A Clinical Study Of The Effect Of Transcatheter Arterial Infusion Combined With Percutaneous Radiofrequency Ablation In Treatment Of Multiple Liver Metastases From Colorectal Cancer

Part I Transcatheter Artery Infusion of Oxaliplatin Combined with Capecitabine in Treatment of Multiple Liver Metastases from Colorectal CancerObjective:To investigate the efficiency and safety of transcatheter artery infusion of oxaliplatin combined with capecitabine in treatment of patients with multiple liver metastasis from colorectal cancer.Methods:Data of 50 patients with multiple liver metastases from colorectal cancer were analyzed.A total of 22 patients in group A underwent transcatheter artery infusion with oxaliplatin combined with capecitabine,while the other 28 patients in group B underwent intravenous oxaliplatin combined with capecitabine.According to the Modified Response Evaluation Criteria in Solid Tumors（mRECIST）,the efficacy of treatments in the two groups was evaluated.The primary endpoint of the study was overall survival（OS）and progress free survival（PFS）after treatment.The secondary study endpoints of this study included changes in serum carcinoembryonic antigen（CEA）before and after 6 cycles treatment,objective response rate（ORR）,and adverse events.Cox regression model was used to explore the prognostic factors affecting the overall survival of patients.Results:There were no significant differences of the baseline data between the two groups including age,gender,KPS score,serum carcinoembryonic antigen（CEA）level,serum alanine aminotransferase（ALT）level,serum aspartate aminotransferase（AST）level,patient Child-Pugh classification,clinic stage,primary lesion location distribution,primary pathological type of the lesion,family history of the tumor,the number of intrahepatic metastases,and the diameter of the largest metastases in the liver.The median overall survival（mOS）and median progress free survival（mPFS）in group A were 29.0 months and 10.0 months respectively,while the mOS and mPFS in group B were 21.5 months and 6.5 months respectively,statistically significant difference was found between the two groups(χ_OS²=8.153,χ² _PFS=13.194,p<0.05).In both groups,serum carcinoembryonic antigen（CEA）decreased apparently after 6 cycles treatment（t_A=4.636,t_B=4.115,p<0.05）,while no statistical difference of CEA was obvserved between the two proups afterment（t=1.059,p>0.05）.The objective response rate（ORR）in group A and B was 59.09%（13/22）and 35.71%（10/28）respectively（Z=-2.262,p>0.05）.Pathological types（p=0.001）,the number of liver metastatic lesion（p=0.028）and adminstration of oxaliplatin（p=0.001）were the factors affecting OS of patients.The incidence of peripheral neurotoxicity in group A（4.55%）was significantly lower than that in group B（32.14%）（χ²=4.266,p<0.05）.There was no significant difference about the other incidence of adverse reactions such as nausea,vomiting,diarrhea,myelosuppression and hand-foot syndrome between the two groups（p>0.05）.Conclusion:Transcatheter artery infusion with oxaliplatin combined with Capecitabine is an effective treatment for patients with multiple liver metastases from colorectal cancer,which can improve the objective response rate,prolong the survival time of patients,and reduce the incidence of adverse reaction.Part II Transcatheter Arterial Infusion Combined with Percutaneous Radiofrequency Ablation for Multiple Liver Metastases from Colorectal CancerObjective:To investigate the efficacy and safety of transcatheter arterial infusion（TAI）and percutaneous radiofrequency ablation（PRFA）in treatment of patients with multiple liver metastases from colorectal cancer.Methods:According to the inclusion criteria of this study,forty patients with multiple liver metastases from colorectal cancer were randomly divided into two groups with random digital table method.The patients in group A received TAI combined with PRFA,while the patients in group B only received the treatment of TAI.The efficacy of different treatments between the two groups was evaluated using the mRECIST criteria.The primary endpoint of this study was progression-free survival（PFS）,and the secondary endpoint included changes in serum carcinoembryonic antigen（CEA）before and after treatment,objective response rate（ORR）,and the incidence of adverse events.Cox regression model was used to explore the prognostic factors affecting the progress free survival of patients.Results:There were no significant difference of the baseline data between the two groups including age,gender,KPS score,serum carcinoembryonic antigen（CEA）level,serum alanine aminotransferase（ALT）level,serum aspartate aminotransferase（AST）level,Child-Pugh classification,clinic stage,primary lesion location distribution,primary pathological type of the lesion,the family history of the tumor,the number of intrahepatic metastases,and the diameter of the largest metastasis in the liver（p>0.05）.The median PFS was 18.0 months in group A and 10.0 months in group B,statistically significant difference was found between the two groups（χ²=8.976,p<0.05）.In both of the two groups,serum carcinoembryonic antigen（CEA）level decreased significantly after 6 cycles treatment than those before treatment（t_A=-4.437,t_B=-4.503 p<0.05）,while no statistical difference of CEA was observed between the two groups after 6 cycles treatment（t=-0.589 p>0.05）.The objective response rate（ORR）of patients in group A was 80.00%（16/20）,and the ORR of patients in group B was 57.89%（11/19）（Z=-2.195 p<0.05）.Multivariate analysis of Cox regression model showed whether combined PRFA（p=0.001）,number of intrahepatic lesions（p=0.001）,diameter of largest hepatic metastases（p=0.002）and pathological types（p=0.011）were independent factors affecting progression free survival in patients with multiple liver metastases from colorectal cancer.There was no significant difference between the two groups in the incidence of adverse reactions such as nausea,vomiting,diarrhea,myelosuppression,neurotoxicity,hand-foot syndrome,postoperative fever and abdominal pain（p>0.05）.Conclusion:Transcatheter arterial infusion combined with percutaneous radiofrequency ablation is safe and effective in the treatment of multiple liver metastases from colorectal cancer,which can improve the objective response rate and prolong the progression free survival time of patients.The adverse reactions are slight,the patients can tolerate the adverse reactions after symptomatic treatment.