Local Recurrences After Intraoperative Radiofrequency Ablation of Liver Metastases: A Comparative Study with Anatomic and Wedge Resections

Élias, Dominique; Baton, O.; Sidéris, Lucas; Matsuhisa, Tadashi; Pocard, Marc; Lasser, P

doi:10.1245/aso.2004.08.019

Cited by 130 publications

(79 citation statements)

References 16 publications

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“…This finding needs to be validated in larger studies. Even if early detection does not allow potentially curative resection of recurrent liver metastases, there may be significant clinical benefit to the earlier commencement of systemic chemotherapy or the use of radiofrequency ablation (Elias et al, 2004;Gillams and Lees, 2005). The timing of recurrence and its implications for therapy and patient outcome is vital to the design of follow-up protocols.…”

Section: Discussionmentioning

confidence: 99%

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

2006

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The aim of the study was to prospectively evaluate an intensive follow-up programme using serial tumour marker estimations and contrast-enhanced computed tomography (CT) of the chest and abdomen in patients undergoing potentially curative resection of colorectal liver metastases. Seventy-six consecutive patients having undergone potentially curative resections of colorectal liver metastases in a single unit were followed up with a protocol of 3 monthly carcinoembryonic antigen and carbohydrate antigen 19-9 estimations and contrast-enhanced spiral CT of the chest, abdomen and pelvis for the first 2 years following surgery and 6 monthly thereafter. The median period of follow-up was 24 months (range 18 -60). Recurrent tumour was classed as early if within 6 months of liver resection. Thirty-seven of the 76 patients (49%) developed recurrence on follow-up. Nineteen recurrences were in the liver alone (51%), 16 liver and extrahepatic (43%) and two extrahepatic alone (6%). Of the 19 patients with isolated liver recurrence, eight developed within 6 months of liver resection none of which were resectable. Of the 11 recurrences after 6 months, five (45%) were resectable. Of the 37 recurrences, CT indicated recurrence despite normal tumour markers in 19 patients. Tumour markers suggested recurrence before imaging in 12 and concurrently with imaging in 6. In the 12 patients who presented with elevated tumour markers before imaging, there was a median lag period of 3 months (range 1 -21) in recurrence being detected on further serial imaging. Seventeen patients who developed recurrence had normal tumour markers before initial resection of their liver metastases. Of these 17, 10 (58%) had an elevation of tumour markers associated with recurrence. Over a median follow-up of 2 years following liver resection, the use of CT or tumour markers alone would have failed to demonstrate early recurrence in 12 and 18 patients respectively. A combination of tumour markers and CT detected significantly more (Po0.05) recurrence than either modality alone. Tumour markers and CT should be used in combination in the follow-up of patients with resected colorectal liver metatases, including patients whose markers are normal at the time of initial liver resection.

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Section: Discussionmentioning

confidence: 99%

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

2006

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“…Although there is one study showing comparable local tumour progression between wedge resection, anatomical resection and ablation [45], most surgical series report higher local tumour progression following ablation than after resection [43]. Despite this the overall survival is often similar [34].…”

Section: Access To Interventional Oncology Ablation Programmes and Exmentioning

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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“…Even some surgeons are suggesting that RFA may replace resection, especially in certain circumstances such as new hepatic metastases after a first liver resection [38,39,40,41,42,43,44], limited central disease that technically would require a hemihepatectomy [42, 45, 46], small metastases [42, 45,47,48,49] and solitary metastases [50]. …”

Section: Introductionmentioning

confidence: 99%

Radiofrequency Ablation versus Resection for Resectable Colorectal Liver Metastases: Time for a Randomized Trial?

et al. 2008

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Background: A recent proposal of a randomized trial comparing resection and radiofrequency ablation (RFA) in a selected subgroup of patients with small resectable colorectal liver metastases (CRLM) has initiated a debate on this issue. Meanwhile, new data have been published. The aim of the study was to update and critically review the oncological evidence in favor of and against the use of RFA for resectable CRLM in general and in favor of and against conducting a randomized trial in a selected subgroup of patients. Methods: An exhaustive review was carried out of papers and abstracts on RFA of colorectal metastases published before July 15, 2008. Results: Local recurrence rate after resection of CRLM is 1.2–10.4%. Local recurrence rate after RFA of CRLM is between 1.7 and 66.7%. For tumors <3 cm, local control after open RFA is equivalent to resection. Local recurrence rates, however, are higher for larger tumors and for the percutaneous and laparoscopic route. Accumulating evidence suggests that RFA and resection induce profoundly different biological effects, which may influence survival. Conclusions: Local recurrence rate after open RFA for CRLM <3 cm seems to be equivalent to resection. A randomized trial under strict conditions would be justified in this subgroup of patients. A randomized trial is currently not justified for larger tumors or for percutaneous or laparoscopic RFA, since local recurrence rates in these groups are too high to be acceptable for resectable tumors.

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Local Recurrences After Intraoperative Radiofrequency Ablation of Liver Metastases: A Comparative Study with Anatomic and Wedge Resections

Abstract: RFA is as efficient and safe as wedge or anatomic resections in terms of local control.

Cited by 130 publications

References 16 publications

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

Intensive follow-up after liver resection for colorectal liver metastases: results of combined serial tumour marker estimations and computed tomography of the chest and abdomen – a prospective study

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

Radiofrequency Ablation versus Resection for Resectable Colorectal Liver Metastases: Time for a Randomized Trial?

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