CT-guided Radiofrequency Ablation as a Salvage Treatment of Colorectal Cancer Hepatic Metastases Developing after Hepatectomy

Abstract

Purpose To evaluate the clinical outcomes of percutaneous radiofrequency (RF) ablation of colorectal cancer liver metastases (CLM) recurring after hepatectomy. Methods From December 2002 to December 2008 we ablated 71 CLM developing after hepatectomy in 56 patients. We reviewed medical records and imaging to determine: technique effectiveness/complete ablation (ablation defect covering the entire tumor on 4–6 week post-ablation CT), complications and local tumor progression at the site of ablation. Local tumor progression-free and overall survivals were calculated using Kaplan-Meier methodology. A modified clinical risk score (CRS) including nodal status of the primary, time interval from primary to liver metastases, number of tumors and size of the largest tumor was correlated to overall survival and local tumor progression. Results Tumor size ranged between 0.5 and 5.7 cm. Complete ablation was documented in 67/71 (94%) CLM. Complications were: liver abscess (1) and pleural effusion (1). Median overall survival was 31 months. One-, 2- and 3-year overall survival rates were 91%, 66% and 41% respectively. CRS was an independent factor for overall survival (74% for CRS 0–2 vs. 42% for CRS 3–4 at 2 years p=0.03) and for local tumor progression-free survival (66% for CRS 0–2 vs 22% for CRS 3–4 at one year after a single ablation p<0.01). Conclusion CT-guided RF ablation can be used to treat recurrent CLM after hepatectomy. A low CRS is associated with better clinical outcomes.

Percutaneous Radiofrequency Ablation of Colorectal Cancer Liver Metastases: Factors Affecting Outcomes—A 10-year Experience at a Single Center

“…Percutaneous image-guided radiofrequency ablation (RFA) is a generally accepted alternative therapy for patients who are poor surgical candidates and for patients with posthepatectomy recurrences (9)(10)(11)(12). This minimally invasive approach has a favorable safety profile and a low major complications rate of 1.3%-2.2% (13,14).…”

Evaluation of YO-PRO-1 as an early marker of apoptosis following radiofrequency ablation of colon cancer liver metastases

“…Unlike prior studies that evaluated tissues extracted on the RFA electrode with immunohistochemical methods that usually require lengthy processing (Sofocleous et al 2004(Sofocleous et al , 2008(Sofocleous et al , 2011(Sofocleous et al , 2012, we used a green fluorescent dye, in which the incubation period can be as short as 5 min. With such procedure, the specimen can be viewed under the microscope within 30 min from the tissue collection.…”

“…Eight CLM in 7 patients were treated with percutaneous CT-guided RFA, as previously described (Gillams 2005;Livraghi et al 2003;Sofocleous et al 2008Sofocleous et al , 2011Solbiati et al 2001). Briefly, an electrode of appropriate size was inserted to provide complete ablation with clear margins (at least 5 mm) all around the target CLM (Wang et al 2013).…”

“…The 5-year overall survival rate for RFA-treated patients with CLM varies widely between 14.3 % and 55.4 % (Gwak et al 2011;Hur et al 2009;Kim et al 2011). However, local tumor progression (LTP) remains a significant limitation of ablation (Mulier et al 2008;Sofocleous et al 2011). LTP occurrence following RFA can be as high as 60 % (Abitabile et al 2007; Amersi et al 2006;Kingham et al 2012;Kuvshinoff and Ota 2002;Sofocleous et al 2008Sofocleous et al , 2011 and has been attributed to residual tumor cells at the ablation site (Pulvirenti et al 2001).…”

“…Based on these findings, we postulated that YP1 could also be used in human liver tissues obtained after RFA, and would thus allow an early assessment of apoptosis leading to cellular death. In the current study, we obtained tissues adherent to the electrodes used in the RFA procedure, as previously described (Snoeren et al 2009(Snoeren et al , 2011Sofocleous et al 2004Sofocleous et al , 2008Sofocleous et al , 2011. Further, we performed needle biopsies from central and marginal regions of the ablation zone in an effort to collect additional tumor and surrounding liver tissue for analysis and to permit us to include cases with no tissues adherent to the electrode.…”