HIFU for the treatment of gastric cancer with liver metastases with unsuitable indications for hepatectomy and radiofrequency ablation: a prospective and propensity score-matched study

Bin Zhou,Jianjun Zheng,Xudong Gao,Ping Chen,Derry Minyao Ng,Tong Yang,Qi Zheng,Xiaoxiang Fan,Kun Yan,Zhi Zheng,Ning He,Jiaze Hong

doi:10.1186/s12893-021-01307-y

Abstract

BackgroundThe purpose of this study was to explore the efficacy and safety of high intensity focused ultrasound (HIFU) in gastric cancer with liver metastasis (GCLM) patients who were contraindicated for either hepatectomy or radiofrequency ablation (RFA).MethodsThis is a prospective, observational study on GCLM patients with 1–3 liver metastases. The primary gastric lesions were thoroughly resected and any case that exhibited extra-hepatic metastasis was excluded. A 1:2:2 propensity score-matching analysis was performed using a logistic regression model on the HIFU group, best supportive care (BSC) group, and palliative chemotherapy (PC) group. The primary endpoints include progression-free survival (PFS) and overall survival (OS).ResultsForty patients were finally included, there were 8 cases in HIFU group, 16 cases in BSC group, and 16 cases in PC group. The median follow-up time for the entire cohort was 10 months. The median PFS was 16.5 months in HIFU group, 2 months in BSC group, and 5 months in PC group. The median OS was 27.5 months in the HIFU group, 7 months in the BSC group, and 11.5 months in the PC group. Additionally, no grade 3 or higher adverse events occurred in the HIFU group.ConclusionThe results of this study showed that HIFU treatment could improve the long-term prognosis of GCLM patients without a significant increase in the occurrence of adverse events. Compared with PC and BSC, HIFU is the preferred treatment option when GCLM patients without extra-hepatic metastasis are unable to undergo either surgery or RFA.

Highlights

Gastric cancer (GC) is the fifth most commonly diagnosed malignancy and the third leading cause of death from cancer worldwide [1]
After the selection process was performed based on the above-mentioned inclusion and exclusion criteria, a total of 172 gastric cancer with liver metastasis (GCLM) patients initially met the conditions of this study, there were 8 patients in the high intensity focused ultrasound (HIFU) group, 55 patients in the best supportive care (BSC) group, and 109 patients in the palliative chemotherapy (PC) group
There was no significant difference in gender, comorbidity, Child–Pugh class, the time of liver metastases, and the number of lymph nodes retrieved among the three groups

Summary

Introduction

Gastric cancer (GC) is the fifth most commonly diagnosed malignancy and the third leading cause of death from cancer worldwide [1]. Previous studies have shown that systemic chemotherapy is the recommended treatment for patients with gastric cancer with liver metastasis (GCLM) [5]. There is growing evidence that when the metastatic lesions are limited to the liver, local treatments such as hepatectomy and radiofrequency ablation (RFA) are viable alternative therapies [6, 7]. RFA can achieve a better long-term effect in selected patients with GCLM, with a 5-year OS of 3–30% [10, 11]. The purpose of this study was to explore the efficacy and safety of high intensity focused ultrasound (HIFU) in gastric cancer with liver metastasis (GCLM) patients who were contraindicated for either hepatectomy or radiofrequency ablation (RFA)

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Discussion

Conclusion