射频消融术联合SOX方案治疗结直肠癌术后肝转移的疗效观察

Clinical effect of the radiofrequency ablation in combination with SOX regimen for colorectal cancer with liver metastases

目的探讨射频消融术（RFA）联合奥沙利铂＋替吉奥（SOX）方案治疗结直肠癌术后肝转移的临床疗效。方法收集2011年4月至2013年4月收治的结直肠癌术后肝转移患者44例,其中21例接受RFA联合SOX方案治疗（联合治疗组）,23例仅接受SOX方案治疗（单纯化疗组）,分别按照实体瘤的疗效评价标准（RECIST）1.1和三期增强CT评价化疗和RFA近期疗效,随访患者的远期生存情况并记录RFA并发症及化疗不良反应。结果全组44例患者均可评价疗效,其中联合治疗组21例中获CR 9例,PR 6例,SD 3例,PD 3例,有效率（RR）和疾病控制率（DCR）分别为71.4%和85.7%;单纯化疗组23例中获CR 2例,PR 6例,SD 5例,PD 10例,RR和DCR分别为34.8%和56.5%。联合治疗组的RR和DCR均高于单纯化疗组,差异有统计学意义（P〈0.05）;联合治疗组中接受RFA治疗的31个病灶中,完全损毁率为61.3%（19/31）,局部复发率为41.9%（13/31）,肝内1个病灶的RFA疗效优于2~3个,直径≤3 cm病灶的RFA疗效优于3~6 cm病灶（P〈0.05）。联合治疗组的1、2、3年生存率依次为71.4%（15/21）、52.4%（11/21）和33.3%（7/21）,均高于单纯化疗组的26.1%（6/23）、21.7%（5/23）和8.70%（2/23）,差异有统计学意义（P〈0.05）。RFA主要并发症为发热和局部疼痛,两组化疗不良反应类似,以骨髓抑制和消化道反应为主,差异无统计学意义（P〉0.05）。结论 RFA联合全身化疗治疗结直肠癌术后肝转移的疗效确切,可有效控制肿瘤,延长患者生存期。

Objective To explore the clinical effect of the radiofrequency ablation（ RFA） in combination with S-1 and oxaliplatin（ SOX regimen） for colorectal cancer with liver metastases. Methods Among 44 patients with colorectal liver metastasis from April 2011 to April 2013,21 cases received RFA in combination with SOX regimen（ combined treatment group） and other 23 cases only received SOX regimen（ chemotherapy alone group）. The curative effect of chemotherapy and RFA was analyzed according to Response Evaluation Criteria in Solid Tumors（ RECIST） 1. 1 or three-phase enhanced CT,respectively. The long-term survival of the patients was followed up,and the complications of RFA and the chemotherapy-induced adverse reactions were recorded. Results All the44 patients were evaluable for response. In combined treatment group,there were 9 cases of CR,6 cases of PR,3 cases of SD and 3cases of PD with the response rate（ RR） and disease control rate（ DCR） of 71. 4% and 85. 7%. In chemotherapy alone group,there were 2 cases of CR,6 cases of PR,5 cases of SD and 10 cases of PD with RR and DCR of 34. 8% and 6. 5%. There were higher DCR and RR in combined treatment group versus chemotherapy alone group（ P〈0. 05）. Among the 31 lesions receiving RFA,19 lesions（ 61. 3%） were completely destroyed and 13 lesions（ 41. 9%） were locally recurred. The survival rates of 1-,2-,3-year were 71. 4%（ 15 /21）,52. 4%（ 11 /21） and 33. 3%（ 7 /21） in combined treatment group,higher than 26. 1%（ 6 /23）,21. 7%（ 5 /23） and8. 70%（ 2 /23） in chemotherapy alone group（ P〈0. 05）. The main complications of RFA were fever and local pain. There were similar adverse reactions in both groups,mainly including bone marrow suppression and gastrointestinal reaction,and the difference had not statistical significance（ P〈0. 05）. Conclusion RFA in combination with systemic chemotherapy treatment of colorectal liver metastasis can effectively control the tumor and prolong the patients＇ survival.