver tumors. Of these, 53 patients (about 10%) had 192 lesions due to noncolorectal and nonneuroendocrine cancers, including sarcoma (18), breast cancer (10), esophageal cancer (4), lung cancer (3), melanoma (4), ovarian cancer (2), pancreatic cancer (2), unknown (2), choleangiocarcinoma (2), rectal squamous cell carcinoma (2), renal cancer (2), and hemangioendothelioma (1).

All patients demonstrated exclusive liver disease on preoperative imaging and had failed chemotherapy.

"The selection criteria was an important consideration," noted Dr. Berber. "In contrast to patients from the other three groups (patients with primary liver tumors or colorectal/neuroendocrine metastases) who are expected to die of liver disease progression, these patients are expected to die of disseminated systemic disease — treating liver metastases for these unusual tumor types is not normally recommended."

Of the 53 patients, 8 (15%) required repeat treatment. The average length of hospital stay was one day with no 30-day mortality. Adverse events included one postoperative hemorrhage, one liver abscess, and one wound infection.

During a median follow-up period of 24 months, tumors recurred in 19% of lesions. Overall median survival after RFA for the series was 33 months, with more than 51 months for patients with breast cancer and 25 months for sarcoma.

"Local recurrence rates and patient morbidity were similar to that observed in patients with other tumor types treated with RFA, including colorectal or neuroendocrine liver metastases, or hepatocellular primary cancers," Dr. Berber said.

"In this heterogenous group of patients that were selected primarily because of their unusual presentation of liver exclusive disease, laparoscopic RFA provided the same local control and outcomes regarding morbidity and mortality that is achieved for more conventional tumors, as reported in the literature," concluded Dr. Berber.

SAGES 2005 Annual Meeting: Abstract S116. Presented April 15, 2005.

Reviewed by Gary D. Vogin, MD

    
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