Imaging to optimize liver tumor ablation

Pua, Bradley B.; Sofocleous, Constantinos T.

doi:10.2217/iim.10.32

Cited by 11 publications

(8 citation statements)

References 57 publications

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“…An ablation defect completely covering the target CLM was considered a complete and technically effective RFA. Irregular peripheral or nodular enhancement within 1 cm of the ablated area on this postprocedure CT was considered untreated (residual) tumor and a technical failure [19–21]. …”

Section: Methodsmentioning

confidence: 99%

Margin Size is an Independent Predictor of Local Tumor Progression After Ablation of Colon Cancer Liver Metastases

Wang

Sofocleous

Erinjeri

et al. 2012

Cardiovasc Intervent Radiol

289

249

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Purpose This study was designed to evaluate the relationship between the minimal margin size and local tumor progression (LTP) following CT-guided radiofrequency ablation (RFA) of colorectal cancer liver metastases (CLM). Methods An institutional review board-approved, HIP-PA-compliant review identified 73 patients with 94 previously untreated CLM that underwent RFA between March 2003 and May 2010, resulting in an ablation zone completely covering the tumor 4–8 weeks after RFA dynamic CT. Comparing the pre- with the post-RFA CT, the minimal margin size was categorized to 0, 1–5, 6–10, and 11–15 mm. Follow-up included CT every 2–4 months. Kaplan–Meier methodology and Cox regression analysis were used to evaluate the effect of the minimal margin size, tumor location, size, and proximity to a vessel on LTP. Results Forty-five of 94 (47.9 %) CLM progressed locally. Median LTP-free survival (LPFS) was 16 months. Two-year LPFS rates for ablated CLM with minimal margin of 0, 1–5 mm, 6–10 mm, 11–15 mm were 26, 46, 74, and 80 % (p < 0.011). Minimal margin (p = 0.002) and tumor size (p = 0.028) were independent risk factors for LTP. The risk for LTP decreased by 46 % for each 5-mm increase in minimal margin size, whereas each additional 5-mm increase in tumor size increased the risk of LTP by 22 %. Conclusions An ablation zone with a minimal margin uniformly larger than 5 mm 4–8 weeks postablation CT is associated with the best local tumor control.

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Section: Methodsmentioning

confidence: 99%

Margin Size is an Independent Predictor of Local Tumor Progression After Ablation of Colon Cancer Liver Metastases

Wang

Sofocleous

Erinjeri

et al. 2012

Cardiovasc Intervent Radiol

289

249

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“…All ablations were planned after a contrast enhanced CT of the liver within 30 days prior to the ablation(25). …”

Section: Methodsmentioning

confidence: 99%

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

Sofocleous

Petre

Gönen

et al. 2011

Journal of Vascular and Interventional Radiology

106

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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.

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“…By referencing the first post-RFA study, technique effectiveness was defined as an ablation defect that completely encompassed the targeted tumor, and failure was defined as any evidence of residual tumor within 1 cm of the ablation defect. The ablation defect at the first 4-8-week post-RFA contrast-enhanced CT examination was considered the new baseline for future comparisons (25). LTP was defined as any new peripheral or nodular enhancement within 1 cm or an enlargement of the baseline ablation defect.…”

Section: Definitionsmentioning

confidence: 99%

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

Shady¹,

Petre²,

Gönen³

et al. 2016

Radiology

310

329

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Radiology: Volume 278: Number 2-February 2016 n radiology.rsna.org 601 Purpose:To identify predictors of oncologic outcomes after percutaneous radiofrequency ablation (RFA) of colorectal cancer liver metastases (CLMs) and to describe and evaluate a modified clinical risk score (CRS) adapted for ablation as a patient stratification and prognostic tool. Materials and Methods:This study consisted of a HIPAA-compliant institutional review board-approved retrospective review of data in 162 patients with 233 CLMs treated with percutaneous RFA between December 2002 and December 2012. Contrast material-enhanced CT was used to assess technique effectiveness 4-8 weeks after RFA. Patients were followed up with contrast-enhanced CT every 2-4 months. Overall survival (OS) and local tumor progression-free survival (LTPFS) were calculated from the time of RFA by using the Kaplan-Meier method. Log-rank tests and Cox regression models were used for univariate and multivariate analysis to identify predictors of outcomes. Results:Technique effectiveness was 94% (218 of 233). Median LTPFS was 26 months. At univariate analysis, predictors of shorter LTPFS were tumor size greater than 3 cm (P , .001), ablation margin size of 5 mm or less (P , .001), high modified CRS (P = .009), male sex (P = .03), and no history of prior hepatectomy (P = .04) or hepatic arterial infusion chemotherapy (P = .01). At multivariate analysis, only tumor size greater than 3 cm (P = .01) and margin size of 5 mm or less (P , .001) were independent predictors of shorter LTPFS. Median and 5-year OS were 36 months and 31%. At univariate analysis, predictors of shorter OS were tumor size larger than 3 cm (P = .005), carcinoembryonic antigen level greater than 30 ng/mL (P = .003), high modified CRS (P = .02), and extrahepatic disease (EHD) (P , .001). At multivariate analysis, tumor size greater than 3 cm (P = .006) and more than one site of EHD (P , .001) were independent predictors of shorter OS. Conclusion:Tumor size of less than 3 cm and ablation margins greater than 5 mm are essential for satisfactory local tumor control. Tumor size of more than 3 cm and the presence of more than one site of EHD are associated with shorter OS.q RSNA, 2015

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Imaging to optimize liver tumor ablation

Cited by 11 publications

References 57 publications

Margin Size is an Independent Predictor of Local Tumor Progression After Ablation of Colon Cancer Liver Metastases

Margin Size is an Independent Predictor of Local Tumor Progression After Ablation of Colon Cancer Liver Metastases

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

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

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