Radiofrequency ablation for hepatocellular carcinoma and metastatic liver tumors: a comparative study

BACKGROUND: This study compared the effectiveness of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and liver metastases. METHODS: We compared the outcomes of 240 patients with HCC and 44 patients with liver metastases treated with RFA. Data were prospectively collected and retrospectively analyzed. Effects of different variables on recurrences were studied. RESULTS: A total of 406 tumor nodules were treated. The median size of the largest ablated tumor was 2.5 cm, and the median tumor number was 1. Complete tumor ablation was achieved in 91.2%. Local recurrence rate was 15.4% after a median follow-up of 24.5 months. There was no significant impact of tumor pathology on local recurrence. However, patients with liver metastasis had higher extrahepatic recurrence rate (P = 0.019) and shorter disease-free survival (P = 0.007). Patients with multiple tumors had higher local (P = 0.047) and extrahepatic (P = 0.019) recurrence rates than those with a solitary tumor. Tumor size had an impact on local recurrence rate only in patients with liver metastasis with a higher rate in those with tumor > 2.5 cm in diameter (P = 0.028). CONCLUSIONS: Tumor pathology does not appear to have a significant impact on local recurrence rates. RFA is effective in local tumor control for both HCC and liver metastasis.     

Hepatectomy and lung radiofrequency ablation for hepatic and subsequent pulmonary metastases from colorectal carcinoma

BACKGROUND: Lung radiofrequency ablation (RFA) is a relatively safe procedure and may have a useful role in the management of non-surgical candidates with colorectal pulmonary metastases. METHODS: This study consisted of 30 patients, who had previously undergone hepatectomy for colorectal liver metastases and subsequently developed pulmonary metastases, which were then treated with lung RFA. Lung RFA was performed percutaneously under local anesthesia and conscious sedation. The primary aim of this article was to demonstrate the survival outcome in this particular patient population after lung RFA. The secondary aim was to assess the prognostic indicators for survival after lung RFA. RESULTS: The median survival after lung RFA was 32 months, with 3-year survival rate of 45%. The following four factors were found to significantly influence survival in univariate analysis: size of the largest pulmonary metastasis (P = 0.032), proximity of metastases to major pulmonary vessels (P = 0.003), pre-lung RFA CEA levels (P = 0.013) and post-lung RFA CEA levels (P = 0.022). CONCLUSIONS: Lung RFA may have a useful role in the management of non-surgical candidates with colorectal pulmonary metastases.     

Radio-frequency ablation therapy for metastatic liver tumors from colorectal carcinoma

Radio-frequency ablation therapy (RFA) as a treatment for metastatic liver tumors from colorectal carcinoma was examined. METHODS: Ten patients with a total of 30 liver metastases from colorectal carcinoma were treated using a Cool-tip RF system from March 2003 to December 2004. RESULTS: Patients had a mean age of 69.8 years and the mean diameter of the metastatic lesions was 29.5 mm (range, 5-82). Two patients had received RFA therapy 2 times, and another 2 patients had received 3 times. Critical complications were not seen, though 5 therapies were performed using CT-guided trans-pulmonary puncture. The rate of partial recurrence was 23.1% and the average observation period was 14.8 months. The partial recurrence had occurred within the mean period of 6.2 months. Although after multimodal therapy was given, it is suggested that repeated RFA for the liver metastasis would improve survival rates. CONCLUSION: RFA is a safe and effective treatment for metastatic liver tumors from colorectal carcinoma as multimodal therapy.     

Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: a prospective study.

