Thermal Ablation versus Stereotactic Ablative Body Radiotherapy to Treat Unresectable Colorectal Liver Metastases: A Comparative Analysis from the Prospective Amsterdam CORE Registry

Cancers

Birgit I. Lissenberg-Witte¹  Kathelijn S. Versteeg²  M. Petrousjka van den Tol²  Cornelis J. A. Haasbeek³  Bart Geboers⁴  Sanne Nieuwenhuizen⁴  Bente van den Bemd⁴  Hester J. Scheffer⁴  Florentine E. F. Timmer⁴  Martijn R. Meijerink⁴  Irene M. Nota⁴  Jan J. J. de Vries⁴  Madelon Dijkstra⁴  Evelien A. C. Schouten⁴  Jan Hein T. M. van Waesberghe⁴  Robbert S. Puijk⁴  Alette H. Ruarus⁴  Anne M. van Geel⁵  Jip Opperman⁵  Rutger-Jan Swijnenburg⁶ 

[1] Department of Epidemiology and Data Science, Amsterdam UMC, Cancer Center Amsterdam, VU University, 1081 HV Amsterdam, The Netherlands;Department of Medical Oncology, Amsterdam UMC, Cancer Center Amsterdam, VU University, 1081 HV Amsterdam, The Netherlands;Department of Radiation Oncology, Amsterdam UMC, Cancer Center Amsterdam, VU University, 1081 HV Amsterdam, The Netherlands;Department of Radiology and Nuclear Medicine, Amsterdam UMC, Cancer Center Amsterdam, VU University, 1081 HV Amsterdam, The Netherlands;Department of Radiology and Nuclear Medicine, Noordwest Ziekenhuisgroep, 1815 JD Alkmaar, The Netherlands;Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, VU University, 1081 HV Amsterdam, The Netherlands;

关键词: colorectal liver metastases (CRLM);    thermal ablation;    microwave ablation (MWA);    radiofrequency ablation (RFA);    stereotactic ablative radiotherapy (SABR);   

DOI  :  10.3390/cancers13174303

来源: DOAJ

【 摘 要 】

Thermal ablation and stereotactic ablative radiotherapy (SABR) are techniques to eradicate colorectal liver metastases (CRLM). This study compares the safety, efficacy and long-term oncological outcomes of these treatment methods. All prospectively registered patients (AmCORE registry) treated with thermal ablation or SABR alone for unresectable CRLM between 2007 and 2020 were analyzed using multivariate Cox-proportional hazard regression. In total 199 patients were included for analysis: 144 (400 CRLM) thermal ablation; 55 (69 CRLM) SABR. SABR patients were characterized by older age (p = 0.006), extrahepatic disease at diagnosis (p = 0.004) and larger tumors (p < 0.001). Thermal ablation patients were more likely to have synchronous disease, higher clinical risk scores (p = 0.030) and higher numbers of CRLMs treated (p < 0.001). Mortality was zero and morbidity low in both groups: no serious adverse events were recorded following SABR (n = 0/55) and nine (n = 9/144 [6.3%]; all CTCAE grade 3) after thermal ablation. SABR was associated with an inferior overall survival (OS) (median OS 53.0 months vs. 27.4 months; HR = 1.29, 95% CI 1.12–1.49; p = 0.003), local tumor progression-free survival (LTPFS) per-tumor (HR = 1.24, 95% CI 1.01–1.52; p = 0.044) and local control per-patient (HR = 1.57, 95% CI 1.20–2.04; p = 0.001) and per-tumor (HR = 1.89, 95% CI 1.44–2.49; p < 0.001). In this study thermal ablation was superior to SABR with regard to OS, LTPFS and local control, albeit at the cost of a limited risk of serious adverse events. Further studies are required to assess whether the worse outcomes following SABR were the effect of true differences in ablative treatment or a result of residual confounding.

【 授权许可】

Unknown