Radiofrequency ablation of unresectable colorectal liver metastases: trends in management and outcome during a decade at a single center

Abstract

BackgroundRadiofrequency ablation (RFA) is widely used for treatment of colorectal liver metastases (CRLM).PurposeTo evaluate the effect of increased experience in RFA of CRLM on morbidity and survival, and the trends in patient management and outcomes during the last decade.Material and MethodsHospital records of the initial 52 consecutive patients who underwent RFA (56 procedures/70 lesions) were retrospectively reviewed. The patients were divided into two groups according to time period of treatment, period I (2001–2006: n = 26) and period II (2007–2011: n = 26).ResultsConcomitant liver resection was performed in 15 patients in each period. Operative morbidity decreased from 47% to 19% (P = 0.047). Most complications were found in patients who underwent a concomitant liver resection and not related to the ablation per se. Local recurrence rate decreased from 19.4% to 12.9% (P = 0.526). At least one risk factor for recurrence was found in patients with local recurrence (n = 11): subcapsular localization (n = 4), tumor size >3 cm and subcapsular localization (n = 2), and perivascular localization (portal veins/hepatic veins) (n = 5). Median overall survival was 32 months in period I and 49 months in period II, whereas estimated 5-year survival was 19% and 36%, respectively (P = 0.09). Adjuvant chemotherapy was given to four patients (15.4%) in period I and 13 patients (50%) in period II (P = 0.017).ConclusionRFA alone or in combination with liver resection is a potentially curative treatment to selected patients with CRLM. Over time, the morbidity and survival have improved in RFA of CRLM. Although a possible effect of a learning curve should be taken into consideration in the appraisal of this improvement, it is more likely to be attributable to optimization of indication, development in surgical techniques, and increased use of perioperative chemotherapy.

Evidence on percutaneous radiofrequency and microwave ablation for liver metastases over the last decade

“…Cheng et al reported the outcome of RFA using a multielectrode radiofrequency switching controller for resectable metachronous CRLM; the 5-year survival and median OS were 50.7% and 53.4 months, respectively [11]. Table 2 presents the outcomes of RFA and MWA for CRLM including the 5-year OS rates [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. In the listed studies, 5-year OS following ablation ranged from 21 to 65%.…”

Local Therapy Modalities in Management of Colorectal Cancer Liver Metastasis

“…The standard local treatment method for CRLM is resection, but oligometastatic cases can be considered for radiofrequency ablation (RFA). This is the most widely used non-surgical technique in CRLM [13]. The use RFA is a reasonable treatment option for non-surgical candidates.…”

Photodynamic therapy for cancer of the pancreas – The story so far

“…The simplest options are techniques for delivering heat using a probe that can be inserted directly into the pancreas under image guidance. Early studies used a laser fibre for doing this [4], as had been shown to be effective in other organs [5], but in recent years, radiofrequency ablation (RFA) has been the preferred option for interstitial thermal treatment of tumours in solid organs such as the liver and lungs, where it is now well established in routine use [6]. However, thermal ablation damages connective tissue like collagen, which reduces the mechanical integrity of hollow organs like the duodenum and bile duct, with the consequent risk of perforation if treatment extends to these organs.…”