PURPOSE: The aim of this study was to determine the predictors of survival at the time of radiofrequency thermal ablation (RFA) in patients with colorectal liver metastasis. PATIENTS AND METHODS: One hundred thirty-five patients with colorectal liver metastases who were not candidates for resection underwent laparoscopic RFA. RESULTS: The median Kaplan-Meier survival for all patients was 28.9 months after RFA treatment. Patients with a carcinoembryonic antigen (CEA) less than 200 ng/mL had improved survival compared with those with a CEA more than 200 (34 v 16 months; P = .01). Patients with the dominant lesion less than 3 cm in diameter had a median survival of 38 v 34 months for lesions 3 to 5 cm, and 21 months for lesions greater than 5 cm (P = .03). Survival approached significance for patients with one to three tumors versus more than three tumors (29 v 22 months; P = .09). The presence of extrahepatic disease did not affect survival. Only the largest liver tumor size more than 5 cm was found to be a significant predictor of mortality by Cox proportional hazards model, with a 2.5-fold increased risk of death versus the largest liver tumor size less than 3 cm (P = .05). CONCLUSION: This study determines which patients do best after RFA. Historical survival with chemotherapy alone is 11 to 14 months, suggesting RFA has a positive impact on overall survival. Limited amounts of extrahepatic disease do not appear to affect survival adversely. RFA is a useful adjunct to chemotherapy in those patients with liver-predominant disease.     

Iterative treatment with surgery and radiofrequency ablation of uveal melanoma liver metastasis: Retrospective analysis of a series of very long-term survivors

BackgroundAfter treatment of primary ocular uveal melanoma (UM), up to 50% of patients will develop metastases, mostly in the liver. Systemic treatments do not provide any overall survival benefit for these patients and surgery remains the most effective therapy for selected patients. Radiofrequency ablation (RFA) alone or in combination with surgery is frequently used to spare hepatic parenchyma. When patients relapse after treatment of their first metastases, and when the liver recurrence is limited, new local liver treatment is questionable.MethodsA total of 14 patients with liver metastases from uveal melanoma (LMUM) were retrospectively evaluated. All patients had a complete first liver resection and a second treatment with RFA. Overall survival, recurrence-free interval after the first and the second treatment was evaluated.ResultsTreatment of hepatic recurrence was percutaneous RFA for ten patients and per-operative RFA for four patients associated with new metastasectomy. The median time to onset of LMUMs after ocular UM treatment was 50 months, and the median time to recurrence of hepatic metastasis after the first liver treatment was 20 months. The overall survival was 70% at five years and 35% at ten years. The recurrence-free interval was 50% and 56% at two years after the first and the second treatment, respectively.ConclusionProlonged survival can be achieved by exclusive and iterative local treatment combining surgery and RFA in a small proportion of patients with a first recurrence of isolated LMUM.     

Cryosurgery for resectable and unresectable hepatic metastases from colorectal cancer.

AIMS: Hepatic cryosurgery is useful for patients with hepatic metastases from colorectal cancer confined to the liver but considered unresectables because of the number and location of lesions. While encouraging results were reported following cryosurgery for unresectable liver metastases we considered particularly valuable to examine the safety and effectiveness of cryosurgery in patients with resectable and unresectable metastases from colorectal cancer. METHODS: Between January 1997 and September 2005, 53 patients with liver metastases from colorectal cancer underwent hepatic cryosurgery at our institution. Hepatic metastases were resectable in 31 (58.5%) patients and unresectable in 22 (41.5%). RESULTS: A total of 136 liver metastases were treated in 53 patients. The size of treated lesions ranged from 0.5 to 10 cm (mean 2.7). There were 2 postoperative deaths (3.8%) from massive bleeding and from cryoshock. The overall morbidity rate was 66%. The median follow-up was 24.8 months. The overall survival rate at 12 months was 86.1%, at 48 months it was 27%. No significant difference was found between survival rates in patients with resectable or unresectable metastases. Among 31 patients with resectable liver metastases 7 (22.6%) patients developed recurrence at the site of cryosurgery. CONCLUSION: Survival rates were comparables between patients with resectable and unresectable metastases but a high complication rate and a substantial rate of local recurrence following cryosurgery should caution against its use to treat resectable disease.     

Radiofrequency ablation for liver metastasis from gastric cancer

Aims

Several studies have reported the benefit of hepatic resection for metastatic tumor from gastric cancer. However, the value of treatment with radiofrequency ablation (RFA) has not been clearly defined.

