Skip to main content

Advertisement

SpringerLink
Log in

Risk factors for local tumor progression after RFA of pulmonary metastases: a matched case-control study

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Curative treatment of oligometastatic pulmonary disease aims at eradication of all metastases. Radiofrequency ablation (RFA) has been shown to be an efficient method and the frequency of local tumor progression (LTP) should be minimized. The objective of this study was to determine the morphological and treatment-related risk factors for LTP after RFA of pulmonary metastases.

Materials and methods

All patients treated with RFA for pulmonary metastases from 2002 to 2014 were reviewed. All LTPs from 2011 to 2014 were individually matched on the basis of tumor size, number, and histology. In total, 48 LTPs and 112 controls were blindly analyzed for morphological factors including vicinity of bronchus and vessels as well as treatment-related factors such as the size of the ablation zone and ablation margins.

Results

In the simple regression analysis, the significant predictive variables were ≤ 5-mm distance to a large bronchus (OR = 4.94; p = 0.0095) or large vessel (OR = 7.09; p < 0.001), minimal ablation margin (≤ 5 mm (OR = 42.67; p < 0.001), and a central-peripheral ablation offset/ablation zone size > 0.36 (OR = 13.83; p = 0.013). In the multiple regression model, only a minimal ablation margin ≤ 5 mm remained a significant risk factor for LTP.

Conclusion

Only the minimal ablation margin remains significant in the multiple regression analysis; the other factors are presumably surrogates of an insufficient ablation margin. Improvement of lung RFA outcomes can probably be obtained by immediate post RFA evaluation of ablation margins to ensure a minimal ablation margin of at least 5 mm.

Key Points

• A distance < 5 mm to a bronchus or vessel of over 3 mm diameter is associated with insufficient ablation margin and thus risk factors for local tumor progression after pulmonary radiofrequency ablation.

• A minimal ablation margin of > 5 mm after pulmonary RFA is associated with significantly less local tumor progression and should be looked for at the end of treatment session before needle removal in order to decrease local tumor progression.

• Tumor location, pleural contact, occurrence of intra-alveolar hemorrhage, pulmonary atelectasis, and pneumothorax are not associated with an increased risk of local tumor progression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

CT:

Computed tomography

LTP:

Local tumor progression

MPR:

Multiplanar reconstruction

PACS:

Picture Archiving and Communications System

RFA:

Radiofrequency ablation

References

  1. Casiraghi M, De Pas T, Maisonneuve P et al (2011) A 10-year single-center experience on 708 lung metastasectomies: the evidence of the “international registry of lung metastases”. J Thorac Oncol 6(8):1373–1378

    Article  Google Scholar 

  2. Niibe Y, Hayakawa K (2010) Oligometastases and oligo-recurrence: the new era of cancer therapy. Jpn J Clin Oncol 40(2):107–111

    Article  Google Scholar 

  3. McGahan JP, Browning PD, Brock JM et al (1990) Hepatic ablation using radiofrequency electrocautery. Invest Radiol 25(3):267–270

    Article  CAS  Google Scholar 

  4. de Baère T, Palussière J, Aupérin A et al (2006) Midterm local efficacy and survival after radiofrequency ablation of lung tumors with minimum follow-up of 1 year: prospective evaluation. Radiology. 240(2):587–596

    Article  Google Scholar 

  5. Yin X, Cui L, Li F et al (2015) Radiofrequency ablation versus partial nephrectomy in treating small renal tumors: a systematic review and meta-analysis. Medicine (Baltimore) 94(50):e2255

    Article  Google Scholar 

  6. Abboud S, Kosmas C, Novak R et al (2016) Long-term clinical outcomes of dual-cycle radiofrequency ablation technique for treatment of osteoid osteoma. Skeletal Radiol 45(5):599–606

    Article  Google Scholar 

  7. de Baère T, Aupérin A, Deschamps F et al (2015) Radiofrequency ablation is a valid treatment option for lung metastases: experience in 566 patients with 1037 metastases. Ann Oncol 26(5):987–991

    Article  Google Scholar 

  8. Gonzalez M, Poncet A, Combescure C et al (2013) Risk factors for survival after lung metastasectomy in colorectal cancer patients: a systematic review and meta-analysis. Ann Surg Oncol 20(2):572–579

    Article  Google Scholar 

  9. Gadaleta C, Mattioli V, Colucci G et al (2004) Radiofrequency ablation of 40 lung neoplasms: preliminary results. AJR Am J Roentgenol 183(2):361–368

    Article  Google Scholar 

  10. Pastorino U, Buyse M, Friedel G et al (1997) Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 113(1):37–49

    Article  CAS  Google Scholar 

  11. Hatime M, Elmorabit B, Elkhoti Y et al (2012) Oligometastatic disease, a new concept: stereotactic irradiation for lung metastases. Literature review. Cancer Radiother 16(5-6):351–357

    Article  CAS  Google Scholar 

  12. Iida T, Nomori H, Shiba M et al (2013) Prognostic factors after pulmonary metastasectomy for colorectal cancer and rationale for determining surgical indications: a retrospective analysis. Ann Surg 257(6):1059–1064

