Abstract
Purpose
The study aim was to compare the disease control in two groups of patients affected by liver metastases from CRC treated with microwave ablation (MWA) or stereotactic body radiation therapy (SBRT).
Methods
We extracted data of patients treated between 2009 and 2016. Inclusion criteria were: (1) maximum diameter of the liver lesions less than 4 cm; (2) no more than three liver lesions; (3) no evidence of progressive or untreated gross disease outside the liver; (4) adequate liver function; (5) no concurrent chemotherapy; (6) minimum age of 18. Tumour response was classified according to EORTC-RECIST criteria. Aim of the present study was to evaluate freedom from local progression (FFLP). To reduce indication bias, an inverse probability of treatment weighting was used to estimate treatment effect.
Results
A total of 135 patients with 214 lesions were included in the analysis. Median follow-up time was 24.5 months (range 2.4–95.8). The 1-year freedom from local progression (FFLP) was 88% (95%CI 80–92). In the SBRT group, FFLP was statistically longer than MWA group (p = 0.0214); the 1-year FFLP was 91% (95% CI 81–95) in SBRT group and 84% (95% CI 0.72–0.91) in MWA group. Patients treated with SBRT showed a reduce risk of local relapse compared to MWA (adjusted HR 0.31; 95%CI 0.13–0.70, p = 0.005). As expected, analogous result obtained in the inverse probability weighting analysis (HR 0.38; 95%CI 0.18–0.80; p = 0.011).
Conclusion
In conclusion, there seems to be an advantage of SBRT compared to MWA in treating CRC liver metastases, particularly for lesions bigger than 30 mm
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References
Analysis AM (2014) Microwave ablation for hepatic malignancies. Ann Surg 259:1195–1200. https://doi.org/10.1097/SLA.0000000000000234
Ary-pancreas HB, Gillams AR (2009) Five-year survival in 309 patients with colorectal liver metastases treated with radiofrequency ablation. Eur Radiol 19:1206–1213. https://doi.org/10.1007/s00330-008-1258-5
Bae SH, Kim MS, Cho CK et al (2012) High dose stereotactic body radiotherapy using three fractions for colorectal oligometastases. J Surg Oncol 106:138–143. https://doi.org/10.1002/jso.23058
Chang DT, Swaminath A, Kozak M et al (2011) Stereotactic body radiotherapy for colorectal liver metastases. Cancer 117:4060–4069. https://doi.org/10.1002/cncr.25997
Cirocchi R, Trastulli S, Boselli C et al (2012) {R}adiofrequency ablation in the treatment of liver metastases from colorectal cancer. Cochrane Database Syst Rev 6:CD006317. https://doi.org/10.1002/14651858.CD006317.pub3
Comito T, Cozzi L, Clerici E et al (2014) Stereotactic Ablative Radiotherapy (SABR) in inoperable oligometastatic disease from colorectal cancer: a safe and effective approach. BMC Cancer 14:619. https://doi.org/10.1186/1471-2407-14-619
Correa-Gallego C, Fong Y, Gonen M et al (2014) A retrospective comparison of microwave ablation vs. radiofrequency ablation for colorectal cancer hepatic metastases. Ann Surg Oncol 21:4278–4283. https://doi.org/10.1245/s10434-014-3817-0
Eisenhauer E, Verweij J (2009) 11 New response evaluation criteria in solid tumors: RECIST GUIDELINE VERSION 1.1. Eur J Cancer Suppl 7:5. https://doi.org/10.1016/S1359-6349(09)70018-7
Franzese C, Cozzi L, Franceschini D et al (2016) Role of stereotactic body radiation therapy with volumetric-modulated arcs and high-intensity photon beams for the treatment of abdomino-pelvic lymph-node metastases. Cancer Invest. https://doi.org/10.1080/07357907.2016.1197235
Gillams A, Goldberg N, Ahmed M et al (2015) Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, the interventional oncology sans frontières meeting 2013. Eur Radiol 25:3438–3454. https://doi.org/10.1007/s00330-015-3779-z
Hoyer M, Roed H, Hansen AT et al (2006) Phase II study on stereotactic body radiotherapy of colorectal metastases. Acta Oncol 45:823–830
Hur H, Taek Ko Y, Soh Min B et al (2009) Clinical surgery-international comparative study of resection and radiofrequency ablation in the treatment of solitary colorectal liver metastases. Am J Surg 197:728–736. https://doi.org/10.1016/j.amjsurg.2008.04.013
Kim YS, Lee WJ, Rhim H, Lim HK, Choi DLJ (2010) The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (> 2 and < 5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. AJR Am J Roentgenol 195:758–765
Lee M, Kim J, Dinniwell R et al (2009) Phase I study of individualized stereotactic body radiotherapy of liver metastases. J Clin Oncol 27:1585–1591
Lee BC, Lee HG, Park IJ et al (2016) The role of radiofrequency ablation for treatment of metachronous isolated hepatic metastasis from colorectal cancer. Medicine (Baltimore) 95:e4999. https://doi.org/10.1097/MD.0000000000004999
Liu CH, Arellano RS, Uppot RN et al (2010) Radiofrequency ablation of hepatic tumours: effect of post-ablation margin on local tumour progression. Eur Radiol 20:877–885. https://doi.org/10.1007/s00330-009-1610-4
Mansournia MA, Altman DM (2016) Inverse probability weighting. BMJ 352:i189.