Methods

Between Jan 2002 and Dec 2007, 21 patients with primary gastric cancer were diagnosed with synchronous or metachronous liver metastases. All patients were treated with RFA, and the complication, survival, and recurrence rates were assessed.

Results

The postoperative complication rate was 5% (1/21), with no mortality. The median actuarial survival time was 14 months. The 1-yr, 2-yr, 3-yr, and 5-yr survival rates after RFA were 70%, 11%, 5%, and 3%, respectively. With a median follow-up time of 19 months, local recurrence at the RFA site was 19% (4/21). Solitary metastasis had significantly longer survival than multiple lesions after RFA (22 vs 10 months, P = 0.004).

Conclusions

RFA provides a minimally invasive and safe modality of treatment patients with liver metastasis from gastric cancer. Patients with solitary liver lesion were considered appropriate candidates for RFA.     

Debulking treatment with CT-guided percutaneous radiofrequency ablation and hepatic artery infusion of floxuridine improves survival of patients with unresectable pulmonary and hepatic metastases of colorectal cancer

The survival of most patients with both unresectable hepatic and pulmonary metastases of colorectal cancer is poor. In this retrospective study, we investigated the efficacy of computed tomography （CT）-guided radiofrequency ablation （RFA） and systemic chemotherapy plus hepatic artery infusion of floxuridine （HAI-FUDR）. Sixty-one patients were selected from 1,136 patients with pulmonary and hepatic metastases from colorectal cancer. Patients were treated with RFA and systemic chemotherapy plus HAI-FUDR （ablation group, n=39） or systemic chemotherapy plus HAI-FUDR （FUDR group, n=22）. Patients in the two groups were matched by sex, age, number of metastases, and calendar year of RFA or FUDR. Survival data were evaluated by using univariate and multivariate analyses. Clinical characteristics were comparable between the two groups. Al patients in the ablation group underwent RFA and chemotherapy. Median fol ow-up was 56.8 months. The 1-, 3-, and 5-year overall survival （OS） rates were 97%, 64%, and 37%, respectively, for the ablation group, and 82%, 32%, and 19%, respectively, for the FUDR group. The 1-, 3-, and 5-year survival rates after metastasis were 97%, 49%, and 26%for the ablation group, and 72%, 24%, and 24%for the FUDR group, respectively. The median OS times were 45 and 25 months for the ablation and FUDR groups, respectively. In the multivariate analysis, treatment al ocation was a favorable independent prognostic factor for OS （P = 0.001） and survival after metastasis （P = 0.009）. These data suggest that the addition of RFA to systemic chemotherapy plus HAI-FUDR improves the survival of patients with both unresectable hepatic and pulmonary metastases from colorectal cancer.     

Is it necessary to carry out hepatic resection and pulmonary resection to obtain a cure for liver and lung metastases from colorectal cancer ?

If hepatic or pulmonary metastases from colorectal cancer are resectable, we perform the operation, and the 5-year survival rate is 40-50%. Median survival time is over 20 months recently for systemic chemotherapy. However, surgical treatment is the only way to obtain a cure. RFA has the advantage of being minimally invasive. But the local recurrence rate is slightly high. It is important to detect a local recurrence early and perform repeated RFA. Repeated RFA improve the prognosis and get the same overall survival rate of liver resection. If both the hepatic and pulmonary metastases are resectable, we perform both resections, with a good surgical outcome. If we cannot perform a second metastasectomy after first metastasectomy, the prognosis is very poor compared to the prognosis for liver metastasis only or lung metastasis only. It is necessary to add many cases to decide the surgical indication for such cases of both liver and lung metastases.     

