Comparison of Percutaneous Radiofrequency Ablation for Subcapsular and Non-Subcapsular Colorectal Cancer Liver Metastases

Abstract

PurposeTo evaluate the efficacy and safety of percutaneous radiofrequency ablation (RFA) for subcapsular colorectal cancer liver metastases (CLMs).Materials and MethodsWith the approval of the Institutional Review Board, the clinical data of CLM patients who underwent percutaneous RFA for the first time from August 2010 to August 2020 were continuously collected. All CLMs were divided into subcapsular and non-capsular groups. Baseline characteristic data, technical effectiveness, minimal ablative margin, complications, local tumor progression (LTP), and overall survival (OS) between the two groups were analyzed using the t-test or chi-square test. A Cox regression model was used to evaluate the prognostic factors of LTP.ResultsOne hundred and ninety-nine patients (124 males; mean age, 60.2 years) with 402 CLMs (221 subcapsular; mean size, 16.0 mm) were enrolled in the study. Technical effectiveness was achieved in 93.5% (376/402) of CLMs, with a major complication rate of 5.5%. Compared with non-subcapsular tumors, the minimal ablative margin achieved in subcapsular CLM was smaller (χ2 = -8.047, P < 0.001). With a median follow-up time of 23 months (range, 3−96 months), 37.1% of the tumors had LTP. The estimated cumulative OS at 1, 3, and 5 years was 96.1%, 66.0%, and 44.2%, respectively. There were no statistically significant differences between the two groups in terms of technical effectiveness (χ2 = 0.484, P = 0.487), major complications (χ2 = 0.082, P = 0.775), local tumor progression-free survival (LTPFS) (χ2 = 0.881, P = 0.348), and OS (χ2 = 2.874, P = 0.090). Minimal ablative margin, tumor size (≥20 mm), and technical effectiveness were predictors of LTP (all P < 0.05).ConclusionRFA is a safe and effective technique for local tumor control of subcapsular CLMs.

Evidence on percutaneous radiofrequency and microwave ablation for liver metastases over the last decade

“…of patients No. of tumors Size of Tumors [mm] Follow-up [months] Local tumor control [%] Overall survival [months] Overall survival [%] (Disease- or Progression-free survival [%]) 1-year 2-year 3-year 4-year 5-year Cheng et al [ 11 ] 2021 RFA 68 – 29 (median) 59.8 (median) 47.1 53.4 (median) 88.1 – 66.9 – 64.5 Knott et al [ 12 ] 2021 MWA 57 102 18 (mean) 42 (median) 96 52 (median) 96 (93) – 66 (58) – 47 (39) Fan et al [ 13 ] 2021 RFA 199 402 16 (mean) 23 (median) 62.9 Subcapsular 46 (median) 96.1 – 66 – 44.2 non-subcapsular 60 (median) Kurilova et al [ …”

“…Cheng et al reported the outcome of RFA using a multielectrode radiofrequency switching controller for resectable metachronous CRLM; the 5-year survival and median OS were 50.7% and 53.4 months, respectively [11]. Table 2 presents the outcomes of RFA and MWA for CRLM including the 5-year OS rates [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. In the listed studies, 5-year OS following ablation ranged from 21 to 65%.…”

Evaluation of 3D-CEUS in the Recurrence of Liver Cancer after Radiofrequency Ablation

“…With the continuous improvement of minimally invasive medical technology, transcatheter arterial chemoembolization (TACE), radiofrequency ablation (RFA), and other treatment methods have gradually become the conventional treatment of liver cancer. RFA is physical ablation treatment method, which is minimally invasive and repeatable, and can improve the safety of liver cancer treatment [ 6 , 7 ]. According to some studies, the curative effect of RFA is close to that of surgery, but RFA has the defect of 3-D leakage.…”