Durable oncologic outcomes after radiofrequency ablation

BACKGROUND:

Long‐term oncologic outcomes for renal thermal ablation are limited. The authors of this report present their experience with radiofrequency ablation (RFA) therapy for 243 small renal masses (SRMs) over the past 7.5 years.

METHODS:

The authors' institutional, prospectively maintained RFA database was reviewed to determine intermediate and long‐term oncologic outcomes for patients with SRMs (generally <4 cm) who underwent RFA. Particular attention was placed on patients who had a minimum 3 years of follow‐up. Patients were excluded from the analysis if they had received previous treatment for renal cell carcinoma (RCC) on the ipsilateral kidney or if they did not have at least 1 imaging study available for follow‐up.

RESULTS:

Two hundred eight patients (with 243 SRMs) who had no evidence of previous ipsilateral renal cancer treatment underwent RFA and had follow‐up imaging studies available for review. Overall, tumor size averaged 2.4 cm, and follow‐up ranged from 1.5 months to 90 months (mean, 27 months). Of the 227 tumors (93%) that underwent preablation biopsy, RCC was confirmed in 79%. The initial treatment success rate was 97%, and the overall 5‐year recurrence‐free survival rate was 93% (90% for 160 patients who had biopsy‐proven RCC). During follow‐up, 3 patients developed metastatic disease, and 1 patient died of RCC, yielding 5‐year actuarial metastasis‐free and cancer‐specific survival rates of 95% and 99%, respectively.

CONCLUSIONS:

RFA provided successful treatment of SRMs and produced a low rate of recurrence as well as prolonged metastasis‐free and cancer‐specific survival rates at 5 years after treatment. Although longer term follow‐up of RFA will be required to determine late recurrence rates, the current results indicated a minimal risk of disease recurrence in patients who are >3 years removed from RFA. Cancer 2010. © 2010 American Cancer Society.     

Percutaneous radiofrequency ablation of painful osseous metastases

BACKGROUND:

The study was conducted to determine whether radiofrequency ablation (RFA) can safely reduce pain from osseous metastatic disease.

METHODS:

The single‐arm prospective trial included patients with a single painful bone metastasis with unremitting pain with a score >50 on a pain scale of 0‐100. Percutaneous computed tomography‐guided RFA of the bone metastasis to temperatures >60°C was performed. Endpoints were the toxicity and pain effects of RFA before and at 2 weeks, 1 month, and 3 months after RFA.

RESULTS:

Fifty‐five patients completed RFA. Grade 3 toxicities occurred in 3 of 55 (5%) patients. RFA reduced pain at 1 and 3 months for all pain assessment measures. The average increase in pain relief from pre‐RFA to 1‐month follow‐up is 26.3 (95% confidence interval [CI], 17.7‐34.9; P < .0001), and the increase from pre‐RFA to 3‐month follow‐up is 16.38 (95% CI, 3.4‐29.4; P = .02). The average decrease in pain intensity from pre‐RFA to 1‐month follow‐up was 26.9 (P < .0001) and 14.2 for 3‐month follow‐up (P = .02). The odds of lower pain severity at 1‐month follow‐up were 14.0 (95% CI, 2.3‐25.7; P < .0001) times higher than at pre‐RFA, and the odds at 3‐month follow‐up were 8.0 (95% CI, 0.9‐15.2; P < .001) times higher than at pre‐RFA. The average increase in mood from pre‐RFA to 1‐month follow‐up was 19.9 (P < .0001) and 14.9 to 3‐month follow‐up (P = .005).

CONCLUSIONS:

This cooperative group trial strongly suggests that RFA can safely palliate pain from bone metastases. Cancer 2010. © 2010 American Cancer Society     

Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

BACKGROUND:

To improve the efficacy of radiofrequency ablation (RFA) for the treatment of intermediate‐sized hepatocellular carcinomas (HCCs), the authors compared RFA combined with transcatheter arterial chemoembolization (TACE) to RFA alone.

METHODS:

The authors randomly assigned 37 patients with solitary HCCs (diameter, 3.1‐5.0 cm in the greatest dimension) to 2 groups: the TACE‐RFA group, in which the patients received TACE followed by RFA on the same day, and the RFA group, in which the patients received only RFA.