Chemotherapy plus percutaneous radiofrequency ablation in patients with inoperable colorectal liver metastases

AIM:To access the efficacy of chemotherapy plus radiofrequency ablation(RFA)as one line of treatment in inoperable colorectal liver metastases.METHODS:Eligible patients were included in three PhaseⅡstudies.In the first study percutaneous RFA was used first followed by 6 cycles of 5-fluorouracil,leucovorin and irinotecan combination(FOLFIRI)(adjunctive chemotherapy trial).In the other two,chemotherapy(FOLFIRI or 5-fluorouracil,leucovorin and oxaliplatin combination)up to 12 cycles was used first with percutaneous RFA offered to responding patients (primary chemotherapy trials).RESULTS:Thirteen patients were included in the adjunctive chemotherapy trial and 17 in the other two.At inclusion they had 1-4 liver metastases(up to 6.5 cm in size).Two patients died during chemotherapy.All patients in the adjunctive chemotherapy trial and 44%in the primary chemotherapy studies had their metastases ablated.Median PFS and overall survival in the adjunctive study were 13 and 24 mo respectively while in the primary chemotherapy studies they were 10 and 21 mo respectively.Eighty one percent of the patients had tumour relapse in at least one previously ablated lesion.CONCLUSION:Chemotherapy plus RFA in patients with low volume inoperable colorectal liver metastases seems safe and relatively effective.The high local recurrence rate is of concern.     

86例大肠癌肝转移的综合治疗经验

目的总结86例大肠癌肝转移的综合治疗经验。方法对1996年1月至2007年6月收治的86例大肠癌肝转移患者的临床资料、治疗方法及治疗效果进行回顾性对比分析。分组：病灶切除＋全身或者局部化疗（A组）31例;射频消融（RF）＋全身化疗（B组）20例;肝动脉栓塞化疗（HACE）＋全身化疗（C组）18例;单纯全身化疗（D组）11例;拒绝上述任何治疗措施而仅仅中医中药治疗（E组）6例。结果A、B、C、D、E各组的6mo生存率分别为100％、100％、88．9％、72．7％、66．7％;12mo生存率分别为90．3％、50％、50％、45-4％、33．3％;24mo生存率分别为4814％、10％、11．1％、0％、0％;36mo生存率分别为6．5％、0％、0％、0％、0％。A、B、C、D、E各组的中位生存率分别为19mo、12mo、12mo、8mo、4mo。结论大肠癌肝转移的治疗效果依旧不乐观,积极治疗、综合治疗及“个体化治疗”是作者的主要诊治经验。在选择大肠癌肝转移的治疗方法时,应当首先考虑病灶切除加全身或者局部化疗,其次考虑RF或者HACE加全身化疗,不要轻易选择单纯全身化疗,单纯中医中药治疗不应该被推荐。     

Cryosurgery and radiofrequency ablation for unresectable colorectal liver metastases

AimsTo report immediate local treatment efficacy and long-term results of cryosurgical ablation (CSA) and radiofrequency ablation (RFA) in patients with colorectal liver metastases not eligible for resection.MethodsFifty-eight patients with unresectable colorectal liver metastases were included. Under ultrasound guidance, CSA or RFA were performed with or without concomitant resection. CT scanning and FDG-PET were used to determine local efficacy of the ablative procedure.ResultsMedian follow-up was 26 and 25 months for CSA and RFA, respectively. One and 2-year survival rates were 76 and 61% for CSA and 93 and 75% for RFA, respectively. In a lesion based analysis, the local recurrence rate was 9% after CSA and 6% after RFA. Complication rates were 30 and 11% after CSA and RFA, respectively, (p=0.052). In a subgroup analysis on 43 patients with 104 ablated lesions, CT scan immediate after treatment was not able to predict local treatment failure, whereas FDG-PET scan within 3 weeks after local ablative treatment predicted six of the seven local recurrences.ConclusionsIn patients with unresectable colorectal liver metastases, CSA and RFA can be used either alone or as an effective adjunct to resection in achieving complete tumour clearance of the liver. More widespread use of these techniques seems promising but requires further investigation in randomized trials comparing local ablative treatment with chemotherapy.     

