Вместо резекции печени - RFA метастазов
Итальянские исследователи заявляют, что необходимо пересмотреть тактику ведения больных с карциноматозными метастазами в печень. Методика RFA (radio-frequency ablation - радио-частотной аблации) показывает сравнимые с хирургией или даже более высокие показатели выживаемости. Такие данные 16-летних исследований привел в своем докладе на Международном Конгрессе RSNA в Чикаго д-р Рикардо Ленчиони (Dr. Riccardo Lencioni) из университета г. Пиза.
Цифры трех- и пяти-летней выживаемости после применения методики RFA составили 89% и 61% соответственно.
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Defying conventional wisdom, Italian researchers are saying that radio-frequency ablation should be offered as first-line treatment for patients with liver tumors. They presented data to support this breakthrough at the RSNA meeting in Chicago.
“I’m not crazy. This is a conclusion after 16 years of percutaneous ablation of hepatocellular carcinomas in cirrhotic patients,” said Dr. Riccardo Lencioni, an interventional radiologist at the University of Pisa.
The current standard of care is surgical resection, reserving RFA for cases not suitable for surgery. That paradigm needs to be turned on its head, according to Lencioni and colleagues.
They assessed long-term survival rates of 187 cirrhotic patients with HCC treated with RFA. They found five-year survival rates that were similar -- and in some cases superior -- to those for surgery. The prospective study included 240 liver carcinomas that were 5 cm and smaller. These lesions underwent ultrasound-guided RFA. A subgroup of 116 patients with stable liver function and solitary lesions achieved three- and five-year survival rates of 89% and 61%, respectively.
The study broke down overall survival rates:
· one year: 97%, with 18% recurrence
· two years: 89%, with 37% recurrence
· three years: 71%, with 55% recurrence
· four years: 57%, with 71% recurrence
· five years: 48%, with 83% recurrence
Recent findings should prelude a fundamental shift in the way physicians approach unresectable cancers, Lencioni said. After years of RFA research, the evolution of this technology, along with the increased clinical experience, has opened new frontiers in treating other tumor types, including lung, bone, and kidney.
“The positive long-term data being gathered in Europe and the U.S. are powerful indicators that RFA should become an early priority in the treatment continuum for many cancer patients,” he said.