Darmkanker: RFA - Radio Frequency Ablation bij recidief in lever bij darmkanker geeft betere overleving dan operatie ondanks kortere ziektevrije tijd

1 oktober 2010: Bron: Ann Surg. 2010; 251(5):796-803 (ISSN: 1528-1140)

Wanneer RFA wordt toegepast bij een vroege ontdekking van een recidief in de lever van eerdere geopereerde darmkanker dan lijkt RFA - Radio Frequency Ablation een evengoede of wellicht betere behandeling dan een operatieve ingreep. Al zijn er wel onzekerheden n.a.v. de studie die dit aantoont. De studie met 110 darmkankerpatienten (RFA 28 deelnemers, operatie 82 deelnemers) was niet gerandomiseerd. Bovendien was de diameter van de tumor bij RFA maximaal 3 cm. en bij een operatie 5 cm. Bovendien bleek na RFA de ziektevrije tijd beduidend minder dan bij een operatie 32% and 4% (P<0.001). Maar het belangrijkste was dat uiteindelijk mensen die RFA een of meerdere keren hadden gehad na weer een recidief een iets grotere kans hadden op uiteindelijke 3-jaars overleving. 67% was nog in leven in de RFA groep tegenover 60% in de operatiegroep (P=0.93). Hieronder het abstract van de studie met referentielijst van andere studies. Het volledige studieverslag is als u hier klikt te lezenl

Radiofrequency ablation as first-line treatment in patients with early colorectal liver metastases amenable to surgery.

Ann Surg. 2010; 251(5):796-803 (ISSN: 1528-1140)

Otto G; Düber C; Hoppe-Lotichius M; König J; Heise M; Pitton MB
Department of Transplantation and Hepatobiliopancreatic Surgery, Johannes Gutenberg University of Mainz, Mainz, Germany. otto@transplantation.klinik.uni-mainz.de

OBJECTIVE: Aiming at avoidance of futile surgery, we have tested whether radiofrequency ablation (RFA) may be used as first-line treatment in patients with colorectal metastases (CRLM) occurring within the first year after colorectal surgery.

SUMMARY BACKGROUND DATA: Surgical resection is the standard treatment in patients with CRLM. Major retrospective analyses have identified the interval between colorectal surgery and the occurrence of CRLM to be of prognostic importance. So far, it is unknown whether survival of the respective patients is hampered if RFA is used as first-line treatment.

METHODS: According to a clinical pathway, we have treated patients with CRLM detected within the first year after colorectal surgery preferentially by RFA (n=28). Resection (n=82) was performed in patients who were deemed not amenable to RFA due to number, size, or location of metastatic lesions. The diameter of lesions differed between the groups. All other characteristics of patients and lesions were comparable. Local recurrence and new hepatic lesions were treated with repeated RFA or surgery whenever possible.

RESULTS: Local recurrence at the site of ablation or resection occurred in 32% and 4% (P<0.001), new metastases apart from the site of previous treatment in 50% and 34% (P=0.179), and systemic recurrence in 32% and 37% (P=0.820) of the patients after RFA and surgery, respectively. Time to progression was significantly shorter in patients primarily treated with RFA (203 vs. 416 days; P=0.017). After primary treatment, 9 RFA patients and 8 surgery patients were amenable to repeated RFA or repeated surgery resulting in identical rates of disease-free patients and identical 3-year overall survival in both treatment groups: 67% and 60%, respectively; P=0.93.

CONCLUSIONS: Despite striking differences in local tumor recurrence and shorter time to progression, survival in patients with early CRLM does not depend on the mode of primary hepatic treatment.

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