RESULTS:

Technical success was achieved after 1.4 ± 0.5 RFA sessions in the RFA group and after 1.1 ± 0.2 RFA sessions in the TACE‐RFA group (P < .01). The mean diameters of the longer and shorter axes of the RFA‐induced ablated areas were 50 ± 8.0 mm and 41 ± 7.1 mm, respectively, in the RFA group and 58 ± 13.2 mm and 50 ± 11.3 mm, respectively, in the TACE‐RFA group; the mean diameters of the shorter axes were significantly different (P = .012). The rates of local tumor progression at the end of the third year in the RFA and TACE‐RFA groups were 39% and 6%, respectively (P = .012). The 3‐year survival rates of the patients in the RFA and TACE‐RFA groups were 80% and 93%, respectively (P = .369).

CONCLUSIONS:

In patients with intermediate‐sized HCCs, RFA combined with TACE is more effective than RFA alone for extending the ablated area in fewer treatment sessions and for decreasing the local tumor progression rate. Cancer 2010. © 2010 American Cancer Society.     

Percutaneous thermal ablation of medium and large hepatocellular carcinoma

BACKGROUND:

Radiofrequency ablation (RFA) and microwave ablation (MWA) were found to be effective in treating hepatocellular carcinoma (HCC) smaller than 3 cm; however, to the authors' knowledge, the usefulness of thermal ablation in treating larger HCC, especially those >5 cm, has not been well documented. The present study evaluated the therapeutic efficacy of percutaneous thermal ablation with curative intention for HCC measuring between 3.0 cm and 7.0 cm.

METHODS:

Percutaneous RFA or MWA were used to treat 109 HCC patients with at least 1 tumor measuring between 3.0 cm and 7.0 cm. Fifty?eight patients received thermal ablation as the first treatment, and the remaining 51 were treated for posthepatectomy recurrent HCC. A total of 89 patients had a main tumor measuring 3.0 cm to 5.0 cm, and 20 patients had main tumors measuring 5.0 cm to 7.0 cm. Local therapeutic efficacy, long‐term outcome, and prognostic factors were analyzed.

RESULTS:

There were no treatment‐related deaths, and the major complication rate was 9.2%. Complete ablation rate was 92.6%. Local recurrence (LR) occurred in 22% patients, with a median time to LR of 4.6 months. Distant recurrences developed in 53.2% patients. The 1‐year, 3‐year, and 5‐year survival rates were 75.8%, 30.9%, and 15.4%, respectively. Univariate analysis indicated that incomplete tumor ablation, posthepatectomy recurrence, and preablation α‐fetoprotein (AFP) ≥200 ng/mL were 3 unfavorable prognostic factors for long‐term survival (P = .000, .015, and .008, respectively). Cox regression analysis confirmed that incomplete tumor ablation, recurrent tumors, and preablation AFP ≥200 ng/mL were independent unfavorable prognostic factors, with an exp(B) of 4.158 (P = .001), 1.568 (P = .082), and 1.593 (P = .082), respectively.

CONCLUSIONS:

Percutaneous thermal ablation was effective and safe in treating HCC between 3 cm and 7 cm, with acceptable local tumor control and long‐term outcomes. Completeness of ablation, previous history of treatment, and preablation AFP level were significant prognostic factors. Cancer 2009. © 2009 American Cancer Society.     

Hospital volume of percutaneous radiofrequency ablation is closely associated with treatment outcomes for patients with hepatocellular carcinoma

BACKGROUND:

Hospital volume for several major operations is associated with treatment outcomes. In this study, the authors explored the influence of hospital radiofrequency ablation (RFA) volume on the prognosis of patients who received RFA for hepatocellular carcinoma (HCC).

METHODS:

The authors searched for all patients who were diagnosed with stage I or stage II HCC from 2004 to 2006 and who received RFA as first‐line therapy in a population‐based cohort. Overall survival (OS) and liver cancer‐specific survival (CSS) were compared according to hospital volume. A Cox proportional hazards model was used for multivariate analysis.

RESULTS:

In total, 661 patients received first‐line RFA for stage I and II HCC in 28 hospitals. Among these, there were 480 patients (72.6%) in the high‐volume group (those who received RFA at hospitals that treated >10 first‐line patients per year), and there were 181 patients (27.4%) in the low‐volume group (those who received RFA at hospitals that treated ≤10 first‐line patients per year). The sex, age, stage, tumor size, and year of diagnosis for patients in the 2 groups did not differ significantly. Patients in the high‐volume group demonstrated significantly longer OS and CSS than those in the low‐volume group (5‐year OS rate, 58.7% vs 47.2%; P = .001; 5‐year CSS rate, 67.1% vs 57.1%; P = .009). After adjusting for covariates, high‐volume hospitals remained an independent predictor of longer OS (hazard ratio, 0.57; P < .001) and CSS (hazard ratio, 0.57; P = .003).

