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Combined chemoembolization and thermal ablation for the treatment of metastases to the liver

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Abstract

Purpose

The purpose of the study was to evaluate safety, time to recurrence, and overall survival (OS) in patients with liver metastases (LM), treated with transarterial chemoembolization (TACE) followed by ablation.

Materials and methods

This retrospective study included all patients with LM treated with combined TACE and ablation from August 1998 to September 2015. Forty-two patients (12 women, 30 men; age 62.9 ± 11.9 years) were treated for 44 LMs. Tumor characteristics, imaging response to treatment, recurrence, and OS data were reviewed. Statistical analysis included Kaplan–Meier estimation, Cox regression and Fisher’s exact, Wilcoxon rank sum, or log rank tests.

Results

Median follow-up was 10.3 months. Eighteen patients had 1 hepatic lesion, 16 had 2–5, and 8 had > 5. Median index lesion size was 4.7 cm (range 1.5–8 .0 cm). Tumor response (mRECIST) was available for 41/44 treated lesions, with CR in 32 (78.0%), PR in 8 (19.5%), and PD in 1 (2.4%). Long-term imaging follow-up was available for 38 patients. Freedom from local recurrence was 61% at 1 year and 50% at 2 years. OS was 55% at 1 year and 30% at 2 years (median OS, 14.5 months). Tumor size and histology were not predictors of time to progression or OS. Complications occurred in 19 patients (45%). Major complications occurred in 19% of patients and included hospitalization for fever (n = 2), hepatic abscess (n = 3) and fall requiring transfusion, portal vein thrombus causing lobar infarct, biliary fistula, and retroperitoneal hematoma (n = 1 each).

Conclusions

Combined TACE and ablation is effective for local tumor control of liver metastases up to 8 cm when part of a multidisciplinary treatment strategy. Major complications occurred in 19% of patients.

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Acknowledgments

Abramson Cancer Center Support Grant P30-CA016520 (RM)

Author information

Authors and Affiliations

  1. Department of Diagnostic Imaging, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Founders – MRI Education Center, Philadelphia, PA, 19104, USA

    Erica S. Alexander

  2. Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, 609 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA

    Rosemarie Mick

  3. Department of Interventional Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Gregory J. Nadolski, Jeffrey I. Mondschein, S. William Stavropoulos & Michael C. Soulen

Authors
  1. Erica S. Alexander
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  2. Rosemarie Mick
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  3. Gregory J. Nadolski
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  4. Jeffrey I. Mondschein
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  5. S. William Stavropoulos
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  6. Michael C. Soulen
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Corresponding author

Correspondence to Erica S. Alexander.

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Conflict of interest

Dr. Stavropoulos has received research grants from Silajen and Cook; he is also a consultant for Bard. Dr. Soulen has received research grants from Guerbet LLC and BTG International; he is a consultant for Merit Medical, Terumo Medical, Bayer and Guerbet LLC; he is a proctor for Sirtex medical. Dr. Alexander declares that she has no conflict of interest. Prof. Mick declares that she has no conflict of interest. Dr. Nadolski declares that she has no conflict of interest. Dr. Mondschein declares that she has no conflict of interest.

Funding

This study was funded by an Abramson Cancer Center Support Grant P30-CA016520.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant study. Informed consent was waived because of the retrospective nature of the study.

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Alexander, E.S., Mick, R., Nadolski, G.J. et al. Combined chemoembolization and thermal ablation for the treatment of metastases to the liver. Abdom Radiol 43, 2859–2867 (2018). https://doi.org/10.1007/s00261-018-1536-x

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