Treatment of Pulmonary Colorectal Metastases by Radiofrequency Ablation

BackgroundRadiofrequency ablation has emerged as a potential, lung function-preserving treatment of colorectal lung metastases.Patients and MethodsForty-five patients with colorectal pulmonary metastases underwent computed tomography-guided RFA from December 2004 to June 2010. A baseline posttreatment scan was obtained 4-6 weeks after RFA and follow-up imaging studies every 3 months thereafter were obtained and compared to evaluate the tumor progression at site of ablation or elsewhere. The primary end points were LTP-free survival and overall survival from RFA procedure. The Kaplan–Meier method was used to analyze the end points. A Cox proportional hazard model with robust inference was used to estimate the associations between baseline factors and survival end points.ResultsSixty-nine metastases were ablated in 45 patients. Tumor size ranged from 0.4 to 3.5 cm. The median number of metastases ablated per patient was 1 (range, 1-3). Median follow-up after RFA was 18 months. Median survival from the time of RFA was 46 months (95% confidence interval [CI], 27.8-47.3). One-, 2- and 3-year overall survival rates from the time of RFA were 95% (95% CI, 82%-99%), 72% (95% CI, 52%-85%), and 50% (95% CI, 26%-71%), respectively. Nine of 69 lesions (13%) progressed and 4 were retreated with no progression after second RFA. Median time to progression was not reached. LTP-free survival from RFA was 92% (95% CI, 82%-97%) at 1 year, 77% (95% CI, 58%-88%) at 2 years, and 77% (95% CI, 58%-88%) at 3 years.ConclusionRadiofrequency ablation of lung metastases is an effective minimally invasive, parenchymal-sparing technique that has very good local control rates in patients with pulmonary metastases from colorectal cancer, with LTP-free survival of 77% at 3 years.     

Radiofrequency Ablation in Treating Colorectal Cancer Patients with Liver Metastases

Purpose: To evaluate efficacy of radiofrequency ablation (RFA) in treating colorectal cancer patients with liver metastases. Methods: During January 2010 to April 2012, 56 colorectal cancer patients with liver metastases underwent RFA. CT scans were obtained one month after RFA for all patients to evaluate tumor response. (CR+PR+SD)/n was used to count the disease control rates (DCR). Survival data of 1, 2 and 3 years were obtained from follow up. Results: Patients were followed for 10 to 40 months after RFA (mean time, 25±10 months). Median survival time was 27 months. The 1, 2, 3 year survival rate were 80.4%, 71.4%, 41%, 1 % respectively. 3-year survival time for patients with CR or PR after RFA was 68.8% and 4.3% respectively, the difference was statistically significant. The number of CR, PR, SD and PD in our study was 13, 23, 11 and 9 respectively. Conclusions: RFA could be an effective method for treating colorectal cancer patients with liver metastases, and prolong survival time, especially for metastatic lesions less than or equal to 3 cm. But this result should be confirmed by randomized controlled studies.     

59例结直肠癌肝转移的外科治疗

背景与目的:结直肠癌(colorectalcancer,CRC)是最常见的恶性肿瘤之一,肝转移是结直肠癌治疗失败的最主要原因。结直肠癌肝转移若未经治疗,其中位生存期仅为6个月左右,手术切除是延长患者生存期的重要手段。本研究目的是探讨结直肠癌肝转移的外科治疗效果及影响预后的因素。方法:回顾性分析1987年1月～1998年12月行结直肠癌肝转移瘤切除59例患者资料。其中不规则性肝切除45例,规则性肝切除14例。术后发生并发症者4例(6.8%),未出现手术死亡。采用Kaplan鄄Meier法进行生存分析,log鄄rank检验进行统计学比较。应用Cox比例风险模型进行多因素分析。结果:全组总的1、3、5年生存率分别为91.4%、34.8%及21.9%。同时性肝转移患者的生存率显著高于异时性肝转移患者(P<0.01),肝转移瘤最大直径小于等于5.0cm患者的生存率高于大于5.0cm患者。肝转移发生时间与肿瘤最大直径大于5.0cm是影响预后的主要因素,而原发肿瘤淋巴结转移状况、术前癌胚抗原(CEA)水平及转移瘤数量对预后没有显著影响。结论:结直肠癌肝转移的外科治疗可使患者获得长期生存。通过加强随诊,早期发现肝转移瘤,可以提高手术切除率。     

