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Microwave Ablation in the Management of Colorectal Cancer Pulmonary Metastases

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Abstract

Purpose

To review outcomes following microwave ablation (MWA) of colorectal cancer pulmonary metastases and assess predictors of oncologic outcomes.

Methods

Technical success, primary and secondary technique efficacy rates were evaluated for 50 patients with 90 colorectal cancer pulmonary metastases at immediate, 4–8 weeks post-MWA and subsequent follow-up CT and/or 18F-FDG PET/CT. Local tumor progression (LTP) rate, LTP-free survival (LTPFS), cancer-specific and overall survivals were assessed. Complications were recorded according to SIR classification.

Results

Median follow-up was 25.6 months. Median tumor size was 1 cm (0.3–3.2 cm). Technical success, primary and secondary technique efficacy rates were 99, 90 and 92%, respectively. LTP rate was 10%. One-, 2- and 3-year LTPFS were: 93, 86 and 86%, respectively, with median LTPFS not reached. Median overall survival was 58.6 months, and median cancer-specific survival (CSS) was not reached. One-, 2- and 3-year overall and CSS were 94% and 98, 82 and 90%, 61 and 70%, respectively. On univariate analysis, minimal ablation margin (p < 0.001) and tumor size (p = 0.001) predicted LTPFS, with no LTP for minimal margin ≥ 5 mm and/or tumor size < 1 cm. Pleural-based metastases were associated with increased LTP risk (p = 0.002, SHR = 7.7). Pre-MWA CEA level > 10 ng/ml (p = 0.046) and ≥ 3 prior chemotherapy lines predicted decreased CSS (p = 0.02). There was no 90-day death. Major complications rate was 13%.

Conclusions

MWA with minimal ablation margin ≥ 5 mm is essential for local control of colorectal cancer pulmonary metastases. Pleural-based metastases and larger tumor size were associated with higher risk of LTP. CEA level and pre-MWA chemotherapy impacted CSS.

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Acknowledgements

The research funded by the Memorial Sloan Kettering Cancer Center Support Grant/Core Grant (P30 CA008748).

Author information

Author notes

  1. I. Kurilova and A. Gonzalez-Aguirre have contributed equally to this work.

Authors and Affiliations

  1. Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    I. Kurilova, A. Gonzalez-Aguirre, J. Erinjeri, E. N. Petre, S. B. Solomon & C. T. Sofocleous

  2. Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    I. Kurilova & R. G. Beets-Tan

  3. GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands

    I. Kurilova

  4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    M. Gonen

  5. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    M. Bains

  6. Department of Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    N. E. Kemeny

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  1. I. Kurilova
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  2. A. Gonzalez-Aguirre
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  5. E. N. Petre
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  6. M. Gonen
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  9. S. B. Solomon
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  10. C. T. Sofocleous
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Correspondence to C. T. Sofocleous.

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Conflict of interest

C.T. Sofocleous has received research support from BTG, Ethicon (Neuwave); HS Medical, Angiodynamics; Sota Medical; and is a consultant for Ethicon and GE. S.B. Solomon, shareholder of Johnson & Johnson, has received personal fees from Medtronics, Astra Zeneca, Johnson & Johnson and GE Heathcare. Other authors have no conflict of interest.

Ethical Approval

IRB waiver of approval was obtained for this retrospective cohort study. The database was HIPAA registered and compliant.

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Kurilova, I., Gonzalez-Aguirre, A., Beets-Tan, R.G. et al. Microwave Ablation in the Management of Colorectal Cancer Pulmonary Metastases. Cardiovasc Intervent Radiol 41, 1530–1544 (2018). https://doi.org/10.1007/s00270-018-2000-6

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  • DOI: https://doi.org/10.1007/s00270-018-2000-6

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