CONCLUSIONS:

Patients who received first‐line RFA for HCC in high‐volume hospitals demonstrated better survival outcomes. Cancer 2013. © 2012 American Cancer Society.     

Local progression after radiofrequency ablation for pulmonary metastases

BACKGROUND:

Local treatment for pulmonary metastases is considered to be a reasonable treatment option in patients with oligometastatic disease. Percutaneous radio frequency ablation (RFA) has been reported as an alternative to surgery. Results of RFA for local control of pulmonary metastases were evaluated.

METHODS:

All consecutive patients treated with RFA for pulmonary metastases (2004‐2009) were included. RFA was performed percutaneously under computed tomographic guidance. Follow‐up was scheduled at 1, 3, and 6 months after treatment and every 6 months thereafter. Major outcome parameters were local and any‐site progression, complications, and survival.

RESULTS:

Ninety pulmonary metastases were treated, in 46 patients at 65 sessions. Many patients had recurrent metastases after previous surgery (n = 36 of 46). Pneumothorax occurred in 34% (chest drain in 25%) and major complications in 6%. After median follow‐up of 22 months (range, 2‐65 months), 25 local progressions occurred after RFA; the 2‐year local progression rate per lesion was 35%. Overall survival at 3 years was 69%.

CONCLUSIONS:

Notwithstanding its relatively low morbidity, follow‐up after RFA for pulmonary metastases shows a considerable rate of local progression. The role of local ablation techniques for long‐term disease control in oligometastatic disease is discussed. Cancer 2011. © 2011 American Cancer Society.     

Percutaneous image‐guided cryoablation of painful metastases involving bone

BACKGROUND:

This study sought to describe the results of a single‐arm multicenter clinical trial using image‐guided percutaneous cryoablation for the palliation of painful metastatic tumors involving bone.

METHODS:

Over a 44‐month period, 61 adult patients with 1 or 2 painful bone metastases with a score of 4 or more on a scale of 0 to 10 (≥4/10) worst pain in a 24‐hour period who had failed or refused conventional treatment were treated with percutaneous image‐guided cryoablation. Patient pain and quality of life was measured using the Brief Pain Inventory prior to treatment, 1 and 4 days after the procedure, weekly for 4 weeks, and every 2 weeks thereafter for a total of 6 months. Patient analgesic use was also recorded at these same follow‐up intervals. Complications were monitored. Analysis of the primary endpoint was undertaken via paired comparison procedures.

RESULTS:

A total of 69 treated tumors ranged in size from 1 to 11 cm. Prior to cryoablation, the mean score for worst pain in a 24‐hour period was 7.1/10 with a range of 4/10 to 10/10. At 1, 4, 8, and 24 weeks after treatment, the mean score for worst pain in a 24‐hour period decreased to 5.1/10 (P < .0001), 4.0/10 (P < .0001), 3.6/10 (P < .0001), and 1.4/10 (P < .0001), respectively. One of 61 (2%) patients had a major complication with osteomyelitis at the site of ablation.

CONCLUSIONS:

Percutaneous cryoablation is a safe, effective, and durable method for palliation of pain due to metastatic disease involving bone. Cancer 2013. © 2012 American Cancer Society.     

Active treatment of localized renal tumors may not impact overall survival in patients aged 75 years or older

BACKGROUND:

Although nephrectomy cures most localized renal cancers, this oncologic benefit may be outweighed by the renal functional costs of such an approach. In this study, the authors examined overall survival in 537 patients who had localized renal tumors ≤7 cm detected at age ≥75 years to investigate whether surgical intervention improved survival compared with active surveillance.

METHODS:

Clinical T1 renal tumors were managed with surveillance (20%), nephron‐sparing interventions (53%), or nephrectomy (27%). Cox regression models were constructed based on age, comorbidity, management type, renal function, and other variables.

