oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2018-17-3-34-40oncotomsk-761Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESКОМБИНИРОВАННОЕ ЛЕЧЕНИЕ БОЛЬНЫХ НЕОПЕРАБЕЛЬНЫМИ МЕТАСТАЗАМИ КОЛОРЕКТАЛЬНОГО РАКА ПЕЧЕНИCOMBINED MODALITY TREATMENT FOR PATIENTS WITH INOPERABLE COLORECRAL LIVER METASTASEShttps://orcid.org/0000-0002-4230-8033ШабунинА. В.ShabuninA. V.

125993, г. Москва, ул. Баррикадная, 2/1, стр. 1

125284, Москва, 2-й Боткинский проезд, 5

доктор медицинских наук, член-корреспондент РАН, профессор, заведующий кафедрой хирургии, Российская медицинская академия непрерывного постдипломного образования Минздрава России; главный врач ГКБ им. С.П. Боткина (г. Москва, Россия). SPIN-код: 8917-7732. ResearcherID: W-1068-2017

2/1, Barrikadnaya Street, 125993-Moscow, Russia

5, 2-nd Botkinsky proezd, 125284-Moscow, Russia

MD, Professor, Corresponding Member of the Russian Academy of Sciences, Head of Surgery Department, Russian Medical Academy of Postgraduate Education; Chief  Physician of S.P. Botkin City Clinical Hospital (Moscow,  Russia). ResearcherID: W-1068-2017

info@botkinmoscow.ruhttps://orcid.org/0000-0003-0335-1204ТавобиловМ. М.TavobilovM. M.

125993, г. Москва, ул. Баррикадная, 2/1, стр. 1

125284, Москва, 2-й Боткинский проезд, 5

кандидат медицинских наук, доцент кафедры хирургии, Российская медицинская академия непрерывного постдипломного образования Минздрава России; заведующий отделением хирургии печени и  поджелудочной железы, ГКБ им. С.П. Боткина (г. Москва, Россия). SPIN-код: 9554-5553.

2/1, Barrikadnaya Street, 125993-Moscow, Russia

5, 2-nd Botkinsky proezd, 125284-Moscow, Russia

MD, PhD, Surgery Department, Russian Medical Academy of Postgraduate Education; Head of the Department of Liver and Pancreas Surgery, S.P. Botkin City Clinical Hospital (Moscow, Russia)

info@botkinmoscow.ruhttps://orcid.org/0000-0001-8391-1210ГрековД. Н.GrekovD. N.

125993, г. Москва, ул. Баррикадная, 2/1, стр. 1

125284, Москва, 2-й Боткинский проезд, 5

кандидат медицинских наук, доцент кафедры хирургии, Российская медицинская академия непрерывного постдипломного образования Минздрава России; заведующий отделением абдоминальной хирургии, ГКБ им. С.П. Боткина (г. Москва, Россия). SPIN-код: 6734-9727

2/1, Barrikadnaya Street, 125993-Moscow, Russia

5, 2-nd Botkinsky proezd, 125284-Moscow, Russia

MD, PhD, Surgery Department, Russian Medical Academy of Postgraduate Education, Head of the Abdominal Surgery Department, S.P. Botkin City Clinical Hospital (Moscow, Russia)

info@botkinmoscow.ruhttps://orcid.org/0000-0001-8016-1610ДроздовП. А.DrozdovP. A.

125284, Москва, 2-й Боткинский проезд, 5

врач-хирург отделения хирургии печени и поджелудочной железы, ГКБ им. С.П. Боткина (г. Москва, Россия). SPIN-код: 8184-8918

5, 2-nd Botkinsky proezd, 125284-Moscow, Russia

MD, Physician, Department of Liver and Pancreas Surgery, S.P. Botkin City Clinical Hospital (Moscow, Russia)

dc.drozdov@gmail.comГБОУ ДПО «Российская медицинская академия непрерывного постдипломного образования» Минздрава России ГБУЗ «Городская клиническая больница им. С.П. Боткина»РоссияRussian Medical Academy of Postgraduate Education S.P. Botkin City Clinical HospitalRussian FederationГБУЗ «Городская клиническая больница им. С.П. Боткина»РоссияS.P. Botkin City Clinical HospitalRussian Federation2018030720181733440Copyright © Шабунин А.В., Тавобилов М.М., Греков Д.Н., Дроздов П.А., 20182018Шабунин А.В., Тавобилов М.М., Греков Д.Н., Дроздов П.А.Shabunin A.V., Tavobilov M.M., Grekov D.N., Drozdov P.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/761

Цель исследования – улучшить результаты лечения больных с нерезектабельными метастазами колоректального рака печени путем комбинации химиоэмболизации  печеночной артерии и радиочастотной аблации.

Материал и методы

Материал и методы. Проанализированы результаты лечения 60 больных с метахронныминерезектабельными метастазами колоректального рака в печень. Критерии включения: отсутствие экстрапеченочных метастазов; размер метастазов от 3 до 5 см; невозможность  проведения резекционного вмешательства. Больные были разделены на основную группу  (30 пациентов), куда вошли те, кому проведена комбинация регионарной химиотерапии и  радиочастотной аблации, и контрольную группу (30 пациентов), в нее вошли больные, которым проведена радиочастотная аблация.

Результаты

Результаты. Постэмболизационный и постаблационный синдром был у всех больных основной и контрольной групп. Осложнения были у 4 из 60 больных (2 больных в основной  группе и 2 больных в контрольной группе (p=1)) – правосторонний гидроторакс (II класс по Clavien-Dindo). Безрецидивная выживаемость в основной группе за первый год составила 96,6 %, за второй – 76,6 %, за третий – 53,3 %. В контрольной группе – 90,0,  53,6 и 30,0 % соответственно (p=0,049). Общая одно-, двух- и трехлетняя выживаемость у  больных основной группы составила 100, 90 и 63,3 %. В контрольной группе – 100, 70 и 50,0 % соответственно (p=0,202).

Заключение

Заключение. Применение на практике комбинированного метода позволило улучшить  результаты лечения больных с нерезектабельными метастазами колоректального рака печени за счет увеличения общей и безрецидивной выживаемости.

The purpose of the study was to improve treatment outcomes for patients with inoperable colorectal liver metastases using the  combination of chemoembilization of the hepatic artery and radiofrequency ablation.

Material and methods

Material and methods. Treatment outcomes of 60 patients with methachronic unresectable liver metastases from colorectal cancer  were analyzed. Eligibility criteria were as follows: absence of  extrahepatic metastases, size of metastases from 3 to 5 cm, and  inability to perform resection. All patients were divided into two groups. Group I included 30 patients who received combination  of regional chemotherapy and radiofrequency ablation. Group II (the control group) consisted of 30 patients who received radiofrequency ablation only.

Results

Results. Post-embolization and post-ablation syndromes were observed in both groups of patients. Rightsided hydrothorax  (Clavien-Dindo grade II) was found in 4 out of 60 patients (2  patients in Group I and 2 patients in Group II). One-, two- and  three-year disease-free survival rates in Group I patients were 96.6  %, 76.6 % and 53.3 %, respectively. The corresponding rates in the  control group patients were 90.0 %, 53.6 % and 30.0 %,  respectively (p=0.049). The overall one-, two-and three-year  survival rates in Group I patients were 100 %, 90 % and 63.3 %,  respectively. The corresponding rates in the control group patients  were 100 %, 70 % and 50.0 %, respectively (p=0.202).

Conclusion

Conclusion. The combination of regional chemotherapy and radiofrequency ablation led to the improvement in overall and disease-free survival rates.

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The authors declare that there are no conflicts of interest present.