    Article  Google Scholar 

  13. Chua TC, Sarkar A, Saxena A et al (2010) Long-term outcome of image-guided percutaneous radiofrequency ablation of lung metastases: an open-labeled prospective trial of 148 patients. Ann Oncol 21(10):2017–2022

    Article  CAS  Google Scholar 

  14. Gillams A, Khan Z, Osborn P et al (2013) Survival after radiofrequency ablation in 122 patients with inoperable colorectal lung metastases. Cardiovasc Intervent Radiol 36(3):724–730

    Article  Google Scholar 

  15. Hamada A, Yamakado K, Nakatsuka A et al (2012) Radiofrequency ablation for colorectal liver metastases: prognostic factors in non-surgical candidates. Jpn J Radiol 30(7):567–574

    Article  Google Scholar 

  16. Yamamoto A, Nakamura K, Matsuoka T et al (2005) Radiofrequency ablation in a porcine lung model: correlation between CT and histopathologic findings. AJR Am J Roentgenol 185(5):1299–1306

    Article  Google Scholar 

  17. Cheang S, Abtin F, Guteirrez A, Genshaft S, Suh R (2013) Imaging features following thermal ablation of lung malignancies. Semin Interv Radiol 30(2):157–168

    Article  Google Scholar 

  18. Okuma T, Matsuoka T, Yamamoto A et al (2010) Determinants of local progression after computed tomography-guided percutaneous radiofrequency ablation for unresectable lung tumors: 9-year experience in a single institution. Cardiovasc Intervent Radiol 33(4):787–793

    Article  Google Scholar 

  19. Yamagami T, Kato T, Hirota T et al (2007) Risk factors for occurrence of local tumor progression after percutaneous radiofrequency ablation for lung neoplasms. Diagn Interv Radiol 13(4):199–203

    PubMed  Google Scholar 

  20. Hiraki T, Sakurai J, Tsuda T et al (2006) Risk factors for local progression after percutaneous radiofrequency ablation of lung tumors: evaluation based on a preliminary review of 342 tumors. Cancer. 107(12):2873–2880

    Article  Google Scholar 

  21. Gillams AR, Lees WR (2008) Radiofrequency ablation of lung metastases: factors influencing success. Eur Radiol 18(4):672–677

    Article  Google Scholar 

  22. Laimer G, Schullian P, Jaschke N et al (2020) Minimal ablative margin (MAM) assessment with image fusion: an independent predictor for local tumor progression in hepatocellular carcinoma after stereotactic radiofrequency ablation. Eur Radiol 30(5):2463–2472

    Article  Google Scholar 

  23. Wang X, Sofocleous CT, Erinjeri JP et al (2013) Margin size is an independent predictor of local tumor progression after ablation of colon cancer liver metastases. Cardiovasc Intervent Radiol 36(1):166–175

    Article  CAS  Google Scholar 

  24. Hiraki T, Gobara H, Mimura H et al (2010) Does tumor type affect local control by radiofrequency ablation in the lungs? Eur J Radiol 74(1):136–141

    Article  Google Scholar 

  25. Zorbas G, Samaras T (2015) A study of the sink effect by blood vessels in radiofrequency ablation. Comput Biol Med 57:182–186

    Article  Google Scholar 

  26. Kurilova I, Gonzalez-Aguirre A, Beets-Tan RG et al (2018) Microwave ablation in the management of colorectal cancer pulmonary metastases. Cardiovasc Intervent Radiol 41(10):1530–1544

    Article  CAS  Google Scholar 

  27. Callstrom MR, Woodrum DA, Nichols FC et al (2020) Multicenter Study of Metastatic Lung Tumors Targeted by Interventional Cryoablation Evaluation (SOLSTICE). J Thorac Oncol 15(7):1200–1209

    Article  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland

    Arash Najafi

  2. Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France

    Arash Najafi, Thierry de Baere, Edouard Purenne, Amine Bayar, Marc Al Ahmar, Alexandre Delpla, Charles Roux, Khaled Madani, Jessica Assouline, Frederic Deschamps & Lambros Tselikas

Authors
  1. Arash Najafi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thierry de Baere
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Edouard Purenne
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amine Bayar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marc Al Ahmar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexandre Delpla
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Charles Roux
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Khaled Madani
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jessica Assouline
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Frederic Deschamps
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Lambros Tselikas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arash Najafi.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Thierry de Baere.

Conflict of interest

The authors declare no conflict of interest.

Statistics and biometry

One of the authors (Amine Bayar) is a statistician.

Informed consent

Written informed consent was obtained from every patient.

Ethical approval

The study was approved by our institutional review board and ethical approval was waived according to institute standards regarding retrospective patient chart reviews.

Study subjects or cohorts overlap

Most of the patients in the control group were reported in a previous study regarding general efficacy of RFA without assessment of factors influencing local tumor progression, as outlined in the manuscript.

Methodology

• retrospective

• matched cases and controls

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Najafi, A., de Baere, T., Purenne, E. et al. Risk factors for local tumor progression after RFA of pulmonary metastases: a matched case-control study. Eur Radiol 31, 5361–5369 (2021). https://doi.org/10.1007/s00330-020-07675-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-020-07675-y

Keywords

Search

Navigation