Radiofrequency ablation is a valid treatment option for lung metastases: experience in 566 patients with 1037 metastases

Radiofrequency of lung metastases below 4 cm, demonstrated an overall survival of 62 months, associated with a 4-year local efficacy of 89%. Repeatability of the technique allows a 4-year lung disease control rate of 44.1%, with patient retreated safely up to four times. Radiofrequency is an option for treatment of small size lung metastases, namely the ones below 2 to 3 cm in diameter.BackgroundMinimal invasive methods are needed as an alternative to surgery for treatment of lung metastases.Patients and methodsThe prospective database of two cancer centers including all consecutive patients treated with radiofrequency ablation (RFA) for lung metastasis over 8 years was reviewed. RFA was carried out under general anesthesia, with computed tomography guidance using a 15-gauge multitined expandable electrodes RF needle.ResultsFive hundred sixty-six patients including 290 men (51%), 62.7 ± 13.2 years old with primary tumor to the colon (34%), rectum (18%), kidney (12%), soft tissue (9%) and miscellaneous (27%) received 642 RFA for 1037 lung metastases. Fifty-three percent of patients had 1 metastasis, 25% had 2, 14% had 3, 5% had 4 and 4% had 5–8. Metastases were unilateral (75%), or bilateral (25%). The median diameter [extremes] of metastases was 15 mm (4–70). Twenty-two percent of patients had extrapulmonary disease amenable to local therapy including 49 liver, 16 bone and 60 miscellaneous metastases.Median follow-up was 35.5 months. Median overall survival (OS) was 62 months. Four-year local efficacy was 89%. Four-year lung disease control rate was 44.1%, with patient retreated safely up to four times. Primary origin, disease-free interval, size and number of metastases were associated with OS in multivariate analysis. Progression at RFA site was associated with poor OS [P = 0.011, hazard ratio (HR): 1.69 (95% confidence interval 1.13–2.54)]. In the 293 colorectal cancer metastases, size >2 cm (HR = 2.10, P = 0.0027) and a number of metastases ≥3 (HR = 1.86, P = 0.011) remained significantly associated with OS. A prognostic score made of three groups based on the four above-mentioned prognostic factors demonstrated 3-year OS rates of respectively 82.2%, 69.5% and 53.6% (log-rank test, P ≤ 0.0001) among the three groups in the overall population, and of 81.3%, 72.8% and 57.9% (log-rank test, P = 0.005) in the colorectal cancer patients.ConclusionRadiofrequency is an option for treatment of small size lung metastases, namely the ones below 2–3 cm.     

Improved survival using multi-modality therapy in patients with lung metastases from colorectal cancer: a preliminary study

This retrospective study was conducted to assess the safety, efficacy, and long-term results of multi-modality therapy including radio-frequency thermal ablation (RFA) and radiotherapy as an additional cytoreductive method for eliciting the marked effects of chemotherapy in treating unresectable lung metastases from colorectal cancer. Total of 21 patients with lung metastasis from colorectal cancer were included. They were treated with modified pharmacokinetic modulating chemotherapy (PMC). Eleven were also treated with RFA and/or radiotherapy (multi-modality group), and 10 were treated with chemotherapy alone (chemotherapy group). Characteristics and survival of patients in the multi-modality group were compared with those of the chemotherapy group. The median survival of all patients was 38.6 months after the initial PMC. The cumulative 3-year survival rate of patients in the multi-modality group was 87.5% compared with 33.3% in the chemotherapy group (p=0.0041). The course of multi-modality therapy was uneventful except for pneumothorax in those who received RFA. Although pneumothorax developed in 4 of 11 patients (36.4%) treated with RFA, all were able to receive chemotherapy within 2 weeks after RFA. In conclusion, multi-modality therapy combined with modified PMC, radiation and RFA is a feasible choice of treatment associated with reasonable morbidity and mortality in patients with inoperable lung metastases from colorectal cancer.     

