Abstract: Aim: was to develop a score scale for the prediction of complete tumor necrosis to assess the potential effectiveness of radiofrequency ablation of colorectal cancer focals in liver, on the base of results of the use of radiological diagnostic methods. Materials and methods: a comparative analysis of results of radiological diagnosis of solitary colorectal cancer metastases in liver was carried out in 51 patients, depending on their characteristics before and at different times after radiofrequency ablation (RFA). The survey and interventions were carried out between 2014 and 2020 in accordance with standards of treatment approved in Belarus. Ultrasound and CT with bolus contrast enhancement were used as radiation diagnostic methods. The initial morphological parameters of tumor focals were evaluated according to results of ultrasound examination. CT with bolus contrast was used to control the effectiveness of RFA (determining the frequency of complete tumor necrosis): on the day of discharge of patients from the hospital, after 1 month, and then - once every 3 months (quarterly) during the year. Results: the dependence of the effectiveness of RFA (frequency of complete tumor necrosis) on initial characteristics of solitary focals of colorectal cancer in liver was revealed and confirmed by results of a comparative statistical analysis. On the basis of obtained data, a score scale for predicting the effectiveness of RFA was developed and validated. The sensitivity of the new technique was 80,0%; specificity - 82,9%. Conclusion: for the first time, a scale for the prediction of complete tumor necrosis was developed to assess the potential effectiveness of radiofrequency ablation of solitary colorectal cancer focals in liver. ROC-analysis of the scale validation results showed that the sensitivity and specificity of the model are sufficient for its application in practice: 80,0% and 82,93%, respectively. References 1. Hideo T, Eren B. Role of thermal ablation in the management of colorectal liver metastasis. Hepatobiliary Surg. Nutr. 2020; 9(1): 49-58. https://doi.org/10.21037/hbsn.2019.06.08 2. Machi J, Oishi AJ, Nancy LF, Robert HO. Sonographically guided radio frequency thermal ablation for unresectable recurrent tumors in the retroperitoneum and the pelvis. J. Ultrasound. Med. 2003; 22(5): 507-13. https://doi.org/10.7863/jum.2003.22.5.507 3. Furrukh J, Cameron S, Iswanto S. The use of thermal ablation in the treatment of colorectal liver metastasis-proper selection and application of technology. Hepatobiliary Surg. Nutr. 2021; 10(2): 279-280. https://doi.org/10.21037/hbsn-21-54 , Image-Guided Thermal Ablation for Colorectal Liver Metastases. Tech. Vasc. Interv. Radiol. 2020; 23(2): 100672. https://doi.org/10.1016/j.tvir.2020.100672 5. Rafael D-N, Stephen F, Hassan M, Graeme P. Defining the Optimal Use of Ablation for Metastatic Colorectal Cancer to the Liver Without High-Level Evidence. Curr. Treat. Options. Oncol. 2017; 18(2): 8. https://doi.org/10.1007/s11864-017-0452-6 6. Мурашко К.Л., Сорокин В.Г., Громов Д.Г. Методы локального воздействия на очаговые образования печени, применяемые в онкорадиологии. Диагностическая и интервенционная радиология. 2020;14: 60-66. Murashko KL, Sorokin VG, Gromov DG. Metody lokal'nogo vozdejstviya na ochagovye obrazovaniya pecheni, primenyaemye v onkoradiologii. Diagnosticheskaya i intervencionnaya radiologiya. 2020; 14: 60-66 [In Russ]. https://doi.org/10.25512/DIR.2020.14.2.07 7. Binbin J, Hongjie L, Kun Y, Zhongyi Z. Ten-Year Outcomes of Percutaneous Radiofrequency Ablation for Colorectal Cancer Liver Metastases in Perivascular vs. Non-Perivascular Locations: A Propensity-Score Matched Study. Front. Oncol. 