Long-term results of radiofrequency ablation in colorectal lung metastases: Single center experience

Abstract

Abstract. This study was undertaken to evaluate long-term results of radiofrequency (RF) ablation in patients with colorectal lung metastases and to stratify patients benefitting from lung RF ablation. Lung RF ablation was performed in 78 patients with 198 colorectal lung metastases. Safety, local tumor progression, and survival were evaluated retrospectively. The mean follow-up period after the 140 lung RF ablation sessions was 24.6±7.6 months. Pneumothorax and pleural effusion requiring chest tube placement occurred respectively in 18 (12.9%, 18/140) and 2 (1.4%, 2/140) sessions. The respective 1-, 3-and 5-year local tumor progression rates were 10.1% (95% CI, 2.9-17.3%), 20.6% (95% CI, 8.9-22.2%) and 20.6% (95% CI, 8.9-22.2%). The 1-, 3-and 5-year survival rates were 83.9% (95% CI, 75.2-92.7%), 56.1% (95% CI, 41.7-70.5%) and 34.9% (95% CI, 18.0-51.9%), with median survival time of 38.0 months. Univariate analysis revealed maximum tumor diameter of 3 cm or less, single-lung metastasis, lack of extrapulmonary metastasis and normal carcinoembryonic antigen (CEA) level as better prognostic factors. The latter two were significant independent prognostic factors. The 1-, 3-and 5-year survival rates were 97.7% (95% CI, 93.3-100%), 82.5% (95% CI, 68.2-96.8%) and 57.0% (95% CI, 34.7-79.2%) in 54 patients with no extrapulmonary metastases and 96.9% (95% CI, 90.8-100%), 86.1% (95% CI, 71.1-100%) and 62.5% (95% CI, 36.3-88.6%) in 33 patients with negative CEA levels. Lung RF ablation is a safe and useful therapeutic option. These identified prognostic factors will help to stratify patients who benefit from lung RF ablation.

The Clinical Utility and Safety of Radiofrequency Ablation for Malignant Lung Tumors: Preliminary Results

“…The 5-year survival rates after lung RFA have been reported to be 27-61% for NSCLC [11][12][13] and 20-69% for metastatic lung cancer [14][15][16]. Our results seemed to be comparable with these previously reported findings.…”

“…However, some patients cannot undergo surgery because of poor respiratory function, advanced age, or comorbid disease. Recently, radiofrequency ablation (RFA) of the lung for patients who are not surgical candidates has been reported to achieve comparable results to surgical resection [11][12][13][14][15][16][17][18][19]. However, the availability of this treatment in Japan and re- ports on its outcomes from this country are limited because of lack of coverage within the national health insurance system.…”

Standards of Practice: Guidelines for Thermal Ablation of Primary and Secondary Lung Tumors

“…A significant difference between the survival curves was associated with large ([3 cm) or small (B3 cm) tumor diameter. In a study that included patients with colorectal lung metastases, a 5-year overall survival rate of 35% was reported [62]. Two other prognostic factors were found to be carcinoembryonic antigen levels and extrapulmonary disease.…”

Radiofrequency ablation as an adjunct to systemic chemotherapy for colorectal pulmonary metastases

“…The 1-year and 3-year overall survival rates were 83.9% (95% confidence interval [95% CI], 92.7%-75.2%) and 56.1% (95% CI, 70.5%-41.7%), respectively, and the median survival time was 38.0 months in all patients. 2 In the article by Chua et al, the survival curve was plotted only between patients treated with and without adjunctive systemic chemotherapy (the median survival times were 59 months and 21 months, respectively, as shown in Figure 5 in their article), 1 although the presence of extrapulmonary metastases at the time of RFA treatment, identified as a negative predictive factor for patient survival in both studies, was found to be significantly dominant (P ¼ .019 using the chi-square test) in our study cohort compared with that of Chua et al (24 of 78 patients and 16 of 100 patients, respectively). 1,2 This finding might also support the benefit of systemic chemotherapy as an adjunct to RFA in patients with pulmonary metastases from colorectal cancer in multimodality therapy.…”