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Termoablação de metástases hepáticas de carcinoma colorretal : estudo retrospetivo bicêntrico
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A termoablação de metástases hepáticas de cancro colorretal (MHCCR) é atualmente a única terapêutica com potencial curativo no caso de doença cirurgicamente irressecável. A evidência atual recomenda a sua utilização como terapêutica complementar à cirurgia e no tratamento de lesões de pequenas dimensões independentemente da ressecabilidade.
Este estudo retrospetivo avaliou 149 doentes com MHCCR, 122 submetidos a cirurgia isolada e 27 submetidos a termoablação por micro-ondas (TMO) como complementar à cirurgia (total 33 intervenções). A TMO foi usada em combinação com cirurgia de modo a atingir resseção R0 e como terapêutica de resgate nos casos de doença cirurgicamente irressecável. A idade média foi 60,8 ± 12,2 anos (intervalo 39 - 86) e o tamanho médio das MHCCR foi 3,5 ± 0.5 cm (intervalo 1 – 8). Mediana do tempo entre cirurgia e TMO foi de 15,2 ± 12,5 meses (intervalo 1,43 – 45,53). Recorreu-se à análise de Kaplan-Meier para estimar a sobrevivência global (SG), sobrevivência livre de progressão local (SLPL), sobrevivência livre de progressão da doença (SLPD) e sobrevivência livre de progressão para doença irressecável (SLPDI), ao teste de log-rank para testar a comparabilidade dos dois grupos quanto à SG e SLPDI e análise univariada para testar preditores de SG e SLPL.
Os doentes submetidos a TMO complementar a cirurgia apresentaram SG a 1, 2 e 3 anos de 89%, 73% e 52% (mediana SG 38,3 meses). A SLPL a 1 ano foi de 29% (mediana SLPL 8,4 meses). A taxa de complicações associadas à TMO foi 3%. A progressão local (PL) foi de 89,3% após TMO. O ECOG/PS demonstrou correlacionar-se positivamente com o risco de morte (p=0,044). Não foi detetada diferença quanto à SG e SLPDI entre os doentes submetidos a TMO em combinação a cirurgia e os submetidos a cirurgia de modo isolado (p=0,331).
A TMO demonstra-se eficaz quando a terapêutica cirúrgica isolada não é suficiente, reiterando o seu papel enquanto terapêutica de 2ª linha no tratamento de MHCCR irressecáveis. Fica for clarificar como se compara à cirurgia no tratamento de lesões ressecáveis, sendo para isso necessários mais estudos.
Thermoablation of colorectal liver metastasis (CRLM) presents itself as the only potentially curative technique for surgically unresectable disease. Current evidence advocates its use as complementary to surgery and in the treatment of small lesions independently of their ressectability status. This retrospective study evaluated 149 patients with CRLM, 122 treated with surgery alone and 27 treated with microwave ablation (MWA) complementary to surgery (total of 33 interventions). MWA was used in combination to surgery as a means to achieve R0 resection and as a rescue therapy for surgically irresectable lesions. Mean age was 60,8 ± 12,2 years (range 39 - 86) and mean tumour size was 3,5 ± 0.5 cm (range 1 – 8). Mean time between surgery and MWA was 15,2 ± 12,5 months (range 1,43 – 45,53). Kaplan-Meier analysis was used to estimate overall survival (OS), local progression-free survival (LPFS), disease progression-free survival (DPFS) and irresectable disease progression-free survival (IDPFS); log-rank test to test compare OS and IDPFS between MWA and surgery-only groups. Univariate analysis was conducted to test predictors of OS and LPFS. For the use of MWA as complementary to surgery the reported 1, 2 and 3-year OS was 89%, 73% e 52% (median OS 38,3 months). 1-year LPFS was 29% (median LPFS 8,9 months). Complication rates for MWA were 3%. Local progression was observed in 89,3% of cases following MWA. ECOG/PS demonstrated a positive correlation for the risk of death (p=0,044). No difference was observed regarding OS and IDPFS between MWA plus surgery and surgery only groups (p=0,331). MWA is effective as a 2nd line therapeutic option in the treatment of CRLM, when surgical resection is no longer feasible. It is still unclear how it compares with surgery in the treatment of resectable CRLM and further studies are needed.
Thermoablation of colorectal liver metastasis (CRLM) presents itself as the only potentially curative technique for surgically unresectable disease. Current evidence advocates its use as complementary to surgery and in the treatment of small lesions independently of their ressectability status. This retrospective study evaluated 149 patients with CRLM, 122 treated with surgery alone and 27 treated with microwave ablation (MWA) complementary to surgery (total of 33 interventions). MWA was used in combination to surgery as a means to achieve R0 resection and as a rescue therapy for surgically irresectable lesions. Mean age was 60,8 ± 12,2 years (range 39 - 86) and mean tumour size was 3,5 ± 0.5 cm (range 1 – 8). Mean time between surgery and MWA was 15,2 ± 12,5 months (range 1,43 – 45,53). Kaplan-Meier analysis was used to estimate overall survival (OS), local progression-free survival (LPFS), disease progression-free survival (DPFS) and irresectable disease progression-free survival (IDPFS); log-rank test to test compare OS and IDPFS between MWA and surgery-only groups. Univariate analysis was conducted to test predictors of OS and LPFS. For the use of MWA as complementary to surgery the reported 1, 2 and 3-year OS was 89%, 73% e 52% (median OS 38,3 months). 1-year LPFS was 29% (median LPFS 8,9 months). Complication rates for MWA were 3%. Local progression was observed in 89,3% of cases following MWA. ECOG/PS demonstrated a positive correlation for the risk of death (p=0,044). No difference was observed regarding OS and IDPFS between MWA plus surgery and surgery only groups (p=0,331). MWA is effective as a 2nd line therapeutic option in the treatment of CRLM, when surgical resection is no longer feasible. It is still unclear how it compares with surgery in the treatment of resectable CRLM and further studies are needed.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Cancro colorretal Termoablação Metástases hepáticas Tratamento de metástases Terapêutica hepática dirigida Gastroenterologia