2020; 16(10): 553556. https://doi.org/10.3389/fonc.2020.553556 8. Lu DSK, Steven SR, Limanond P, et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J. Vasc. Interv. Radiol. 2003; 14(10): 1267-74. https://doi.org/10.1097/01.rvi.0000092666.72261.6b 9. Lu DS, et al. Effect of vessel size on creation of hepatic radiofrequency lesions in pigs: Assessment of the “heat sink” effect. Am. J. Roentgenol. 2002; 178: 47-51. https://doi.org/10.2214/ajr.178.1.1780047 10. You L, Hui H, Ziwei W, et al. Evaluation of models for predicting the probability of malignancy in patients with pulmonary nodules. Biosci. Rep. 2020; 28; 40(2): BSR20193875. https://doi.org/10.1042/BSR20193875 11. Wang QQ, Yu SC, Qi X, et al. Overview of logistic regression model analysis and application. Zhonghua Yu. Fang. Yi. Xue. Za. Zhi. 2019; 6; 53(9): 955-960. https://doi.org/10.3760/cma.j.issn.0253-9624.2019.09.018 12. Adina NK, Trevor C, Ruwanthi K-D. Time-dependent ROC curve analysis in medical research: current methods and applications. BMC Med. Res. Methodol. 2017; 17(1): 53. https://doi.org/10.1186/s12874-017-0332-6 13. Nakas CT, Reiser B. Editorial for the special issue of “Statistical Methods in Medical Research” on “Advanced ROC analysis”. Statistical Methods in Medical Research. 2018; 27(3): 649-650. https://doi.org/10.1177/0962280217742536 14. Xieling C, Haoran X, Fu L, et al. A bibliometric analysis of natural language processing in medical research. BMC Med. Inform. Decis. Mak. 2018; 18(1): 14. https://doi.org/10.1186/s12911-018-0594-x 15. Young C, Soung WJ, Jae YJ, Yong JK. Recent Updates of Transarterial Chemoembolilzation in Hepatocellular Carcinoma. Int. J. Mol. Sci. 2020; 31; 21(21): 8165. https://doi.org/10.3390/ijms21218165 16. Riccardo L. Loco-regional treatment of hepatocellular carcinoma. Hepatology. 2010; 52(2): 762-73. https://doi.org/10.1002/hep.23725 17. Hinshaw JL, Lubner MG, Ziemlewicz TJ, et al. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation - what should you use and why? Radiographics. 2014; 34(5): 1344-62. https://doi.org/10.1148/rg.345140054 18. Pierre A, Roberto LC, Guillaume K, et al. Percutaneous tumor ablation. Presse. Med. 2019; 48(10): 1146-1155. https://doi.org/10.1016/j.lpm.2019.10.011 19. Fan Z, Hongying S, Xiangjun H, et al. Tumor Thermal Ablation Enhancement by Micromaterials. Curr. Drug. Deliv. 2017; 14(3): 323-333. https://doi.org/10.2174/1567201813666160108114208 20. Mehta A, Oklu R, Sheth RA. Thermal Ablative Therapies and Immune Checkpoint Modulation: Can Locoregional Approaches Effect a Systemic Response? Gastroenterol. Res. Pract. 2016; 9251375.
Abstract: Introduction. The RECIST criteria, which are routinely used to assess results of treatment of colorectal liver metastases with the transarterial chemoembolization (TACE), are not based on the identification of the tumor necrosis, and therefore their objectivity is questionable. Aim: was to develop method of assessment of tumor response, based on tumor necrosis after TACE. Materials and Methods: own technique of assessment of the tumor responce, based on measurement of computed tomography density of metastatic lesions in native and post-contrast phases, before and after treatment («criteria of N») is offered. Data of 13 patients who have undergone treatment of metastases of a colorectal cancer in a liver by the TACE method with application of microspheres «DC Beads» and irinotekan are analysed. Comparison of results of treatment according to criteria of RECIST and «criteria of N» is carried