RESULTS:

The median follow‐up was 3.9 years, and death from any cause occurred in 148 patients (28%). The most common cause of death was cardiovascular (29%), and cancer progression was responsible in only 4% of deaths. Kaplan‐Meier analysis revealed decreased overall survival for patients who underwent surveillance and nephrectomy relative to nephron‐sparing intervention (P = .01); however, surveilled patients were older and had greater comorbidity. In multivariate analysis, significant predictors of overall survival included age (P = .0004) and comorbidity (P < .0001) but not management type (P = .3). Preoperative renal function (P = .006) and comorbidity (P = .005) were predictors of cardiovascular mortality, and nephrectomy was associated with greatest loss of renal function.

CONCLUSIONS:

In patients aged ≥75 years, surgical management of clinically localized renal cortical tumors was not associated with increased survival. Patients died mostly of cardiovascular causes, similar to the general elderly population. Nephrectomy accelerated renal dysfunction, which was associated with cardiovascular mortality. Current paradigms suggest that there is over treatment of localized renal tumors, and further study will be required to evaluate the advisability of various options in patients with limited life expectancy. Cancer 2010. © 2010 American Cancer Society.     

A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer

BACKGROUND:

A recent randomized trial to compare external beam radiation therapy (EBRT) to cryoablation for localized disease showed cryoablation to be noninferior to external beam EBRT in disease progression and overall and disease‐specific survival. We report on the quality of life (QOL) outcomes for this trial.

METHODS:

From December 1997 through February 2003, 244 men with newly diagnosed localized prostate cancer were randomly assigned to cryoablation or EBRT (median dose 68 Gy). All patients received neoadjuvant antiandrogen therapy. Patients completed the EORTC QLQ C30 and the Prostate Cancer Index (PCI) before treatment and at 1.5, 3, 6, 12, 18, 24, and 36 months post‐treatment.

RESULTS:

Regardless of treatment arm, participants reported high levels of QOL with few exceptions. cryoablation was associated with more acute urinary dysfunction (mean PCI urinary function cryoablation = 69.4; mean EBRT = 90.7; P < .001), which resolved over time. No late arising QOL issues were observed. Both EBRT and cryoablation participants reported decreases in sexual function at 3 months with the cryoablation patients reporting poorer functioning (mean cryoablation = 7.2: mean EBRT = 32.9; P < .001). Mean sexual function score was 15 points lower at 3 years for the cryoablation group and 13% more of the cryoablation men said that sexuality was a moderate or big problem.

CONCLUSIONS:

In this randomized trial, no long‐term QOL advantage for either treatment was apparent with the exception of poorer sexual function reported by those treated with cryoablation. Men who wish to increase their odds of retaining sexual function might be counseled to choose EBRT over cryoablation. Cancer 2009. © 2009 American Cancer Society.     

Impact of lympho‐vascular space invasion on tumor characteristics and survival outcome of women with low‐grade serous ovarian carcinoma

Background and Objectives

To examine association of lympho‐vascular space invasion (LVSI) with clinico‐pathological factors and to evaluate survival of women with low‐grade serous ovarian carcinoma containing areas of LVSI.

Methods

This is a multicenter retrospective study examining consecutive cases of surgically treated stage I‐IV low‐grade serous ovarian carcinoma (n = 178). Archived histopathology slides for the ovarian tumors were reviewed, and LVSI was scored as present or absent. LVSI status was correlated to clinico‐pathological findings and survival outcome.

Results

LVSI was seen in 79 cases (44.4%, 95% confidence interval [CI] 37.1‐51.7). LVSI was associated with increased risk of omental metastasis (87.0% vs 64.9%, odds ratio [OR] 3.62, P = 0.001), high pelvic lymph node ratio (median 12.9% vs 0%, P = 0.012), and malignant ascites (49.3% vs 32.6%, OR 2.01, P = 0.035). On multivariable analysis, controlling for age, stage, and cytoreductive status, presence of LVSI in the ovarian tumor remained an independent predictor for decreased progression‐free survival (5‐year rates 21.0% vs 35.7%, adjusted‐hazard ratio 1.57, 95%CI 1.06‐2.34, P = 0.026). LVSI was significantly associated with increased risk of recurrence in lymph nodes (OR 2.62, 95%CI 1.08‐6.35, P = 0.047).

Conclusion

LVSI in the ovarian tumor is associated with adverse clinico‐pathological characteristics and decreased progression‐free survival in women with low‐grade serous ovarian carcinoma.