Mulier S, Ni Y, Jamart J et al (2005) Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 242:158–171. https://doi.org/10.1097/01.sla.0000171032.99149.fe
Rusthoven KE, Kavanagh BD, Cardenes H et al (2009) Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol 27:1572–1578. https://doi.org/10.1200/JCO.2008.19.6329
Scorsetti M, Comito T, Tozzi A et al (2015) Final results of a phase II trial for stereotactic body radiation therapy for patients with inoperable liver metastases from colorectal cancer. J Cancer Res Clin Oncol 141:543–553. https://doi.org/10.1007/s00432-014-1833-x
Shady W, Petre EN, Gonen M et al (2016) Percutaneous radiofrequency ablation of colorectal cancer liver metastases: factors affecting outcomes–A 10-year experience at a single center. Radiology 278:601–611. https://doi.org/10.1148/radiol.2015142489
Simon CJ, Dupuy DE, Mayo-Smith WW (2005) Microwave ablation: principles and applications. RadioGraphics 25:S69–S83. https://doi.org/10.1148/rg.25si055501
Solbiati L, Ahmed M, Cova L, Ierace T, Brioschi MGS (2012) Small liver colorectal metastases treated with percutaneous radiofrequency ablation: local response rate and long-term survival with up to 10-year follow-up. Radiology 265:958–968
Stewart BW, Kleihues P (2003) Eds. Colorectal cancer. World cancer report. IARC Press, Lyon, 163–166
Timmerman L, Papiez L, McGarry R, Likes L (2003) Extracranial stereotactic radioablation: results of a phase I study in medically inoperable stage I non-small cell. Chest 124(5):1946–1955
Van Tilborg AAJM, Meijerink MR, Sietses C et al (2011) Long-term results of radiofrequency ablation for unresectable colorectal liver metastases: a potentially curative intervention. Br J Radiol 84:556–565. https://doi.org/10.1259/bjr/78268814
van der Pool AE, Romero AM, Wunderink W et al (2010) Stereotactic body radiation therapy for colorectal liver metastases. Br J Surg 97:377–382
Wahl DR, Stenmark MH, Tao Y et al (2015) Outcomes after stereotactic body radiotherapy or radiofrequency ablation for hepatocellular carcinoma. J Clin Oncol. https://doi.org/10.1200/JCO.2015.61.4925
Wang X, Sofocleous CT, Erinjeri JP, Petre EN 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
Wong SL, Mangu PB, Choti MA et al (2010) American Society of Clinical Oncology 2009 clinical evidence review on radiofrequency ablation of hepatic metastases from colorectal cancer. J Clin Oncol 28:493–508. https://doi.org/10.1200/JCO.2009.23.4450
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Figure S1 Freedom from local progression for lesion smaller or equal to 30 mm and according to the treatment (weighted analysis) (TIFF 1941 KB)
432_2018_2692_MOESM2_ESM.tiff
Figure S2 Freedom from local progression for lesion bigger than 30 mm and according to the treatment (weighted analysis) (TIFF 1941 KB)
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Franzese, C., Comito, T., Clerici, E. et al. Liver metastases from colorectal cancer: propensity score-based comparison of stereotactic body radiation therapy vs. microwave ablation. J Cancer Res Clin Oncol 144, 1777–1783 (2018). https://doi.org/10.1007/s00432-018-2692-7
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DOI: https://doi.org/10.1007/s00432-018-2692-7