out. Results: аccording to RECIST criteria stable disease was achieved in 11(85%) patients, and 2(15%) patients had a partial response. Neither complete response, nor progressive disease was observed. Later, progressive disease occurred in 11 patients. The period from the start of treatment until progression fixation averaged 7-9 months. According to the «N criteria», 4 (31%) patients had a complete response, 6(46%) patients had a partial response: and in 3(23%) patients we detected stable disease. Then progressive disease was monitored in all 13 patients, the period from the start of treatment until the progression fixation averaged 3-6 months. In 4 cases the progression process according to «N criteria» was detected earlier than by RECIST criteria. Conclusion: The usе of RECIST criteria may underestimate the objective response to treatment, and as a result - the progression of disease later on. The proposed method of tumor response assessment, based on the analysis of tumor necrosis («the N criteria»), proves to be more productive. References 1. Pickren J.W., Tsukada Y., Lane W.W. Liver metastasis. in: Weiss L, Gilbert HA (eds) Analysis of autopsy data. GK Hall, Boston. 1982: 2-18. 2. Vogl T.J., Zangos S., Balzer J.O., Thalhammer A., Mack M.G. Transarterial chemoembolization of liver metastases: indication, technique, results. Rofo. 2002; 174(6): 675-683. 3. Pwint T.P., Midgley R., Kerr D.J. Regional hepatic chemotherapies in the treatment of colorectal cancer metastases to the liver. Semin. Oncol. 2010; 37(2): 149-159. 4. Cohen A.D., Kemeny N.E. An update on hepatic arterial infusion chemotherapy for colorectal cancer. Oncologist. 2003; 8(6): 553-566. 5. Ji S.H., Park Y.S., Lee J., Lim D.H., Park B.B., Park K.W., Kang J.H., Lee S.H., Park J.O., Kim K., Kim W.S., Jung C., im Y.H. Kang W.K., Park K. Phase ii study of irinotecan, 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer. Jpn. J. Clin. Oncol. 2005; 35(4): 214-217. 6. Kemeny N., Garay C.A., Gurtler J., Hochster H., Kennedy P., Benson A., Brandt D.S., Polikoff J., Wertheim M., Shumaker G., Hallman D., Burger B., Gupta S. Randomized multicenter phase ii trial of bolus plus infusional fluorouracil/leucovorin compared with fluorouracil/leucovorin plus oxaliplatin as third-line treatment of patients with advanced colorectal cancer. J. Clin.Oncol. 2004; 22(23): 4753-4761. Erratum in: J. Clin. Oncol. 2005; 23(1): 248. 7. Liapi E., Geschwind J.F. Chemoembolization for primary and metastatic liver cancer. Cancer J. 2010; 16(2): 156-162. 8. Fiorentini G., Aliberti C., Turrisi G., Del Conte A., Rossi S., Benea G., Giovanis P. intraarterial hepatic chemoembolization of liver metastases from colorectal cancer adopting irinotecan-eluting beads: results of a phase ii clinical study. in Vivo. 2007; 21(6): 10851091. 9. Martin R.C., Joshi J., Robbins K., Tomalty D., Bosnjakovik P., Derner M., Padr R., Rocek M., Scupchenko A., Tatum C. Hepatic intra-arterial injection of drug-eluting bead, irinotecan (DEBiRi) in unresectable colorectal liver metastases refractory to systemic chemotherapy: results of multi-institutional study. Ann. Surg. Oncol. 2011; 18(1): 192-198. 10. Narayanan G., Barbery K., Suthar R., Guerrero G., Arora G. Transarterial chemoembolization using DEBiRi for treatment of hepatic metastases from colorectal cancer. Anticancer Res. 2013; 33(5): 2077-2083. 11. Martin R.C., Howard J., Tomalty D., Robbins K., Padr R., Bosnjakovic P.M., Tatum C. Toxicity of irinotecan-eluting beads in the treatment of hepatic malignancies: results of a multi-institutional registry. Cardiovasc Intervent Radiol. 2010; 33(5): 960-966.
