射频消融先后顺序对XELOX方案治疗结直肠癌肝转移患者安全性和预后的影响

丁晓燕; 陈京龙; 孙巍; 李文东; 郭晓笛; 申燕军; 孙莎莎; 庄秀芬

doi:10.3969/j.issn.1001-5256.2018.12.019

射频消融先后顺序对XELOX方案治疗结直肠癌肝转移患者安全性和预后的影响

DOI: 10.3969/j.issn.1001-5256.2018.12.019

1. 首都医科大学附属北京地坛医院肿瘤内科
2. 江苏大学附属医院化疗科

基金项目:

国家自然科学基金青年基金(1721280028)；

详细信息

中图分类号: R735.34
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出版历程
- 出版日期: 2018-12-20

Influence of time schedule of radiofrequency ablation on the safety and prognosis of patients with colorectal cancer liver metastasis receiving XELOX regimen: A single-center clinical study

Research funding:

摘要

摘要: 目的探讨在射频消融（RFA）联合XELOX方案治疗结直肠癌肝转移患者过程中,RFA不同时间顺序对于患者安全性和预后的影响。方法回顾性分析北京地坛医院2011年1月-2017年8月RFA联合XELOX方案治疗结直肠癌肝转移的患者48例,依据RFA的时间顺序分为2组,一组为RFA序贯全身化疗±靶向治疗（A组,n=25）,另一组为先化疗±靶向治疗后RFA（B组,n=23）;疾病稳定或部分缓解患者继续口服希罗达直至疾病进展或副反应不可耐受。主要观察终点为肿瘤客观缓解率,次要观察终点为疾病进展时间（TTP）、总生存期（OS）和安全性。结果 A组肿瘤客观缓解率（68. 0%,其中CR 8例、PR 9例）与B组（43. 5%,其中CR 2例、PR 8例）差异无统计学意义（χ2=2. 927,P=0. 087）。A组和B组中位TTP分别为9. 0个月和8. 0个月,中位OS分别为33个月和30个月,2组间差异均无统计学意义（χ2值分别为2. 660、0. 562,P值均> 0. 05）。对于单纯肝转移患者,A组和B组中位TTP分别为15. 0个月和8. 0个月,差异有统计学意义（χ2=4. 33...
- 肿瘤转移 /
- 结直肠肿瘤 /
- 导管消融术 /
- 药物疗法,联合
Abstract: Objective To investigate the influence of time schedule of radiofrequency ablation (RFA) on the safety and prognosis of patients with colorectal cancer liver metastasis treated with RFA combined with XELOX regimen. Methods A retrospective analysis was performed for the clinical data of 48 patients with colorectal cancer liver metastasis who received RFA combined with XELOX regimen in Beijing Ditan Hospital from January 2011 to August 2017, and according to the time schedule of RFA, these patients were divided into group A (25 patients treated with RFA and sequential systemic chemotherapy ± targeted therapy) and group B (23 patients treated with chemotherapy ±targeted therapy and then RFA) . The patients with a stable disease or partial remission continued to take Xeloda orally until disease progression or intolerable side effects. The primary endpoint was objective response rate (ORR) of tumor, and the secondary endpoints included time to progression (TTP) , overall survival (OS) , and safety. Results There was no significant difference in ORR between group A and group B [68. 0% (8 patients with complete response and 9 with partial response) vs 43. 5% (2 patients with complete response and 9 with partial response) , χ2= 2. 927, P = 0. 087]. There were no significant differences between group A and group B in median TTP (9. 0 months vs 8. 0 months, χ2= 2. 660, P > 0. 05) and median OS (33 months vs 30 months, χ2= 0. 562, P > 0. 05) . For the patients with liver metastasis alone, there was a significant difference in median TTP between group A and group B (15. 0 months vs 8. 0 months, χ2= 4. 331, P = 0. 037) . Both groups had similar incidence and degree of common adverse events (AEs) (all P > 0. 05) . Most treatment-related AEs were mild or moderate; the most common mild AE (grade I/II) was leucopenia (93. 8%) , followed by nausea (91. 7%) and abdominal pain (81. 3%) . There were no fatal AEs, and the most common grade III/IV treatment-related AE was hematological toxicity observed in14 patients (29. 2%) . All AEs were resolved without sequelae. Conclusion RFA combined with XELOX-Xeloda maintenance chemotherapy is well tolerated and has a good clinical effect in patients with colorectal cancer liver metastasis. For patients with liver metastasis alone, RFA followed by chemotherapy can improve ORR of tumor.
- neoplasm metastasis /
- colorectal neoplasms /
- catheter ablation /
- drug therapy, combination

