背景:全身治疗是不可切除的结直肠癌肝转移(CRCLM)的标准治疗方法。使用药物洗脱珠(DEB-TACE)的经动脉化疗栓塞被认为是CRCLM的有效治疗选择。很少有研究调查DEB-TACE的组合,化疗,和CRCLM的靶向治疗。在本研究中,我们评估了疾病控制率(DCR),不良事件,接受DEB-TACE联合化疗/靶向治疗的CRCLM患者的生存率。
方法:我们回顾性分析了2015年1月至2021年1月期间接受治疗的35例CRCLM患者。标准全身化疗,靶向治疗,共进行了66次DEB-TACE手术。收集每个DEB-TACE程序的数据,包括化疗药物,肝转移的肿瘤负荷,DEB-TACE课程的数量,和不良事件。将一线全身治疗失败后接受DEB-TACE的患者分为一线失败组。二线失败后接受DEB-TACE的患者,第三行,或四线治疗分为另一组.采用亚组分析比较两组总生存期(OS)和无进展生存期(PFS)。
结果:总计,纳入35例CRCLM患者(腺癌34例,神经内分泌癌1例)。总的来说,13例(37.1%)在初始诊断时发生肝外转移。在这项研究中,进行了66例DEB-TACE程序。DCR为54.3%。中位OS期为47.4个月,估计3年OS率为59.5%。中位PFS期为6.3个月,估计1年PFS率为20.6%。一线故障组的PFS期比其他组的PFS期长(7.2vs.6.3个月)。两组间OS差异无统计学意义。观察到4次(6.1%)3级腹腔内感染。
结论:联合化疗,靶向治疗,和DEB-TACE可导致CRCLM患者良好的DCR和生存结局。DEB-TACE的早期干预(即,一线治疗失败后)有可能延长CRCLM患者的PFS期。严重不良事件罕见且可控。进一步的前瞻性,有必要进行随机对照研究,以获得更多的结论.
BACKGROUND: Systemic therapy is the standard treatment for unresectable colorectal cancer with liver metastasis (CRCLM). Transarterial chemoembolization with drug-eluting beads (DEB-TACE) is considered an effective treatment option for CRCLM. Few studies have investigated the combination of DEB-TACE, chemotherapy, and targeted therapy for CRCLM. In the present study, we evaluated the disease control rate (DCR), adverse events, and survival among patients with CRCLM who underwent the combination of DEB-TACE and chemotherapy/targeted therapy.
METHODS: We retrospectively reviewed 35 patients with CRCLM who were treated between January 2015 and January 2021. Standard systemic chemotherapy, targeted therapy, and 66 DEB-TACE procedures were administered. Data were collected on each DEB-TACE procedure, including chemotherapy agents, tumor burden of liver metastasis, number of DEB-TACE courses, and adverse events. Patients who received DEB-TACE after failure of first-line systemic therapy were categorized into the first-line failure group. Patients who received DEB-TACE after the failure of second-line, third-line, or fourth-line therapy were categorized into the other group. Subgroup analysis was performed to compare overall survival (OS) and progression-free survival (PFS) between the two groups.
RESULTS: In total, 35 patients with CRCLM (34 patients with adenocarcinoma and 1 patient with neuroendocrine carcinoma) were enrolled. In total, 13 patients (37.1%) had extrahepatic metastases at initial diagnosis. In this study, 66 DEB-TACE procedures were performed. The DCR was 54.3%. The median OS period was 47.4 months, and the estimated 3-year OS rate was 59.5%. The median PFS period was 6.3 months, and the estimated 1-year PFS rate was 20.6%. The PFS period was longer in the first-line failure group than in the other group (7.2 vs. 6.3 months). No significant difference was observed in OS between the two groups. Four episodes (6.1%) of grade 3 intra-abdominal infection were observed.
CONCLUSIONS: The combination of chemotherapy, targeted therapy, and DEB-TACE can lead to a favorable DCR and survival outcomes in patients with CRCLM. Early intervention with DEB-TACE (i.e., after the failure of first-line therapy) has the potential to extend the PFS period in patients with CRCLM. Severe adverse events were rare and manageable. Further prospective, randomized controlled studies are warranted to obtain more conclusive findings.