European Radiology

, Volume 22, Issue 4, pp 930–937 | Cite as

Percutaneous stereotactic radiofrequency ablation of colorectal liver metastases

  • Reto Bale
  • Gerlig Widmann
  • Peter Schullian
  • Marion Haidu
  • Georg Pall
  • Alexander Klaus
  • Helmut Weiss
  • Matthias Biebl
  • Raimund Margreiter
Oncology
First Online:
Received:
Revised:
Accepted:

Abstract

Objectives

To evaluate the outcome of patients with colorectal liver metastasis (CRLM) treated with stereotactic radiofrequency ablation (SRFA).

Methods

Following IRB approval, a retrospective evaluation of 98 SRFA treatment sessions of 189 CRLMs in 63 consecutive patients was performed. Local recurrence rate (LR), overall survival (OS) and disease-free survival (DFS) were analysed.

Results

LR was identified in 16% of the tumours (31/189), with no significant differences (P = 0.635) when comparing tumour sizes <3 cm (17.7%), 3–5 cm (11.1%) and >5 cm (17.4%). The median OS from SRFA treatment was 33.2 months after a mean follow-up of 25 months (range 2–66); the corresponding 1-, 3- and 5- year survival rates were 87%, 44% and 27%. The median OS was significantly different when comparing unresectable and resectable patients (27 vs. 58 months, P = 0.002) with OS rates of 92%, 66% and 48% at 1, 3 and 5 years in resectable patients. Tumour size did not affect OS and DFS.

Conclusion

Due to the favourable outcome, SRFA challenges resection as first-line local treatment of patients with CRLM. As long as randomised studies are pending, we recommend entering an individual decision-making process with every patient.

Key Points

• Large colorectal liver metastases can be effectively treated by stereotactic radiofrequency ablation (SRFA).

• Using SRFA the overall survival is not affected by tumour size.

• SRFA achieves similar overall and disease-free survival rates as surgical resection.

• SRFA challenges surgical resection as the first-line treatment for colorectal liver metastases.

Keywords

Liver tumor Stereotaxy Outcome Navigation Ablation 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

The authors thank Michael Vogele, MD for the technical support and the radiation technicians Thomas Lang, Martin Knoflach, Christoph Hinterleithner, Julia Mahlknecht, Yvonne Schlesinger, Martin Fasser and Florian Schanda for their assistance.

