cfthgoe 2010-2-6 11:30
栓塞加上立即摘除對無法切除的肝腫瘤是有潛力的
作者：Thomas R. Collins
出處：WebMD醫學新聞
January 19, 2010 （佛州好萊塢）－根據一項於2010年臨床介入腫瘤學研討會發表的初期研究結果顯示，以微孔進行栓塞治療加上立即進行摘除，對過於複雜或太大無法外科切除的肝腫瘤是有潛力的。
來自義大利米蘭歐洲腫瘤機構介入性放射學單位的主要研究者Franco Orsi醫師指出，這19位接受合併治療的病患在最後一次追蹤時（平均追蹤時間為17個月；範圍從1~33個月），疾病仍然未發。
研究者們持續追蹤這些病患。
因為外科治療對肝臟功能潛在的風險，許多病患並不適合接受肝臟切除。許多非外科治療病例接受放頻切除，但是肝腫瘤過大，以及/或是位於重要位置時，只進行放頻摘除的預後可能更差。
因此，Orsi醫師與其同事們，以栓塞治療後，當這些難以治療的肝臟腫瘤最脆弱時，立即進行摘除。Orsi醫師表示，目前並沒有類似研究。
Orsi醫師告訴與會者，我們的想法是合併兩種技術，以取得微孔栓塞治療的低灌流與缺血性效應來增加摘除的腫瘤壞死作用。
微孔栓塞技術使用微孔阻斷腫瘤周圍的血管，即使是細小到直徑僅有10微米的血管。他解釋，沒有特殊構造的球狀表面代表沒有化學治療成分。
在栓塞後的同一次治療間，外科醫師立即進行摘除。
大部分的肝臟腫瘤，被認為是無法切除的，從其他許多部位轉移而來的，包括大腸直腸、膽道、肺臟、子宮與乳房。其中兩個病灶是原發性腫瘤。
這些病患的平均年齡為65.3歲，其中一半是男性，腫瘤大小平均為3.8公分。
有兩件病例被Orsi醫師描述為重大併發症，其中一位病患罹患膽囊損傷，且接受經皮左肝動脈膽囊引流，另一位病患發生肝臟出血，需要進行動脈線圈栓塞止血。
Orsi醫師報告，研究已經證實腫瘤大小小於直徑3公分的高達80%~100%可以被射頻摘除，但是對3.5公分~5公分的腫瘤，僅有50%~80%可以用這個術式完全摘除；而那些超過5公分的腫瘤，僅有25%可以被完全摘除。
Orsi醫師表示，這是因為我們需要進行栓塞的血管型式大約是10~120微米，且無法以標準術式進行栓塞。微孔可以關閉這些非常微小的血管。
Orsi醫師指出，同一次療程中合併兩種術式是絕對可行的，且可能預防多重住院，因此這相較於標準執業方式被認為是可以更便宜的。他在發表會後向Medscape腫瘤學表示，微孔也可以透過視覺的方式協助確認腫瘤，使摘除時進行的治療更精確。
密爾瓦基威斯康辛醫學院血管與介入性放射部門主任William Rilling醫師，他參加Orsi醫師的發表會且擔任其他場次會議的引言人，他表示，如果病患繼續顯示出很好的結果，該術式可以更廣泛地被採用。
Rilling醫師向Medscape腫瘤學表示，他報告的病例都是非常具挑戰性的病例，且沒有很多手術選擇，因此他所使用非常積極的治療策略是非常令人印象深刻的。
他表示，這項研究中所治療的腫瘤轉移是非常多樣化的，我們遇到越來越多這樣的病患，因為一般而言癌症病患的生命周期越來越長。
這項研究並未接受商業贊助。Orsi醫師與Rilling醫師表示已無相關資金上的往來。
Embolization Plus Immediate Ablation Promising for Unresectable Liver Tumors
By Thomas R. Collins
Medscape Medical News
January 19, 2010 (Hollywood, Florida) — Treatment with embolization using microspheres followed by immediate radiofrequency ablation is showing promising results in patients with liver tumors that are too complex or too big to be treated with surgery, according to early results from a study presented here at the 2010 Symposium on Clinical Interventional Oncology.
All 19 patients in whom the combination was used were disease-free at their last follow-up (average follow-up, 17 months; range, 1 to 33 months), said lead investigator Franco Orsi, MD, from the Unit for Interventional Radiology at the European Institute of Oncology in Milan, Italy.
Researchers are continuing to follow the patients.
Because of the potential risks to liver function with surgical management, many patients are not candidates for liver resection. Many nonsurgical cases are treated with radiofrequency ablation. But liver tumors that are large and/or located in vital areas could have even worse outcomes when radiofrequency ablation is used by itself.
As a result, Dr. Orsi and colleagues treated these more difficult tumors with ablation immediately after embolization, when the lesions are at their most vulnerable. Dr. Orsi said he is unaware of similar work being conducted anywhere else.
"The idea was to combine the 2 techniques in order to take advantage of the hypoperfusion and ischemic effect of the microbland embolization to enhance the necrotic effect of the ablation," Dr. Orsi told meeting attendees.
The microbland embolization technique uses microspheres to block blood vessels immediately around the tumor, even those as small as 10?microns in diameter. The "bland"-ness of the spheres means that there is no chemotherapeutic component, he explained.
Immediately after embolization, during the same session, surgeons performed ablation.
Most of the liver tumors, all of which were considered unresectable, were metastases stemming from a variety of tumors elsewhere — colorectal, the bile duct, the lung, the uterus, and the breast. Two of the lesions were primary liver tumors.
The average age of the patients was 65.3 years, and half were male. The average tumor size was 3.8?cm.
There were 2 instances that Dr. Orsi described as "major complications." One patient had biliary damage and was treated with percutaneous left hepatic biliary drainage, and another had liver bleeding, requiring arterial coil embolization.
Studies have shown that 80% to 100% of tumors 3?cm in diameter or smaller are completely killed by radiofrequency ablation alone. But for those in the 3.5 to 5.0?cm range, studies have shown that only 50% to 80% get completely ablated with that technique. For those larger than 5?cm, only 25% get ablated completely, studies have found, Dr. Orsi reported.
"This is because the type of vessel we need to embolize is around 10 to 120?microns" and cannot be closed off with standard techniques, Dr. Orsi said. The microspheres can shut down even these tiniest of vessels.
"A combined technique in the same session is absolutely feasible and it might prevent multiple hospital admissions, so it can be even considered cheaper" than standard practice, Dr. Orsi said.
The microspheres also help visually to identify the tumor, making treatment during ablation more precise, he told Medscape Oncology after his presentation.
If the patients continue to show good results, the technique could be used more widely, said William Rilling, MD, director of vascular and interventional radiology at the Medical College of Wisconsin, Milwaukee, who attended Dr. Orsi's presentation and moderated other sessions at the meeting.
"The cases he showed were very challenging cases without great surgical options, so the very aggressive protocol that he used was pretty impressive," Dr. Rilling told Medscape Oncology.
He noted the wide variety of metastases the study treated. "We run into more and more patients like that all the time," he said, "because patients are living longer with cancer in general."
This study did not receive commercial support. Dr. Orsi and Dr. Rilling have disclosed no relevant financial relationships.
2010 Symposium on Clinical Interventional Oncology. Presented January 16, 2010.