     

Comparative assessment of 5 methods (methylation-specific polymerase chain reaction, MethyLight, pyrosequencing, methylation-sensitive high-resolution melting, and immunohistochemistry) to analyze O6-methylguanine-DNA-methyltranferase in a series of 100 glioblastoma patients

BACKGROUND:

There is a strong need to determine the best technique for O⁶‐methylguanine‐DNA‐methyltranferase (MGMT) analysis, because MGMT status is currently used in clinical trials and occasionally in routine clinical practice for glioblastoma patients.

METHODS:

The authors compared analytical performances and predictive values of 5 techniques in a series of 100 glioblastoma patients who received standard of care treatment (Stupp protocol).

RESULTS:

MGMT promoter was considered methylated in 33%, 33%, 42%, and 60% of patients by methylation‐sensitive high‐resolution melting, MethyLight, pyrosequencing (with an optimal risk cutoff at 8% for the average percentage of the 5 CpGs tested), and methylation‐specific polymerase chain reaction (MS‐PCR), respectively. Fifty‐nine percent of the samples had <23% (the optimal risk cutoff) of MGMT‐positive tumor cells. The best predictive values for overall survival (OS), after adjustment for age and performance status, were obtained by pyrosequencing (hazard ratio [HR], 0.32; P < .0001), MS‐PCR (HR, 0.37; P < .0001), and immunohistochemistry (HR, 0.43; P = .0005) as compared with methylation‐sensitive high‐resolution melting (HR, 0.52 P = .02) and MethyLight (HR, 0.6; P = .05). For progression‐free survival (PFS), the best predictive values were obtained with pyrosequencing (HR, 0.35; P < .0001), methylation‐sensitive high‐resolution melting (HR, 0.46; P = .002), and MS‐PCR (HR, 0.49; P = .002). Combining pyrosequencing and immunohistochemistry slightly improved predictive power for OS, but not for PFS. Poor reproducibility and interobserver variability were, however, observed for immunohistochemistry.

CONCLUSIONS:

Good prediction of survival in addition to high reproducibility and sensitivity made pyrosequencing the best among the 5 techniques tested in this study. Cancer 2012. © 2012 American Cancer Society     

Combined transcatheter arterial chemoembolization and radiofrequency ablation in single‐session for solitary hepatocellular carcinoma larger than 7 cm

1 Aims

To evaluate technical feasibility and treatment results of combined transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) in single‐session for solitary hepatocellular carcinoma (HCC) larger than 7 cm in diameter.

2 Methods

Institutional review board approved this retrospective study. Written informed consent was obtained from all patients. Between June 2007 and July 2013, 87 patients (75 men, 12 women; mean age, 55.5 years ± 15.0) with solitary HCC with a mean maximum diameter of 9.5 cm ± 2.4 (range, 7.1–13.5 cm) not feasible for surgical resection underwent combined TACE and RFA in a single‐session. Immediately following TACE, RFA was performed under fluoroscopy and CB‐CT guidance. The primary endpoint was overall survival (OS). The secondary endpoints were technical safety and local tumor progression (LTP) rates. OS and time to progression (TTP) were analyzed with the Kaplan–Meier method. Univariate and multivariate analyses were performed to identify prognostic factors affecting OS and TTP.

3 Results

Technical success of combined TACE and RFA in a single‐session was achieved in all patients (100%). On 1‐month follow‐up MRI, complete response (CR) was observed in 76 of 87 patients (87.4 %), partial response (PR) in 8 and stable disease (SD) in 3 patients. The median follow‐up period was 49.5 months (interquartile range, 30.0–70.0 months). The median OS was 39 months (range, 15–86 months). The cumulative OS rates at 1, 3 and 5 years were 100%, 65.5% and 47.5%, respectively. The estimated 1, 3 and 5 year LTP rates were 0 %, 29.9% and 55.2 %, respectively. Univariate and multivariate analyses showed a tumor larger than 10.0 cm (P < 0.05) and presence of portal vein branch invasion (P < 0.05) led to the worst prognosis. No major complications were noted.

4 Conclusions

Combined use of TACE and RFA in single‐session is a safe and effective option in the treatment of patients with solitary large HCC (> 7 cm) not amenable to surgery.     

Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for early stage hepatocellular carcinoma

BACKGROUND:

Radiofrequency ablation (RFA) is becoming a well‐known local therapy for hepatocellular carcinoma (HCC). Transcatheter arterial chemoembolization (TACE) is expected to enhance the effects of subsequent RFA by reducing arterial blood flow. However, the long‐term efficacy of this combined therapy has not been elucidated. In this study, the survival rates of patients who received TACE combined with RFA (TACE + RFA) were compared with those of patients treated surgically.

