射频消融联合化疗治疗乳腺癌肝转移六例疗效分析

Curative effect of radiofrequency ablation combined with chemotherapy for liver metastases from breast cancer in 6 cases

目的探讨射频消融（RFA）联合化学药物治疗（化疗）对乳腺癌肝转移的治疗效果。方法回顾性分析2009年1月至2012年12月在中山大学附属第三医院接受诊治的6例乳腺癌肝转移患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。患者均为女性；年龄35～65岁，中位年龄54岁；肝转移灶均为单发；肿瘤直径1.5～4.5 cm，中位直径2.5 cm；治疗前6～30个月曾行乳腺癌改良根治术；术后均接受过化疗。肝内转移灶均经超声、CT 和 MRI 检查证实,并在超声引导下经皮穿刺行 RFA 治疗。RFA 治疗后1周，根据患者既往化疗方案结合肝转移情况行个体化化疗。RFA 治疗后1个月复查增强 CT 或 MRI 明确病灶坏死情况。根据影像学检查结果，评价 RFA 治疗疗效；根据患者存活和肿瘤复发情况，绘制 Kaplan-Meier 生存曲线，进行生存分析。结果6例患者肝转移灶经过第1次 RFA 治疗后，病灶完全坏死5例、不完全坏死1例。1例不完全坏死病灶再次行RFA。随访期间肿瘤局部复发1例，全部患者存活，中位无瘤生存时间为18个月。结论 RFA 联合化疗治疗乳腺癌肝转移疗效确切，是一种安全、有效的综合治疗方案。

Objective To investigate the curative effect of radiofrequency ablation （RFA） combined with chemotherapy for liver metastases from breast cancer. Methods Clinical data of 6 patients with liver metastases from breast cancer in the Third Affiliated Hospital of Sun Yet-sen University from January 2009 to December 2012 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. All the patients were female with the age ranging from 35 to 65 years old and a median of 54 years old. The liver metastases were all single metastases. The tumor diameter was 1.5 to 4.5 cm with a median of 2.5 cm. The patients received modified radical mastectomy 6 to 30 months before treatments and all received chemotherapy after the operations. The liver metastases were confirmed by ultrasound, CT and MRI. RFA was performed percutaneously under the guidance of ultrasound on the patients. After 1 week of RFA treatment, individual chemotherapy was given to the patients according to their previous chemotherapy regimen and the situation of liver metastases. The focus necrosis was checked by contrast enhanced CT or MRI examination 1 month after the RFA treatment. The curative effect of RFA was observed based on the imaging examinations. According to the patients＆#39; survival and tumor recurrence, survival analysis was conducted by drawing Kaplan-Meier curves. Results After the first RFA on 6 cases, the liver metastases in 5 cases were observed with total necrosis, and 1 case with partial necrosis. The one with partial necrosis then received the second RFA. Local recurrence of the tumor was observed in 1 case during the follow-up. All the patients survived with a median tumor-free survival time of 18 months. Conclusions The combination theraphy of RFA and chemotherapy has a definite effect for liver metastases from breast cancer and is a safe, effective comprehensive therapeutic regimen.