Radiofrequency Ablation of 100 Hepatic Metastases with a Mean Follow-Up of More Than 1 Year

Baère, Thierry De; Élias, Dominique; Dromain, Clarisse; Din, Mostafa Gamal El; Kuoch, Viseth; Ducreux, Michel; Boige, Valérie; Lassau, Nathalie; Marteau, V.; Lasser, P; Roche, Alain

doi:10.2214/ajr.175.6.1751619

Cited by 371 publications

(185 citation statements)

References 23 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: 66%

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

Tilborg

Meijerink

Sietses³

et al. 2011

BJR

113

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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: 66%

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

Tilborg

Meijerink

Sietses³

et al. 2011

BJR

113

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“…Local recurrence following open ablation varies between 6 % and 60 % and following percutaneous ablation between 10 % and 52 % (Table 3) [44,46,84,85]. All studies report lower rates of local recurrence in smaller tumours.…”

Section: Choice Of Approach Local Recurrencementioning

confidence: 99%

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

et al. 2015

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Objectives Previous attempts at meta-analysis and systematic review have not provided clear recommendations for the clinical application of thermal ablation in metastatic colorectal cancer. Many authors believe that the probability of gathering randomised controlled trial (RCT) data is low. Our aim is to provide a consensus document making recommendations on the appropriate application of thermal ablation in patients with colorectal liver metastases. Methods This consensus paper was discussed by an expert panel at The Interventional Oncology Sans Frontières 2013. A literature review was presented. Tumour characteristics, ablation technique and different clinical applications were considered and the level of consensus was documented.Eur Radiol (2015) Results Specific recommendations are made with regard to metastasis size, number, and location and ablation technique. Mean 31 % 5-year survival post-ablation in selected patients has resulted in acceptance of this therapy for those with technically inoperable but limited liver disease and those with limited liver reserve or co-morbidities that render them inoperable.Conclusions In the absence of RCT data, it is our aim that this consensus document will facilitate judicious selection of the patients most likely to benefit from thermal ablation and provide a unified interventional oncological perspective for the use of this technology. Key Points• Best results require due consideration of tumour size, number, volume and location.• Ablation technology, imaging guidance and intraprocedural imaging assessment must be optimised.• Accepted applications include inoperable disease due to tumour distribution or inadequate liver reserve.• Other current indications include concurrent co-morbidity, patient choice and the test-of-time approach.• Future applications may include resectable disease, e.g. for small solitary tumours.

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“…), thereby making comparisons with patients who have undergone complete surgical resection difficult. In general, studies with isolated RFA show a median survival duration of about 30 -35 months and a 3-year survival rate of 20%-36% [75,[82][83][84]. In a recent study comparing recurrence and outcome following hepatic resection, RFA, and combined resection and RFA for colorectal liver metastases, Abdalla et al [11] reported a significantly worse disease-free and overall survival rate for patients treated with RFA.…”

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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Radiofrequency Ablation of 100 Hepatic Metastases with a Mean Follow-Up of More Than 1 Year

Abstract: Radiofrequency ablation appears to be a promising therapeutic modality capable of extending the possibilities of partial hepatectomy and of efficiently treating small metastases percutaneously.

Cited by 371 publications

References 23 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

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

Expanding Criteria for Resectability of Colorectal Liver Metastases

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