Impact of Systemic Therapy and Recurrence Pattern on Survival Outcome after Radiofrequency Ablation for Colorectal Liver Metastases

Abstract

Background: Most patients undergoing radiofrequency ablation (RFA) of colorectal liver metastasases (CLM) develop disease recurrence, but little is known about the effect of recurrence patterns and/or systemic therapy on outcome. In this study, we examined the recurrence patterns and survival after systemic therapy plus RFA in patients with unresectable CLM without extrahepatic disease. The aims were to analyze the effect of recurrence patterns on survival and to assess the relative benefit contributed by systemic therapy and local ablation to disease control and patient outcome.Methods: From January 2002 to December 2012, 113 patients underwent RFA of liver-limited CLM after systemic therapy. Univariate and multivariate analyses for associations between clinical and/or treatment-related variables, recurrence-free survival (RFS), recurrence patterns, and overall survival (OS) were carried out.Results: Of 113 patients, 105 (92.8%) had disease recurrence (median RFS: 6.1 months). Lower post-recurrence OS was observed after early (≤6 months) than after late recurrence (8.5 versus 24.0 months, p < 0.001). Recurrence sites were RFA-sites only (4.8%), liver-only (57.1%), lung-only (10.5%), or multiple (27.6%); the corresponding post-recurrence OS was 21, 19, 39, and 7 months (p < 0.001), respectively. Response to pre-RFA systemic therapy was the strongest predictor for OS (hazard ratio [HR] 5.28), RFS (HR 3.30), early (odds ratio [OR] 6.34) and multiple-site recurrence (OR 3.83) (p < 0.01), respectively; only responders achieved 5-year OS and RFS (29% and 12% versus 0% and 0% for non-responders, p < 0.001, respectively).Conclusions: Survival after RFA for liver-limited CLM is strongly linked to the timing and pattern of non-local disease recurrence. Local ablation efficacy is necessary but not sufficient to obtain long-term disease control. Effective pre-RFA systemic therapy does favourably affect the incidence, timing and patterns of recurrence and long-term survival and appears essential for the tailoring of RFA application to maximize patient benefit.

The local efficacy and influencing factors of ultrasound-guided percutaneous microwave ablation in colorectal liver metastases: a review of a 4-year experience at a single center

“…In the present study, chemotherapy itself presented no positive role in reducing the rate of LTP, but the response to chemotherapy was a strong independent predictor for LTP. Similar results have been reported in the literature on RFA [36]. CRLM with PR may present with smaller sizes and relatively little blood supply, which is conducive to achieving adequate safety margins for ablation.…”

“…CRLM with PR may present with smaller sizes and relatively little blood supply, which is conducive to achieving adequate safety margins for ablation. Meanwhile, chemotherapy may eradicate micrometastases surrounding CRLM [7,36], which may help to prevent LTP following ablation.…”

Impact of Elevated Circulating Histones on Systemic Inflammation after Radiofrequency Ablation in Lung Cancer Patients

“…RFA is currently regarded as a safe and effective treatment for lung primary and metastatic tumors, especially for these inoperable patients [ 3 , 20 ]. It has key advantages, for example, precise treatment effect, high safety, and small trauma, which have become an important part in nonsurgery treatment of lung cancer.…”

The Association of KRAS Mutation and Primary Tumor Location with Recurrence in Colorectal Liver Metastases Undergoing Radiofrequency Ablation

“…Recurrence after RFA could in uence treatment and survival for CLM [20]. Thus, a better understanding of recurrence was necessary.…”

“…There were several studies investigated the coloration KRAS gene and recurrence after RFA for CLM [18,19]. A recent report showed that recurrence after RFA could in uence the treatment and survival of CLM patients [20].Therefore, A better comprehension of correlation may improve decision-making about pre-, intra-, and post-RFA.…”