What to choose as radical local treatment for lung metastases from colo-rectal cancer : Surgery or radiofrequency ablation?
A partir d'une revue systématique de la littérature publiée entre 2001 et 2011 (27 études ; durée minimale de suivi : 24 mois : nombre minimal de patients par étude : 50), cette étude compare l'efficacité de la chirurgie, de l'ablation par radiofréquence et de la radiothérapie stéréotaxique pour traiter localement des métastases pulmonaires ayant pour origine un cancer colorectal
Background : Long-term survival can be obtained with local treatment of lung metastases from colorectal cancer. However, it is unclear as to what the optimal local therapy is: surgery, radiofrequency ablation (RFA) or stereotactic radiotherapy (SBRT). Methods : A systematic review included 27 studies matching with the a priori selection criteria, the most important being 50 patients and a follow-up period of 24months. No SBRT studies were eligible. The review was therefore conducted on 4 RFA and 23 surgical series. Results : Four of the surgical studies were prospective, all others were retrospective. No randomized trial was found. The reporting of data differed between the studies, which led to difficulties in the analyses. Treatment-related mortality rates for RFA and surgery were 0% and 1.4–2.4%, respectively, whereas morbidity rates were reported inconsistently but seemed the lowest for surgery. Conclusion : Due to the lack of phase III trials, no firm conclusions can be drawn, although most evidence supports surgery as the most effective treatment option. High-quality trials comparing currently used treatment modalities such as SBRT, RFA and surgery are needed to inform treatment decisions.