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参考文献(26)

[1] SIEGEL RL, MILLER KD, JEMAL A. Cancer statistics, 2016[J]. CA Cancer J Clin, 2016, 66 (1) :7-30.

[2] KANAS GP, TAYLOR A, PRIMROSE JN, et al. Survival after liver resection in metastatic colorectal cancer:Review and meta-analysis of prognostic factors[J]. Clin Epidemiol, 2012, 4:283-301.

[3] van CUTSEM E, CERVANTES A, ADAM R, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer[J]. Ann Oncol, 2016, 27 (8) :1386-1422.

[4] BAI H, HUANGZ X, JING L, et al. The effect of radiofrequency ablation vs. liver resection on survival outcome of colorectal liver metastases (CRLM) :A meta-analysis[J]. Hepatogastroenterology, 2015, 62 (138) :373-377.

[5] LIANG RF, ZHENG LL. The efficacy and safety of panitumumabin the treatment of patients with metastatic colorectal cancer:A meta-analysis from five randomized controlled trials[J]. Drug Des Devel Ther, 2015, 9:4471-4478.

[6] YAMAZAKI K, NAGASE M, TAMAGAWA H, et al. Randomized phase III study of bevacizumab plus FOLFIRI and bevacizumab plus m FOLFOX6 as first-line treatment for patients with metastatic colorectal cancer (WJOG4407G) [J]. Ann Oncol, 2016, 27 (8) :1539-1546.

[7] van CUTSEM E, LENZ HJ, KOHNE CH, et al. Fluorouracil, leucovorin, and irinotecan plus cetuximab treatment and RAS mutations in colorectal cancer[J]. J Clin Oncol, 2015, 33 (7) :692-700.

[8] PETRELLI F, BARNI S. Resectability and outcome with anti-EGFR agents in patients with KRAS wild-type colorectal liver-limited metastases:A meta-analysis[J]. Int J Colorectal Dis, 2012, 27 (8) :997-1004.

[9] 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 phase II study (EORTC 40004) [J]. Ann Oncol, 2012, 23 (10) :2619-2626.

[10] LI S, HE N, LI W, et al. Debulking treatment with CT-guided percutaneous radiofrequency ablation and hepatic artery infusion of floxuridine improves survival of patients with unresectable pulmonary and hepatic metastases of colorectal cancer[J]. Chin J Cancer, 2014, 33 (6) :295-305.

[11] BOAME N, GRESHAM G, JONKER D, et al. Use of chemotherapy and radiofrequency ablation to treat colorectal cancer metastases:A retrospective review of The Ottawa Hospital Cancer Centreover 7years[J]. Curr Oncol, 2014, 21 (4) :e557-e563.

[12] LUO HY, LI YH, WANG W, et al. Single-agent capecitabine as maintenance therapy after induction of XELOX (or FOLFOX) in firstline treatment of metastatic colorectal cancer:Randomized clinical trial of efficacy and safety[J]. Ann Oncol, 2016, 27 (6) :1074-1081.

[13] BENDELL JC, ZAKARI A, PEYTON JD, et al. A phase II study of FOLFOXIRI plus panitumumab followed by evaluation for resection in patients with metastatic KRAS wild-type colorectal cancer with liver metastases only[J]. Oncologist, 2016, 21 (3) :279-280.

