Long-Term Outcomes in Percutaneous Radiofrequency Ablation for Histologically Proven Colorectal Lung Metastasis

Abstract

Introduction To evaluate the long-term outcome of image-guided radiofrequency ablation (RFA) when treating histologically confirmed colorectal lung metastasis in terms of overall survival (OS), progression-free survival (PFS) and local tumour control (LTC). Materials and Methods Retrospective single-centre study. Consecutive RFA treatments of histologically proven lung colorectal metastases between 01/01/2008 and 31/12/14. The primary outcome was patient survival (OS and PFS). Secondary outcomes were local tumour progression (LTP) and complications. Prognostic factors associated with OS/ PFS were determined by univariate and multivariate analyses. Results Sixty patients (39 males: 21 females; median age 69 years) and 125 colorectal lung metastases were treated. Eighty percent (n = 48) also underwent lung surgery for lung metastases. Mean metastasis size (cm) was 1.4 ± 0.6 (range 0.3–4.0). Median number of RFA sessions was 1 (1–4). During follow-up (median 45.5 months), 45 patients died (75%). The estimated OS and PFS survival rates at 1, 3, 5, 7, 9 years were 96.7%, 74.7%, 44.1%, 27.5%, 16.3% (median OS, 52 months) and 66.7%, 31.2%, 25.9%, 21.2% and 5.9% (median PFS, 19 months). The LTC rate was 90% with 6 patients developing LTP with 1-, 2-, 3- and 4-year LTP rates of 3.3%, 8.3%, 10.0% and 10.0%. Progression-free interval < 1 year (P = 0.002, HR = 0.375) and total number of pulmonary metastases (≥ 3) treated (P = 0.037, HR = 0.480) were independent negative prognostic factors. Thirty-day mortality rate was 0% with no intra-procedural deaths. Conclusion The long-term OS and PFS following RFA for the treatment of histologically confirmed colorectal lung metastases demonstrate comparable oncological durability to surgery.

Reply to: The PulMiCC Trial Provides Control Data for Colorectal Lung Metastases Amenable to Local Treatments

“…We thank William et al letter to Editor [ 1 ] for their response to the study “Long-Term Outcomes in Percutaneous Radiofrequency Ablation for Histologically Proven Colorectal Lung Metastasis” [ 2 ] and for sharing the updated findings of their multi-centre randomised control trial (RCT), which compares active monitoring with lung metastasectomy [ 3 ]. The updated PulMiCC trial analysis was published online on 9th May 2020, which was just after our manuscript submission on 5th May 2020.…”

Artificial Pneumothorax Improves Radiofrequency Ablation of Pulmonary Metastases of Hepatocellular Carcinoma close to Mediastinum

“…Comparatively, Wah et al reported that the estimated OS rates at 1 and 3 years were 96.7% and 74.7%, respectively, after 60 colorectal pulmonary oligometastases treated by RFA 27 . To the treatment of extrahepatic oligmetastases from HCC, Zhao et al have reported that the 1-, 2-year OS rates were 91% and 70%, respectively 28 .…”

Artificial pneumothorax improves radiofrequency ablation of pulmonary metastases of hepatocellular carcinoma close to mediastinum

“…Unfortunately, only 63% of 2-year OS rate was reported after 327 inoperable pulmonary oligometastases treated with stereotactic body radiotherapy (SBRT) [ 26 ]. Comparatively, Wah et al reported that the estimated OS rates at 1 and 3 years were 96.7 and 74.7%, respectively, after 60 colorectal pulmonary oligometastases treated by RFA [ 27 ]. To the treatment of extrahepatic oligmetastases from HCC, Zhao et al have reported that the 1-, 2-year OS rates were 91 and 70%, respectively [ 28 ].…”