Article

CT-guided radiofrequency ablation as a salvage treatment of colorectal cancer hepatic metastases developing after hepatectomy.

Department of Interventional Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA.
Journal of vascular and interventional radiology: JVIR (Impact Factor: 1.81). 06/2011; 22(6):755-61. DOI: 10.1016/j.jvir.2011.01.451
Source: PubMed

ABSTRACT To evaluate the clinical outcomes of percutaneous radiofrequency (RF) ablation of colorectal cancer liver metastases (CLMs) that recur after hepatectomy.
From December 2002 to December 2008, 71 CLMs that developed after hepatectomy were ablated in 56 patients. Medical records and imaging were reviewed to determine technique effectiveness/complete ablation (ie, ablation defect covering the entire tumor on 4-6-week postablation computed tomography [CT]), complications, and local tumor progression (LTP) at the site of ablation. LTP-free and overall survival were calculated by using Kaplan-Meier methodology. A modified clinical risk score (CRS) including nodal status of the primary tumor, time interval between diagnoses of the primary tumor and liver metastases, number of tumors, and size of the largest tumor was assessed for its effect on overall survival and LTP.
Tumor size ranged between 0.5 and 5.7 cm. Complete ablation was documented in 67 of 71 cases (94%). Complications included liver abscess (n = 1) and pleural effusion (n = 1). Median overall survival time was 31 months. One-, 2- and 3-year overall survival rates were 91%, 66%, and 41%, respectively. CRS was an independent factor for overall survival (74% for CRS of 0-2 vs 42% for CRS of 3-4 at 2 y; P = .03) and for LTP-free survival (66% for CRS of 0-2 vs 22% for CRS of 3-4 at 1 y after a single ablation; P <.01).
CT-guided RF ablation can be used to treat recurrent CLM after hepatectomy. A low CRS is associated with better clinical outcomes.

0 Bookmarks
 · 
194 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: We present a case of a patient with stage IIIC metastatic seminoma with a persistent chemorefractory liver lesion. The patient was deemed a poor surgical candidate due to the tumor's aggressive biology with numerous other liver lesions treated with chemotherapy and a relatively high probability for additional recurrences. Further chemotherapy with curative intent was not a feasible option due to the fact that the patient had already received second-line high-dose chemotherapy and four cycles of third-line treatment complicated by renal failure, refractory thrombocytopenia, and debilitating neuropathy. After initial failure of laser, microwave ablation of the chemorefractory liver metastasis resulted in prolonged local tumor control and rendered the patient disease-free for more than 35 months, allowing him to regain an improved quality of life.
    CardioVascular and Interventional Radiology 06/2014; DOI:10.1007/s00270-014-0924-z · 1.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Increasing data on treatment of liver metastases with locoregional therapies have solidified the expanding role of interventional radiologists (IRs) in the treatment of liver metastases from colorectal cancer. Ablative approaches such as radiofrequency ablation and microwave ablation have shown durable eradication of tumors. Catheter-directed therapies such as transarterial chemoembolization, drug-eluting beads, yttrium-90 radioembolization, and intra-arterial chemotherapy ports represent potential techniques for managing patients with unresectable liver metastases. Understanding the timing and role of these techniques in multidisciplinary care of patients is crucial. Implementation of IRs for consultation enables better integration of these therapies into patients' overall care. Copyright © 2015 Elsevier Inc. All rights reserved.
    Hematology/Oncology Clinics of North America 02/2015; 29(1):117-133. DOI:10.1016/j.hoc.2014.09.007 · 2.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although ultrasound and magnetic resonance imaging are competitive imaging modalities for the guidance of needle-based interventions, computed tomography (CT) is the only modality suitable for image-guided interventions in all regions of the body, including the lungs and bone. The ongoing technical development of CT involves accelerated image acquisition, significantly improved spatial resolution, CT scanners with an extended gantry diameter, acceleration of the procedure through joystick control of relevant functions of interventional CT by the interventional radiologist and tube current modulation to protect the hands of the examiner and radiosensitive organs of the patient. CT fluoroscopy can be used as a real-time method (the intervention is monitored under continuous CT fluoroscopy) or as a quick check method (repeated acquisitions of individual CT fluoroscopic images after each change of needle or table position). For the two approaches, multislice CT fluoroscopy (MSCTF) technique with wide detectors is particulary useful because even in the case of needle deviation from the center slice the needle tip is simultaneously visualised in the neighboring slices. With the aid of this technique a precise placement of interventional devices is possible even in angled access routes and in the presence of pronounced respiratory organ movements. As the reduction of CT fluoroscopy time significantly reduces radiation exposure for the patient and staff, the combination of a quick check technique and a low milliampere technique with multislice CT fluoroscopy devices is advantageous.
    Der Radiologe 11/2013; 53(11):974-985. DOI:10.1007/s00117-012-2460-7 · 0.41 Impact Factor

Full-text (2 Sources)

Download
24 Downloads
Available from
Jun 1, 2014