METHODS:

The study included consecutive patients who received TACE + RFA or surgical resection as the initial curative treatment for HCC between 2000 and 2005 at Tokai University Hospital. Inclusion criteria were a single HCC ≤50 mm or up to 3 HCCs ≤30 mm, presence of cirrhosis classified as Child‐Pugh class A, no vascular invasion, and no extrahepatic metastasis.

RESULTS:

Sixty‐two patients (23 women, 39 men; aged 67.5 ± 8.4 years [mean ± standard deviation]) received TACE + RFA, and 55 patients (15 women, 40 men; aged 66.1 ± 8.4 years) underwent surgical resection. Median follow‐up periods were similar (50 months in the TACE + RFA group vs 49 months in the resection group). The probabilities of overall survival at 1, 3, and 5 years in the TACE + RFA group (100%, 94.8%, and 64.6%, respectively) were similar (P = .788) to those in the resection group (92.5%, 82.7%, and 76.9%, respectively). Two major RFA‐related complications were observed (1.5%).

CONCLUSIONS:

RFA combined with TACE is an efficient and safe treatment that provides overall survival rates similar to those achieved with surgical resection. Cancer 2010. © 2010 American Cancer Society.     

Current or recent pregnancy is associated with adverse pathologic features but not impaired survival in early breast cancer

BACKGROUND:

Pregnancy‐associated breast cancer (PABC) may be defined as breast cancer diagnosed during pregnancy or within 1 year of giving birth. Conflicting data exist regarding the impact of pregnancy on clinical features and prognosis of breast cancer.

METHODS:

A single‐institution retrospective chart review was performed of 99 patients identified with PABC between 1992 and 2007. Non‐PABC controls were matched 2:1 to PABC cases by year of diagnosis and age. The differences in clinical features were compared between cases and controls using chi‐square tests. Univariate and multivariate analyses were performed to assess the effect of PABC on survival.

RESULTS:

Of the 99 PABC cases, breast cancer was diagnosed during pregnancy in 36 patients, and after delivery in 63. PABC cases were more likely than controls to be negative for estrogen receptor (59% vs 31%, P < .0001) and negative for progesterone receptor (72% vs 40%, P < .0001). Cases were also more likely to have advanced T class (P = .0271) and N class (P = .0104) and higher grade tumors (P = .0115). With a median follow‐up of 6.3 years for cases and 4.7 years for controls, overall survival did not differ between cases and controls (P = .0787). On multivariate analysis, the independent prognostic factors for overall survival were estrogen receptor status (P = .0031) and N class (P = .0003). The diagnosis of PABC was not an independent prognostic factor (P = .1317).

CONCLUSIONS:

PABC is associated with more adverse tumor features than non‐PABC matched for age and year of diagnosis. After correcting for pathologic features, the diagnosis of PABC is not in itself an adverse prognostic factor for survival. Cancer 2011. © 2011 American Cancer Society.     

Hepatic resection combined with radiofrequency ablation for initially unresectable colorectal liver metastases after effective chemotherapy is a safe procedure with a low incidence of local recurrence

Background

Chemotherapy can lead to tumor down-staging in patients with initially unresectable colorectal liver metastases (CRLM); however, more than half of such cases are still considered to be unresectable because of disease progression, including multiple or bilobar CRLM, and an insufficient predicted remnant liver volume. In addition, there is little evidence supporting the use of radiofrequency ablation (RFA) for patients with CRLM. This study compared the safety and efficacy of hepatic resection (HR) combined with RFA versus HR alone after effective chemotherapy in patients with initially unresectable CRLM.

Methods

Data were prospectively collected on 118 consecutive patients with initially unresectable CRLM who received FOLFOX ± bevacizumab as the first-line chemotherapy. 48 of these patients (41 %) underwent HR or HR + RFA after the chemotherapy. HR was performed in 35 patients (HR group), and HR + RFA in 13 (HR + RFA group).

Results

There was no mortality in either group. Postoperative morbidity rates in the HR group and the HR + RFA group were 17 and 23 %, respectively (P = 0.640). Local recurrence at the RFA site occurred in only one tumor (1.6 % per lesion, 7.7 % per patients). The 3-year progression-free survival was 45.3 % in the HR group and 12.8 % in the HR + RFA group (P = 0.472). The 3-year overall survival rate was 70.4 % in the HR group and 77.1 % in the HR + RFA group (P = 0.627).