Results of liver resection in combination with radiofrequency ablation for hepatic malignancies

Introduction

Liver tumors should be surgically treated whenever possible. In the case of bilobar disease or coexisting liver cirrhosis, surgical options are limited. Radiofrequency ablation (RFA) has been successfully used for irresectable liver tumors. The combination of hepatic resection and RFA extends the feasibility of open surgical procedures in patients with liver metastases and hepatocellular carcinoma (HCC).

Patients and methods

RFA was performed with two different monopolar devices using ultrasound guidance. Intraoperative use of RFA for the treatment of liver metastases or HCC was limited to otherwise irresectable tumors during open surgical procedures including hepatic resections. Irresectability was considered if bilobar disease was treated, the functional hepatic reserve was impaired or appraised marginal for allowing further resection.

Results

Ten patients with both liver metastases and HCC, and two patients with cholangiocellular carcinoma were treated. Complete initial tumor clearance was achieved in all patients. Two patients of the metastases group and five patients of the HCC group suffered from local recurrence after a median of 12 months (1–26) (local recurrence rate 32%). Five patients of the metastases group and six patients of the HCC group developed recurrent tumors in different areas of the ablation site after a median time of 4 months (2–18) (distant intrahepatic recurrence in 55%). Survival at 31 months was 36%.

Conclusion

RFA extends the scope of surgery in some candidates with intraoperatively found irresectability.     

Percutaneous laser ablation in patients with isolated unresectable liver metastases from colorectal cancer: Results of a phase II study

We prospectively evaluated the safety, local tumor control, and impact on survival parameters of percutaneous laser ablation (PLA) in patients with colorectal liver metastases not amenable to surgical resection. The study included 44 individuals with 75 unresectable liver metastases and no known extrahepatic disease. The median number of metastases treated for each patient was one, with a range of 1-4. Metastases had a median diameter of 3.4 cm (range 0.5-9 cm), and a median volume of 16.8 cm(3) (range 0.4-176.4 cm(3)). All patients also received systemic chemotherapy with modalities that differed according to the type of response to PLA. After treatment, 61% (46/75) of the tumors were ablated completely. The likelihood of achieving a complete ablation was significantly higher when metastases had a diameter <3.0 cm (p = 0.004). Overall survival was 30.0+/-12.7 months in patients with a complete ablation, and 20.2+/-10.2 months in those with a partial ablation (p = 0.002). There were no major complications during or after PLA, the most frequent side effect being abdominal pain that required analgesics. These findings indicate that PLA can be safely used as an adjunct to chemotherapy in unresectable colorectal liver metastases, and may have a positive impact on survival.     

Endoscopic radiofrequency ablation for liver metastasis of colorectal cancer

The application of radiofrequency ablation (RFA) for liver metastasis of colorectal cancer has not yet acquired an established status in clinical cancer therapy research. Removing as much tumor tissue as possible is desirable, but some cases do not allow optimal surgical ablation due to general condition of the patient and tumor status. We introduced endoscopic RFA for liver cancer in 2003, and have applied the procedure to 6 cases with H1 or H2 liver metastases of colorectal cancer to which surgical ablation could not be applied due to the poor general health of patients. Mean tumor diameter was 22.9 mm, and mean number of tumors per patient was 1.2. Tumor location was: S4, n = 2; S5, n = 1; S4, n = 1; S7, n = 2; and S8, n = 1. Mean frequency of session was 3.0. No complications occurred in any cases, and no reoperations were required. Although no recurrence of tumors in the vicinity of ablation was observed, 2 cases of each lung metastasis and intrahepatic recurrence were identified. Intrahepatic recurrence underwent hepatic arterial infusion (HAI) chemotherapy for simultaneous metastatic hepatic tumors (H2) prior to RFA, and relapses occurred in the metastatic focus where the efficacy of HAI was observed. At this point, 2 deaths were reported, 1 each from cancer and other diseases, and mean duration of survival after the procedure was 451.2 days. These results indicate that endoscopic RFA with good local control should be an available treatment for cases involving colorectal cancer with metastasis to the liver in which surgical ablation is difficult to apply.