References

  1. 1.
    Hurwitz H, Fehrenbacher L, Novotny W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 350:2335–2342PubMedCrossRefGoogle Scholar
  2. 2.
    Wagner JS, Adson MA, Van Heerden JA et al (1984) The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg 199:502–508PubMedCrossRefGoogle Scholar
  3. 3.
    Choti MA, Sitzmann JV, Tiburi MF et al (2002) Trends in longterm survival following liver resection for hepatic colorectal metastases. Ann Surg 235:759–766PubMedCrossRefGoogle Scholar
  4. 4.
    Kornprat P, Jarnagin WR, Gonen M et al (2007) Outcome after hepatectomy for multiple (four or more) colorectal metastases in the era of effective chemotherapy. Ann Surg Oncol 14:1151–1160PubMedCrossRefGoogle Scholar
  5. 5.
    Scheele J, Stangl R, Altendorf-Hofmann A (1990) Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg 77:1241–1246PubMedCrossRefGoogle Scholar
  6. 6.
    Nordlinger B, Peschaud F, Malafosse R (2003) Resection of liver metastases from colorectal cancer – how can we improve results? Colorectal Dis 5:515–517PubMedCrossRefGoogle Scholar
  7. 7.
    Van Cutsem E, Nordlinger B, Adam R et al (2006) Towards a pan-European consensus on the treatment of patients with colorectal liver metastases. Eur J Cancer 42:2212–2221PubMedCrossRefGoogle Scholar
  8. 8.
    Gillams AR, Lees WR (2004) Radio-frequency ablation of colorectal liver metastases in 167 patients. Eur Radiol 14:2261–2267PubMedCrossRefGoogle Scholar
  9. 9.
    Nicholl MB, Bilchik AJ (2008) Thermal ablation of hepatic malignancy: useful but still not optimal. Eur J Surg Oncol 34:318–323PubMedCrossRefGoogle Scholar
  10. 10.
    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 242:158–171PubMedCrossRefGoogle Scholar
  11. 11.
    Widmann G, Haidu M, Schullian P, Stoffner R, Bale R (2011) Stereotactic Radiofrequency Ablation (SRFA) of liver lesions: technique effectiveness, safety, and inter-operator performance. Cardiovasc Interv Radiol. doi: 10.1007/s00270-011-0200-4
  12. 12.
    Laeseke PF, Sampson LA, Haemmerich D et al (2005) Multiple electrode radiofrequency ablation: simultaneous production of separate zones of coagulation in an in vivo porcine liver model. J Vasc Interv Radiol 16:1727–1735PubMedCrossRefGoogle Scholar
  13. 13.
    Lee JM, Han JK, Kim HC, Choi YH, Kim SH, Choi JY, Choi BI (2007) Switching monopolar radiofrequency ablation technique using multiple, internally cooled electrodes and a multichannel generator: ex vivo and in vivo pilot study. Invest Radiol 42:163–171PubMedCrossRefGoogle Scholar
  14. 14.
    Bale R, Widmann G, Stoffner DI (2010) Stereotaxy: breaking the limits of current radiofrequency ablation techniques. Eur J Radiol 75:32–36PubMedCrossRefGoogle Scholar
  15. 15.
    Bale R, Widmann G, Haidu M (2011) Stereotactic Radiofrequency Ablation- a technical note. Cardiovasc Interv Radiol 34:852–856CrossRefGoogle Scholar
  16. 16.
    Widmann G, Schullian P, Wiedermann FJ et al (2010) Respiratory motion control for computer-assisted and robotic liver interventions. Int J Med Robot 6:343–349PubMedCrossRefGoogle Scholar
  17. 17.
    Pawlik TM, Scoggins CR, Zorzi D et al (2005) Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg 241:715–722PubMedCrossRefGoogle Scholar
  18. 18.
    Abdalla EK, Vauthey JN, Ellis LM et al (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239:818–825PubMedCrossRefGoogle Scholar
  19. 19.
    De Baere T, Elias D, Dromain C et al (2000) Radiofrequency ablation of 100 hepatic metastases with a mean follow-up of more than 1 year. Am J Roentgenol 175:1619–1625Google Scholar
  20. 20.
    Solbiati L, Livraghi T, Goldberg SN et al (2001) Percutaneous radiofrequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. Radiology 221:159–166PubMedCrossRefGoogle Scholar
  21. 21.
    Sorensen SM, Mortensen FV, Nielsen DT (2007) Radiofrequency ablation of colorectal liver metastases: long-term survival. Acta Radiol 48:253–258PubMedCrossRefGoogle Scholar
  22. 22.
    Park IJ, Kim HC, Yu CS et al (2007) Radiofrequency ablation for metachronous liver metastasis from colorectal cancer after curative surgery. Ann Surg Oncol 15:227–232PubMedCrossRefGoogle Scholar
  23. 23.
    Reuter NP, Woodall CE, Scoggins CR et al (2009) Radiofrequency ablation vs. resection for hepatic colorectal metastasis: therapeutically equivalent? J Gastrointest Surg 13:486–491PubMedCrossRefGoogle Scholar
  24. 24.
    Scheele J, Stangl R, Altendorf-Hofmann A (1990) Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg 77:1241–1246PubMedCrossRefGoogle Scholar
  25. 25.
    DeMatteo RP, Palese C, Jarnagin WR et al (2000) Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases. J Gastrointest Surg 4:178–184PubMedCrossRefGoogle Scholar
  26. 26.
    Cady B, Jenkins RL, Steele GD Jr et al (1998) Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome. Ann Surg 227:566–571PubMedCrossRefGoogle Scholar
  27. 27.
    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 28:493–508PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2011

Authors and Affiliations

  • Reto Bale
    • 1
  • Gerlig Widmann
    • 1
  • Peter Schullian
    • 1
  • Marion Haidu
    • 1
  • Georg Pall
    • 2
  • Alexander Klaus
    • 3
  • Helmut Weiss
    • 3
  • Matthias Biebl
    • 3
  • Raimund Margreiter
    • 3
  1. 1.Department of Microinvasive Therapy (SIP)Medical University InnsbruckInnsbruckAustria
  2. 2.Department of Internal MedicineMedical University InnsbruckInnsbruckAustria
  3. 3.Department of SurgeryMedical University InnsbruckInnsbruckAustria

Personalised recommendations