Conclusions

These results suggest that HR + RFA after effective chemotherapy is a safe procedure with low local recurrence at the RFA site and is a potentially effective treatment option for patients with initially unresectable CRLM.     

Elective irradiation of pelvic lymph nodes during postprostatectomy salvage radiotherapy

BACKGROUND:

Success rates with salvage radiotherapy (SRT) in men who have a postprostatectomy biochemical relapse are suboptimal. One treatment‐intensification strategy includes elective irradiation of the pelvic lymph nodes with whole pelvis radiotherapy (WPRT).

METHODS:

An inter‐institutional retrospective cohort study compared outcomes for patients who received SRT at 2 separate academic institutions with disparate treatment paradigms: almost exclusively favoring WPRT (n = 112) versus limiting treatment to the prostate bed (PBRT) (n = 135). Patients were excluded if they had lymph node involvement or if they received androgen‐deprivation therapy. The Cox proportional hazards model was used to adjust for potential confounders.

RESULTS:

In total, 247 patients were analyzed with a median follow‐up of 4 years. The pre‐SRT prostate‐specific antigen (PSA) level (adjusted hazard ratio [HR], 1.58; P < .0001) and a Gleason score of 8 to 10 (adjusted HR, 3.21; P < .0001) were identified as independent predictors of increased risk of biochemical PSA progression after SRT. However, WPRT was not independently associated with biochemical progression‐free survival in the multivariate model (adjusted HR, 0.79; P = .20). Neither low‐risk patients nor high‐risk patients (defined a priori by a preoperative PSA level ≥20 ng/mL, a pathologic Gleason score between 8 and 10, or pathologic T3 tumor classification) benefited from WPRT. Overall survival was similar between treatment groups. When restricting the analysis to patients with pre‐SRT PSA levels ≥0.4 ng/mL (n = 139), WPRT was independently associated with a 53% reduction in the risk of biochemical progression (adjusted HR, 0.47; P = .031).

CONCLUSIONS:

WPRT did not improve outcomes among the entire group but was independently associated with improved biochemical control among patients with pre‐SRT PSA levels ≥0.4 ng/mL. Cancer 2013. © 2012 American Cancer Society.     

Radiofrequency Ablation for Renal Cancer in Von Hippel–Lindau Syndrome Patients: A Prospective Cohort Analysis

Introduction

Management of renal-cell carcinoma (RCC) in patients with Von Hippel–Lindau syndrome (VHL) represents a clinical dilemma: the oncologic outcomes must be weighed against preservation of renal function. Radiofrequency ablation (RFA) is currently used in selected cases for treatment of small-size RCC. The aim of this study was to evaluate the safety, complications, and functional and oncologic outcomes of RFA in the treatment of RCC in VHL patients.

Epidermal growth factor receptor protein expression and genomic alterations in renal cell carcinoma

BACKGROUND:

Epidermal growth factor receptor (EGFR) is involved in the progression of many cancer types and represents an important therapeutic target.

METHODS:

To determine the role of EGFR in renal cell carcinoma (RCC), the authors analyzed 1088 tumors in a tissue microarray format by using immunohistochemistry and fluorescence in situ hybridization (FISH). A subset of 63 cancers was sequenced for EGFR exon 18 through 21 mutations.

RESULTS:

EGFR expression was observed in 83.8% of clear cell carcinomas, in 68.2% of papillary carcinomas, in 75% of chromophobe carcinomas, and in 50% of oncocytomas. Within clear cell carcinomas, the expression level of EGFR was associated with high tumor grade (P < .0001), advanced pathologic tumor classification (P < .0001), and, to a lesser extent, lymph node status (P = .0326). FISH analysis revealed increased EGFR copy numbers (high polysomy) in 5.5% of tumors and amplification in 0.1% of tumors. EGFR copy number increases were associated with EGFR protein expression (P = .0015). Within clear cell carcinomas, EGFR copy number increases were associated with high tumor grade (P < .0001), advanced pathologic tumor classification (P = .0472), and lymph node status (P = .0065). No exon 18 through 21 mutations were identified in 63 sequenced tumors.

