Percutaneous radiofrequency thermoablation as an alternative to surgery for treatment of liver tumour recurrence after hepatectomy

Élias, Dominique; Baere, T. de; Smayra, Tarek; Ouellet, Jean-François; Roche, Alain; Lasser, P

doi:10.1046/j.1365-2168.2002.02081.x

Cited by 169 publications

(79 citation statements)

References 13 publications

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“…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).…”

Section: Discussionmentioning

confidence: 99%

“…A study in wellselected patients (13) noted a 5-year OS of 48%, and, for the first time, a 10-year OS of 18% was reported. Percutaneous RFA has also been used as a salvage treatment for recurrent CLMs after hepatectomy (9,10). A prior study (10) treated 56 patients with 71 recurrent CLMs after hepatectomy by using a modified test-of-time approach.…”

Section: Discussionmentioning

confidence: 99%

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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

309

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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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

309

329

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“…However, repeat hepatectomy is technically demanding, with a mortality rate close to 2% (17). Hence, RFA has been considered a potential option for the treatment of recurrent liver metastases (19). this study focuses primarily on the outcome and complications of patients with recurrent CLM after surgical resection, treated with percutaneous RFA.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Ultrasound-Guided Radiofrequency Ablation of Recurrent Colorectal Cancer Liver Metastases after Hepatectomy

et al. 2014

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Introduction: to assess the results and outcome of radiofrequency ablation in the treatment of recurrent colorectal liver metastases.Patients and Methods: between January 2005 and September 2012, we treated 59 patients with recurrent colorectal metastases not amenable to surgery with 77 radiofrequency ablation procedures. radiofrequency was indicated if oncologic resection was technically not possible or the patient was not fit for major surgery. a total of 91 lesions were treated. the mean number of liver tumors per patient was 1.5, and the mean tumor diameter was 2.3 cm. in 37.5% of the cases, lesions had a subcapsular location, and 34% were close to a vascular structure.Results: the morbidity rate was 18.7%, and there were no post-procedural deaths. distant extrahepatic recurrence appeared in 50% of the patients. local recurrence at the site of ablation appeared in 18% of the lesions. local recurrence rate was 6% in lesions less than 3 cm and 52% in lesions larger than 3 cm. the size of the lesions (more than 3 cm) was an independent risk factor for local recurrence (p < 0.05). Survival rates at 1, 3, and 5 years were 94.5%, 65.3%, and 21.7%, respectively. Discussion: radiofrequency ablation is a safe procedure and allows local tumor control in lesions less than 30 mm (local recurrence of 6%) and provides survival benefits in patients with recurrent colorectal liver metastases.

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“…In our cohort, 34 patients had small solitary tumours with a median diameter of 2.5 cm, the mean and 3-year survival from ablation was 67 months and 66%, respectively. Two retrospective comparisons between surgery and RFA suggest comparable survival between the two modalities (Elias et al, 2002;Oshowo et al, 2003); however, no prospective studies are underway. A different approach is to use RFA as a 'test of time' -this has been explored by the Milan group who have offered RFA to surgical candidates (Livraghi et al, 2003a).…”

Section: Liver Metastases Colorectalmentioning

confidence: 99%

The use of radiofrequency in cancer

Gillams

2005

Br J Cancer

114

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Radiofrequency ablation (RFA) provides an effective technique for minimally invasive tissue destruction. An alternating current delivered via a needle electrode causes localised ionic agitation and frictional heating of the tissue around the needle. Image-guided, percutaneous ablation techniques have been developed in most parts of the body, but the most widely accepted applications are for the treatment of hepatocellular carcinoma (HCC) in early cirrhosis, limited but inoperable colorectal liver metastases, inoperable renal cell carcinoma and inoperable primary or secondary lung tumours. The procedures are well tolerated and the complication rates low. Patients with coexistent morbidity who are not suitable for surgery are often able to undergo RFA. Most treatments in the lung, kidney and for HCC are performed under conscious sedation with an overnight hospital stay or as a day-case. Larger more complicated ablations, for example, in hepatic metastases may require general anaesthesia. Limitations of RFA include the volume of tissue that can be ablated in a timely fashion, that is, most centres will treat 3 -5 tumours up to 4 -5 cms in diameter. Early series reporting technical success and complications are available for lung and renal ablation. Liver ablation is better established and 5-year survival figures are available from several centres. In patients with limited but inoperable colorectal metastases, the 5-year survival ranges from 26 to 30% and for HCC it is just under 50%. In summary, RFA provides the opportunity for localised tissue destruction of limited volumes of tumour; it can be offered to nonsurgical candidates and used in conjunction with systemic therapy. British Journal of Cancer (2005) Image guided ablation dates to 1989 when the first US guided interstitial laser treatments were performed in liver metastases and the first percutaneous ethanol injections were reported for the treatment of small hepatocellular carcinoma (HCC). Rapid technological developments have resulted in the development of a number of ablative techniques, higher power generators and a range of different electrode designs. Current designs permit ablation of much larger volumes of tissue than was originally possible. Radiofrequency ablation (RFA) has been used in a wide range of locations and applications including adrenal metastases, primary colorectal cancer recurrence and malignant pelvic or paraaortic lymphadenopathy , but in this article we will consider the main areas where RFA has proven effective or is likely to do so.

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Percutaneous radiofrequency thermoablation as an alternative to surgery for treatment of liver tumour recurrence after hepatectomy

Abstract: Percutaneous RF treatment increases the number of patients eligible for curative treatment. It should be preferred to repeat hepatectomy when feasible and safe because it is less invasive. Repeat hepatectomy is indicated only when percutaneous RF ablation is contraindicated or fails.

Cited by 169 publications

References 13 publications

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

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

Safety and Efficacy of Ultrasound-Guided Radiofrequency Ablation of Recurrent Colorectal Cancer Liver Metastases after Hepatectomy

The use of radiofrequency in cancer

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