Clinical Observation Of High Intensity Focused Ultrasound Combined With Chemotherapy In The Treatment Of Liver Metastasis Of Colorectal Cancer

BackgroundThe most common site of colorectal cancer metastasis is the liver,and colorectal liver metastases(CRLM)is one of the most important causes of death in patients with colorectal cancer.Surgical resection of liver metastases is a common clinical treatment for patients with liver metastases from colorectal cancer,but 80% to 85% of patients cannot be surgically resected due to the location,size and multiple intrahepatic metastases of the tumor.Recently,interventional embolization,radiofrequency and other local treatment methods have been gradually used in the clinical treatment of liver metastasis of colorectal cancer.ObjectivesTo evaluate the safety and efficacy of high intensity focused ultrasound(HIFU)combined with chemotherapy in the treatment of liver metastasis from colorectal cancer.MethodsThe clinical data of 48 patients with colorectal liver metastasis who met the inclusion criteria from October 2009 to June 2019 were retrospectively analyzed.Kaplan-Meier method was used for survival analysis.Log-rank was used for univariate analysis of 7 factors including gender,age,extrahepatic metastasis,primary site and tumor stage.Cox multivariate analysis was conducted on the factors that had influence on survival.The adverse reactions and objective efficacy of HIFU combined with chemotherapy were statistically analyzed.Results(1)The objective response rate of the first HIFU treatment was 100%,and the average tumor ablation rate was 84.1%.(2)The mean follow-up time was 25.5 months,median survival time(MST)and median free survival(PFS)were respectively 30 months and 10 months.The overall survival(OS)at 6 months,1 year and 2 years were 100%,89.1% and 35% respectively.(3)Univariate analysis showed that extrahepatic metastasis,primary site and tumor stage were important influencing factors for the prognosis of liver metastasis from colorectal cancer.Cox multivariate analysis showed that extrahepatic metastasis and clinical stage were important factors affecting the prognosis.(4)Among the 45 patients with chemotherapy,grade 1,2 and 3 side effects of chemotherapy(without grade 4 and 5 cases)were espectively 31,11 and 3.Grade 3 toxic and side effects were all severe leukocytopenia,and the residual toxic and side effects were mainly hematological,gastrointestinal and neurotoxic.The main adverse reactions after HIFU were temporary mild increase of liver transaminase(ALT/AST)and mild to moderate skin edema and pain in the local treatment area.No serious complications such as liver failure,gastrointestinal bleeding and perforation were observed.ConclusionsHIFU combined with chemotherapy in the treatment of colorectal liver metastases is safe and effective,which may be an alternative non-surgical treatment for colorectal liver metastases.