Breast Cancer Liver Metastases: US-guided Percutaneous Radiofrequency Ablation—Intermediate and Long-term Survival Rates

Abstract

Purpose To retrospectively assess the local control and intermediate- and long-term survival of patients with liver metastases from breast cancer who have undergone percutaneous ultrasonography (US)-guided radiofrequency (RF) ablation. Materials and Methods This study was approved by the hospital ethics committee, and all patients provided written informed consent. RF ablation was used to treat 87 breast cancer liver metastases (mean diameter, 2.5 cm) in 52 female patients (median age, 55 years). Inclusion criteria were as follows: fewer than five tumors, maximum tumor diameter of 5 cm or smaller, and disease either confined to the liver or stable with medical therapy. Forty-five (90%) of 50 patients had previously undergone chemotherapy, hormonal therapy, or both, and had no response or an incomplete response to the treatment. Contrast material–enhanced computed tomography and US were performed to evaluate complications and technical success and to assess for local tumor progression during follow-up. The Kaplan-Meier method was used to assess survival, and results were compared between groups with a log-rank test. Cox regression analysis was used to assess independent prognostic factors that affected survival. Results Complete tumor necrosis was achieved in 97% of tumors. Two (4%) minor complications occurred. Median time to follow-up from diagnosis of liver metastasis and from RF ablation was 37.2 and 19.1 months, respectively. Local tumor progression occurred in 25% of patients. New intrahepatic metastases developed in 53% of patients. From the time of first RF ablation, overall median survival time and 5-year survival rate were 29.9 months and 27%, respectively. From the time the first liver metastasis was diagnosed, overall median survival time was 42 months, and the 5-year survival rate was 32%. Patients with tumors 2.5 cm in diameter or larger had a worse prognosis (hazard ratio, 2.1) than did patients with tumors smaller than 2.5 cm in diameter. Conclusion Survival rates in selected patients with breast cancer liver metastases treated with RF ablation are comparable to those reported in the literature that were achieved with surgery or laser ablation.

Radiofrequency ablation of metastatic lesions from breast cancer

“…Furthermore, the very restrictive inclusion criteria probably induced selection bias. However, comparison of the results of this study and those reported in the literature (which are still not related to particularly large patient populations) [8,9] show that the present experience is in agreement with the results reported by other authors [8e10] confirming that RFA may complement surgical resection in the treatment of metastases from BC. The number of non-local recurrent lesions (40% of total recurrences) confirms that metastatic BC is a disease which should be addressed in a multidisciplinary context in which the role of chemotherapy is indisputable [4].…”

“…This should be kept in mind particularly in view of the complication rate linked to surgery which is much higher [20e22]. In addition, RFA was repeated in nearly 80% of cases [9] as opposed to resective surgery [21]. These data confirm that RFA is an extremely versatile technique which can be repeated in the same patient to treat new metastases and in cases of incomplete treatment.…”

“…Patient ability to collaborate during the procedure 8. Good US visualization of the lesion These inclusion criteria are identical or in some cases more restrictive than those reported in the literature [8,9].…”

“…RFA has in the recent years been performed under ultrasound (US) guidance [8,9] and computed tomography (CT) guidance [10] in the treatment of lung and liver metastases from BC. The aim of this paper was to compare the results of RFA performed by the authors in the treatment of metastases from BC with the most recent literature on the subject.…”

Contrast enhanced ultrasound: Roles in immediate post-procedural and 24-h evaluation of the effectiveness of thermal ablation of liver tumors

“…It is considered a curative treatment for Barcelona Clinic Liver Cancer Stage I hepatocellular carcinomas (HCC), and reported rates of local tumor control in this setting exceed 80% [1,2]. In addition, local tumor control and survival rates comparable with those obtained with surgical resection have recently been reported in selected patients with liver metastases from colorectal and breast cancers [3,4].…”