CONCLUSIONS:

The authors concluded that increased EGFR expression occurs in a fraction of patients who have RCC with an unfavorable histologic phenotype. EGFR copy number gain represents 1 possible cause for EGFR overexpression; however, many over expressing tumors have a normal genotype. High polysomy (which is suggested to be predictive of a response to tyrosine kinase inhibitors) occurs in 5.6% of RCCs. Thus, the potential utility of anti‐EGFR medications may be worth further investigation in a small but significant subset of patients with RCC. Cancer 2012;. © 2011 American Cancer Society.     

Small renal masses progressing to metastases under active surveillance

BACKGROUND:

The authors systematically reviewed the literature and conducted a pooled analysis of studies on small renal masses who underwent active surveillance to identify the risk progression and the characteristics associated with metastases.

METHODS:

A search of the MEDLINE database was performed to identify all clinical series that reported the surveillance of localized renal masses. For studies that reported individual‐level data, clinical and radiographic characteristics of tumors without progression were compared with the characteristics of tumors that progressed to metastases.

RESULTS:

Eighteen series (880 patients, 936 masses) met screening criteria; and, among these, 18 patients were identified who had tumors that progressed to metastasis (mean, 40.2 months). Six studies (259 patients, 284 masses) provided individual‐level data for pooled analysis. At a mean (±standard deviation) follow‐up of 33.5 ± 22.6 months, the mean initial greatest tumor dimension was 2.3 ± 1.3 cm, and mean linear growth rate was 0.31 ± 0.38 cm per year. Sixty‐five masses (23%) exhibited zero net growth under surveillance, and none of those masses progressed to metastasis. A pooled analysis revealed increased age (age 75.1 ± 9.1 years vs 66.6 ± 12.3 years; P = .03), an initial greatest tumor dimension (4.1 ± 2.1 cm vs 2.3 ± 1.3 cm; P < .0001), initial estimated tumor volume (66.3 ± 100.0 cm³ vs 15.1 ± 60.3 cm³; p = .0001), linear growth rate of (0.8 ± 0.65 cm per year vs 0.3 ± 0.4 cm per year; P = .0001), and a volumetric growth rate of 27.1 ± 24.9 cm³ per year (vs 6.2 ± 27.5 cm³ per year; P < .0001) in the progression cohort.

CONCLUSIONS:

A substantial proportion of small renal masses remained radiographically static after an initial period of active surveillance. Progression to metastases occurred in a small percentage of patients and generally was a late event. The current results indicated that, in patients who have competing health risks, radiographic surveillance may be an acceptable initial approach, and delayed intervention may be reserved for patients who have tumors that exhibit significant linear or volumetric growth. Cancer 2012;. © 2011 American Cancer Society.     

Neurogenesis in colorectal cancer is a marker of aggressive tumor behavior and poor outcomes

BACKGROUND:

Colorectal cancer staging criteria do not rely on examination of neuronal tissue. The authors previously demonstrated that perineural invasion is an independent prognostic factor of outcomes in colorectal cancer. For the current study, they hypothesized that neurogenesis occurs in colorectal cancer and portends an aggressive tumor phenotype.

METHODS:

In total, samples from 236 patients with colorectal cancer were used to create a tissue array and database. Tissue array slides were immunostained for protein gene product 9.5 (PGP9.5) to identify nerve tissue. The correlation between markers of neurogenesis and oncologic outcomes was determined. The effect of colorectal cancer cells on stimulating neurogenesis in vitro was evaluated using a dorsal root ganglia coculture model.

RESULTS:

Patients whose tumors exhibited high degrees of neurogenesis had 50% reductions in 5‐year overall survival and disease‐free survival compared with patients whose tumors contained no detectable neurogenesis (P = .002 and P = .006, respectively). Patients with stage II disease and high degrees of neurogenesis had greater reductions in 5‐year overall survival and disease‐free survival compared with lymph node‐negative patients with no neurogenesis (P = .002 and P = .008, respectively). Patients with stage II disease and high degrees of neurogenesis had lower 5‐year overall survival and disease‐free survival compared with patients who had stage III disease with no neurogenesis (P = .01 and P = .008, respectively). Colorectal cancer cells stimulated neurogenesis and exhibited evidence of neuroepithelial interactions between nerves and tumor cells in vitro.

CONCLUSIONS:

Neurogenesis in colorectal cancer appeared to play a critical role in colorectal cancer progression. Furthermore, the current results indicated that neurogenesis functions as an independent predictor of outcomes and may play a role in therapy stratification for patients with lymph node‐negative disease. Cancer 2011;. © 2011 American Cancer Society.