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

Abstract

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 ...

Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, the interventional oncology sans frontières meeting 2013

“…Analysis of the 5-year survival in four papers where patients without extra-hepatic disease were treated shows a direct correlation between crude liver tumour volume and survival with the best results in those with small volume disease (R 2 0.7) (Fig. 1) [7,30,32,38]. We would therefore recommend that in addition to size and …”

“…Nevertheless, 5-year survival is close to 0 % unless patients can undergo and benefit from surgery. RF ablation has been successfully applied in patients with non-resectable, small-volume liver disease, often in conjunction with chemotherapy, and this has resulted in 3-year survival rates of 37-77 % and 5-year survival rates of 17-51 % (Table 1) [4][5][6][7][29][30][31][32][33][34][35][36][37][38][39]. Abdalla compared ablation in unresectable patients with chemotherapy in un-ablatable patients, all with liver-only disease, and showed a significant improvement in survival in the ablation group median survival: 25 months versus 16.5 months (p=0.005) [4].…”

Serum Carbohydrate Antigen 19-9 as an Indicator of Liver Metastasis in Colorectal Carcinoma Cases

“…Colorectal cancer (CRC) is one of the most common malignancies in the world, which leads to the third highest tumor-related mortality (Gillams and Lees, 2009;Van Tilborg et al, 2011). Liver is the most common organ that CRC metastasize to and liver metastasis (LM) can be detected in about 25% patients at initial diagnosis of CRC (Min et al, 2002).…”

Stereotactic Ablative Radiotherapy to Treat Colorectal Liver Metastases: Ready for Prime-Time?

“…Neo-adjuvant chemotherapeutics are able to downstage metastases and increase the number of patients in which surgical resection is possible [32]. To achieve tumor eradication in unresectable CRLM, RFA is gaining popularity, reaching 5-year survival rates between 18-30% [9,33]. Complete tumor eradication is also aimed for when treating CRLM with SABR, but current median survival rates cannot be compared to those of other local treatment modalities due to patient selection.…”

“…Recent literature suggests that RFA may achieve full tumor clearance, with 5-year survival rates of 18% to 43% [9][10][11]. The main area of concern following RFA is the presence of remnant tumor tissue in the ablation zone of larger lesions, leading to higher local recurrence rates.…”