[14] LEONE F, ARTALE S, MARINO D, et al. Panitumumab in combination with infusional oxaliplatin and oral capecitabine for conversion therapy in patients with colon cancer and advanced liver metastases. The Meta Pan study[J]. Cancer, 2013, 119 (19) :3429-3435.

[15] TAKAHASHI T, SHIBATA Y, TOJIMA Y, et al. Multicenter phase II study of modified FOLFOX6 as neoadjuvant chemotherapy for patients with unresectable liver-only metastases from colorectal cancer in Japan:ROOF study[J]. Int J Clin Oncol, 2013, 18 (2) :335-342.

[16] FATOUROU EM, KOSKINAS JS. Adaptive immunity in hepatocellular carcinoma:Prognostic and therapeutic implications[J]. Expert Rev Anticancer Ther, 2009, 9 (10) :1499-1510.

[17] ALESSANDRO Z, MASSIMO P, AMALIA P, et al. Radiofrequency thermal ablation hepatocellular carcinoma liver nodules responses[J].Cancer Res, 2006, 66 (23) :1139-1146.

[18] ZERBINI A, PILLI M, FAGNONI F, et al. Increased immunostimulatory activity conferred to antigen-presenting cells by exposure to antigen extract from hepatocellular carcinoma after radiofrequency thermal ablation[J]. J Immunother, 2008, 31 (3) :271-282.

[19] ZERBINI A, PILLI M, LACCABUE D, et al. Radiofrequency thermal ablation for hepatocellular carcinoma stimulates autologous NK-cell response[J]. Gastroenterology, 2010, 138 (5) :1931-1942.

[20] HOF J, WERTENBROEK MW, PEETERS PM, et al. Outcomes after resection and/or radiofrequency ablation for recurrence after treatment of colorectal liver metastases[J]. Br J Surg, 2016, 103 (8) :1055-1062.

[21] HUANG CJ, TENG HW, CHIEN CC, et al. Prognostic significance of C-reactive protein polymorphism and KRAS/BRAF in synchronous liver metastasis from colorectal cancer[J]. PLo S One, 2014, 8 (6) :e65117.

[22] ASGHAR U, HAWKES E, CUNNINGHAM D. Predictive and prognostic biomarkers for targeted therapy in metastatic colorectal cancer[J]. Clin Colorectal Cancer, 2010, 9 (5) :274-281.

[23] CLANCY C, BURKE JP, KALADY MF, et al. BRAF mutation is associated with distinct clinicopathological characteristics in colorectal cancer:A systematic review and meta-analysis[J]. Colorectal Dis, 2013, 15 (12) :e711-e718.

[24] ACCIUFFI S, MEYER F, BAUSCHKE A, et al. Analysis of prognostic factors after resection of solitary liver metastasis in colorectal cancer:A22-year bicentre study[J]. J Cancer Res Clin Oncol, 2018, 144 (3) :593-599.

[25] DING XY, CHEN JL, SUN W, et al. Safety and efficacy of lowdose IL-2 plus transcatheter arterial chemoembolization followed by immediate radiofrequency ablation for the treatment of large primary liver cancer:A single-center experience[J]. Clin Med J, 2014, 12 (3) :22-28. (in Chinese) .丁晓燕, 陈京龙, 孙巍, 等.低剂量白介素-2联合肝动脉化疗栓塞术序贯CT引导下射频消融术在≥5 cm的原发性肝癌的疗效和安全性[J].临床药物治疗杂志, 2014, 12 (3) :22-28.

[26] FRANCICA G, PETROLATI A, DI-STASIO E, et al. Effectiveness, safety, and local progression after percutaneous laser ablation for hepatocellular carcinoma nodules up to 4 cm are not affected by tumor location[J]. AJR Am J Roentgenol, 2012, 199 (6) :1393-1401.

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