Factors Influencing the Local Failure Rate of Radiofrequency Ablation of Colorectal Liver Metastases

Duijnhoven, F.H. van; Jansen, Matthijs; Junggeburt, Jan M. C.; Hillegersberg, Richard van; Rijken, Arjen M.; Coevorden, Frits van; Sijp, J. R. van der; Gulik, Thomas M. van; Slooter, Gerrit D.; Klaase, Joost M.; Putter, Hein; Tollenaar, Rob A.E.M.

doi:10.1245/aso.2006.08.014

Cited by 119 publications

(86 citation statements)

References 30 publications

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“…Distant recurrence (elsewhere in the liver or extrahepatic) rates vary from 28% to 84% [17,20]. Reported local recurrence rates (at the RFA site) range widely, from 2% to 60% [19,28,[31][32][33][34]. In our series 12% had local RFA site recurrence.…”

Section: Discussionmentioning

confidence: 65%

Long-term results of radiofrequency ablation for unresectable colorectal liver metastases: a potentially curative intervention

Tilborg

Meijerink

Sietses³

et al. 2011

BJR

114

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Objective: The long-term results and prognostic factors of radiofrequency ablation (RFA) for unresectable colorectal liver metastases (CRLM) in a single centre with .10 years of experience were retrospectively analysed. Methods: A total of 100 patients with unresectable colorectal liver metastases (CRLM) (size 0.2-8.3 cm; mean 2.4 cm) underwent a total of 126 RFA sessions (237 lesions). The mean follow-up time was 29 months (range 6-93 months). Lesion characteristics (size, number and location), procedure characteristics (percutaneous or intra-operative approach) and major and minor complications were carefully noted. Local control, mean survival time and recurrence-free and overall survival were statistically analysed. Results: No direct procedure-related deaths were observed. Major complications were present in eight patients. Local RFA site recurrence was 12.7% (n530/237); for tumour diameters of ,3 cm, 3-5 cm and .5 cm, recurrence was 5.6% (n58/143), 19.5% (n515/ 77) and 41.2% (n57/17), respectively. Centrally located lesions recurred more often than peripheral ones, at 21.4% (n521/98) vs 6.5% (n59/139), respectively, p50.009. Including additional treatments for recurring lesions when feasible, lesion-based local control reached 93%. The mean survival time from RFA was 56 (95% confidence interval (CI) 45-67) months. Overall 1-, 3-, 5-and 8-year survival from RFA was 93%, 77%, 36% and 24%, respectively. Conclusions: RFA for unresectable CRLM is a safe, effective and potentially curative treatment option; the long-term results are comparable with those of previous investigations employing surgical resection. Factors determining success are lesion size, the number of lesions and location. Colorectal carcinoma is one of the most common malignancies in Western countries. In 20-25% of patients with colorectal carcinoma (synchronous) liver metastases are present at the time of diagnosis of the primary tumour [1][2][3]. Another 20-30% of patients develop (metachronous) liver metastases, which usually arise within 3 years of initial treatment of the primary tumour [1,3]. In Europe and the USA, colorectal liver metastases (CRLM) are the most frequent cause of malignant hepatic tumours [4]. The prognosis of patients with untreated CRLM (receiving only symptomatic therapy) is poor, with a median survival rate of 4.5-12 months, depending on the extent of metastatic disease at the time of diagnosis [5]. Chemotherapeutics, using oxaliplatin and fluorouracil (5FU), can prolong survival in a palliative setting with a median survival of approximately 18 months [6][7][8]. More recent results show a median survival of 21.7 months for patients treated with capecitabine, irinotecan and oxaliplatin [9]. Surgical resection is still considered the only method for definite treatment of malignant liver tumours by many [10][11][12][13][14][15][16][17]. Resection of liver metastases with curative intent results in a 5 year overall survival rate of 24-58% and a 10 year survival rate of 28% [11][12][13][14][15][16][17][18][19]. It is not ...

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Section: Discussionmentioning

confidence: 65%

Long-term results of radiofrequency ablation for unresectable colorectal liver metastases: a potentially curative intervention

Tilborg

Meijerink

Sietses³

et al. 2011

BJR

114

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“…While some studies [11, 76 -79] have reported recurrence or persistence of metastatic disease at the site of the RFA to be Ͻ10%, other studies have reported local recurrence rates as high as 47% [80,81]. Survival following ablation is also difficult to interpret, because many patients who undergo this therapy are characterized by a number of poor prognostic factors (e.g., "unresectable" disease, multiple tumors, bilobar location, etc.…”

