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Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983
Affiliation:1. EORTC Headquarters, Brussels, Belgium;2. Department of Surgery, Centre Hospitalier Universitaire Ambroise Pare, Assistance Publique Hopitaux de Paris, Boulogne-Billancourt, France;3. Department of Statistics, EORTC Headquarters, Brussels, Belgium;4. Department of Oncology, Haukeland University Hospital, Bergen, Norway;5. Department of Surgery, The Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands;6. Department of Surgery, Medical University Vienna, Vienna, Austria;7. Department of Surgery, Robert-Roessle-Klinik, Humboldt-Universitat Berlin, Berlin, Germany;8. Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands;9. UCL and UCL Hospitals Comprehensive Biomedical Research Centre, University College London, London, United Kingdom;1. Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Surgery, Stockholm, Sweden;2. Division of Surgery, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden;1. Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, PO Box: 9101, 6500HB, Nijmegen, The Netherlands;2. Department of Radiology, Erasmus MC Cancer Institute Rotterdam, ''s Gravendijkwal 230, PO Box: 2040, 3000 CA, Rotterdam, The Netherlands;3. Department of Surgical Oncology, Erasmus MC Cancer Institute Rotterdam, ''s Gravendijkwal 230, PO Box: 2040, 3000 CA, Rotterdam, The Netherlands;4. Department of Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, PO Box: 9101, 6500HB, Nijmegen, The Netherlands;5. MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Drienerlolaan 5, PO Box: 217, 7500 AE, Enschede, The Netherlands;1. School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, UK;2. North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK;3. Medical University of Vienna, Vienna, Austria;4. Rudolfstiftung Hospital, Vienna, Austria;5. Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK;6. Dr. Josep Trueta Hospital, Institut d''Investigacions Biomediques de Girona (IdIBGi), Girona, Spain;7. Hôpital Universitaire Paul Brousse, Unité Inserm U935, Université Paris Sud, Villejuif, France;1. Department of General and Hepatobiliary Surgery, University Hospital Aintree, Longmoor Lane, Liverpool L69 3GA, United Kingdom;2. Department of General Surgery, Hepatobiliary Service, University Hospital Salzburg, Paracelsus Private Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria;3. School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom;1. The University of Southampton, Southampton, UK;2. University Hospitals Bristol NHS Foundation Trust, Bristol, UK;3. University of Manchester, Manchester, UK;4. The Christie NHS Foundation Trust, Manchester, UK;5. North Manchester General Hospital, Manchester, UK;6. Manchester Royal Infirmary, Manchester, UK;7. Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK;8. Basingstoke and North Hampshire Hospital, Basingstoke, UK;9. University Hospital Southampton NHS Foundation Trust, Southampton, UK;10. Royal Bournemouth Hospital, Bournemouth, UK;11. University Hospital of Wales, Cardiff, UK;12. University of Southampton Clinical Trials Unit, Southampton, UK;13. The University of Edinburgh, Edinburgh, UK;14. The Royal Marsden Hospital NHS Foundation Trust, London, UK;15. Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK;p. University College London Cancer Institute, London, UK;1. Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA;2. Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
Abstract:AimThe aim of this study is to describe local tumour control after radiofrequency ablation (RFA) and surgical resection (RES) of colorectal liver metastases (CLM) in two independent European Organisations for Research and Treatment of Cancer (EORTC) studies.BackgroundOnly 10–20% of patients with newly diagnosed CLM are eligible for curative RES. RFA has found a place in daily practice for unresectable CLM. There are no prospective trials comparing RFA to RES for resectable CLM.MethodsThe CLOCC trial randomised 119 patients with unresectable CLM between RFA (±RES) + adjuvant FOLFOX (±bevacizumab) versus FOLFOX (±bevacizumab) alone. The EPOC trial randomised 364 patients with resectable CLM between RES ± perioperative FOLFOX. We describe the local control of resected patients with lesions ⩽4 cm in the perioperative chemotherapy arm of the EPOC trial (N = 81) and the RFA arm of the CLOCC trial (N = 55).ResultsLocal recurrence (LR) rate for RES was 7.4% per patient and 5.5% per lesion. LR rate for RFA was 14.5% per patient and 6.0% per lesion. When lesion size was limited to 30 mm, LR rate for RFA lesions was 2.9% per lesion. Non-local hepatic recurrences were more often observed in RFA patients than in RES patients, 30.9% and 22.3% respectively. Patients receiving RFA had a more advanced disease.ConclusionsLR rate after RFA for lesions with a limited size is low. The local control per lesion does not appear to differ greatly between RFA and surgical resection. This study supports the local control of RFA in patients with limited liver metastases. Future studies should evaluate in which patients RFA could be an equal alternative to liver resection.
Keywords:Local recurrence  Colorectal liver metastases  Radiofrequency ablation  Resection
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