Section: Combined Local Therapy: Resection Plus Rfamentioning

confidence: 99%

Expanding Criteria for Resectability of Colorectal Liver Metastases

2008

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After completing this course, the reader will be able to:1. Identify the criteria for hepatic resection of colorectal metastases.2. Describe strategies for expanding the number of patients who may potentially benefit from hepatic resection.3. List the factors associated with poor prognosis following hepatic resection.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTSurgical resection is the treatment of choice in patients with colorectal liver metastases, with 5-year survival rates reported in the range of 40%-58%. Over the past 10 years, there has been an impetus to expand the criteria for defining resectability for patients with colorectal metastases. In the past, such features as the number of metastases (three to four), the size of the tumor lesion, and a mandatory 1-cm margin of resection dictated who was "resectable." More recently, the criteria for resectability have been expanded to include any patient in whom all disease can be removed with a negative margin and who has adequate hepatic volume/reserve. Specifically, instead of resectability being defined by what is removed, decisions concerning resectability now center around what will remain after resection. Under this new paradigm, the number of patients with resectable disease can be expanded by increasing/preserving hepatic reserve (e.g., portal vein embolization, two-stage hepatectomy), combining resection with ablation, and decreasing tumor size (preoperative chemotherapy). The criteria for resectability have also expanded to include patients with extrahepatic disease. Rather than being an absolute contraindication to surgery, patients with both intra-and extrahepatic disease should potentially be considered for resection based on strict selection criteria. The expansion of criteria for resectability of colorectal liver metastases requires a much more nuanced and sophisticated approach to the patient with advanced disease. A therapeutic approach that includes all aspects of multidisciplinary and multimodality care is required to select and treat this complex group of patients. The Oncologist 2008;13:51-64

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“…Other factors, such as size of the tumour treatment margins and operator-dependent variables, can contribute to the efficacy of the technique 14,15 . One study compared 190 patients resected without rfa and 101 receiving rfa plus resection 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Survival at 4 years was 65% for hepatectomy that also included rfa compared with 36% for hepatectomy alone. Another study evaluated 87 patients managed with rfa only 15 . Local (hepatic) failure occurred in 47.2% of patients.…”

Section: Discussionmentioning

confidence: 99%

Use of Chemotherapy and Radiofrequency Ablation to Treat Colorectal Cancer Metastases: A Retrospective Review of the Ottawa Hospital Cancer Centre over 7 Years

et al. 2014

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ConclusionsCompared with patients who did not receive chemotherapy, those who received chemotherapy, regardless of timing, experienced improved overall survival and disease-free survival. Use of rfa where required as an adjunct to hepatic resection appears to be effective and is not associated with worse overall survival. KEY WORDSColorectal cancer, hepatic resection, timing of chemotherapy, radiofrequency ablation INTRODUCTIONOf the estimated 23,800 Canadians diagnosed with colorectal cancer (crc) annually, approximately 9200 (40%) will die from their disease, most with distant metastatic spread 1 . When feasible, hepatic resection offers the greatest probability of cure for patients with isolated liver metastases 2 . However, even for those with disease that is largely liver-limited, there are barriers to curative resection such as the extent and distribution of lesions within the liver, extrahepatic disease, comorbidities, and age 3 .The maldistribution of lesions within the liver, making complete excision of all disease impossible without the risk of subsequent liver insufficiency, is one barrier that has received considerable attention. Strategies include serial resection, portal vein embolization, and the adjuvant use of radiofrequency ablation (rfa). The rfa procedure uses heat derived from radiofrequency waves at the end of a probe inserted into a metastasis to induce tumour necrosis. The use of rfa as an adjunct to hepatic resection is gaining acceptance. However, its efficacy in comparison with resection is controversial because of high rates of recurrence at the ablation site in some studies 4 .Despite the increasing opportunity for potentially curative hepatic resection, recurrence in resected patients is the most frequent outcome. Chemotherapy, ABSTRACT BackgroundAlmost 40% of people diagnosed with colorectal cancer will die from their disease, most with metastatic spread. When feasible, hepatic resection offers the greatest probability of cure for isolated liver metastases, but there are barriers to curative resection. Those barriers include the extent and distribution of lesions within the liver, extrahepatic disease, comorbidities, and age. Chemotherapy is often administered before or after resection with the intention of improving disease-free and overall survival. The timing of chemotherapy (adjuvant vs. neoadjuvant vs. perioperative) for patients undergoing potentially curative hepatic resection of metastasis of colorectal cancer origin is controversial. MethodsColorectal cancer patients with liver metastases resected at The Ottawa Hospital between January 1, 2003, and December 31, 2009, were identified, and their clinical records were retrospectively reviewed. Patients receiving intraoperative radiofrequency ablation (rfa) as part of their management were included. Factors associated with overall and diseasefree survival were evaluated. ResultsThe 168 identified patients (57% men, 43% women) had a median age of 63 years (range: 31-84 years). After hepatectomy, 10% had positive resection margi...

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Factors Influencing the Local Failure Rate of Radiofrequency Ablation of Colorectal Liver Metastases

Cited by 119 publications

References 30 publications

Long-term results of radiofrequency ablation for unresectable colorectal liver metastases: a potentially curative intervention

Long-term results of radiofrequency ablation for unresectable colorectal liver metastases: a potentially curative intervention

Expanding Criteria for Resectability of Colorectal Liver Metastases

Use of Chemotherapy and Radiofrequency Ablation to Treat Colorectal Cancer Metastases: A Retrospective Review of the Ottawa Hospital Cancer Centre over 7 Years

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