A Retrospective Study Of Clinical Efficacy Of Radiofrequency Ablation In59Cases With Colorectal Liver Metastases

Purpose:The aim of this study was to achieve rates and patterns of disease progression following radiofrequency ablation, and study the predictors of PFS, OS in patients with colorectal liver metastases (CRLM). And to evaluate the role of radiofrequency ablation as an adjunct to surgery and chemotherapy in the treatment of colorectal liver metastases by revising clinical articles and reviews.Methods:Between March2003and August2013, fifty nine patients with colorectal liver metastases who were not candidates for resection underwent radiofrequency ablation (RFA). The mean number of liver metastases ablated was1.98±1.18(Range1to7), and total number was117, and the median size of the largest tumor was2cm (range from0.98to6.50cm). The mean follow-up time after RFA treatment was22.9months (range4.2to75.0).Results:No RFA-related mortality occurred. Local recurrence rates reached18.6%overall and22.0%for distant metastases rates. The median Kaplan-Meier OS for all patients was43.3months after the diagnosis of CRLM, and median PFS was4.8months after RFA treatment. The presence of extrahepatic disease exerted negative effect on PFS (2.5vs5.2months, P=0.02). Patients with ablated lesions less than3had improved PFS compared with those more than3(5.8vs3.0months; P=0.01). Survival approached significance for patients without prior hepatectomy (5.3vs3.5months, P=0.02). Patients with distant metastases as recurrence had advantages over those with both intra-and extra-hepatic recurrence (61.8vs19.6months, P=0.02). Patients with the dominant lesion less than3cm in diameter had a median PFS of5.6vs3.0months for lesions3to5cm (P=0.03), and also had a median OS of54.3vs21.9months(P=0.00). And patients with metachronous hepatic metastases had an improved OS of60.0vs29.8months for those with synchronous metastases (P=0.01). The previous hepatectomy, number of ablated lesions and the presence of extrahepatic diseases were found to be significant predictors of PFS by Cox proportional hazards model, while the type of liver metastases and size of the greatest ablated lesion were prognostic factors towards OS.Conclusion:RFA can be used as an important adjunct to chemotherapy, can bring patients shorter hospital staying, lower medical cost and less complications. Combined with repeated liver PRFA, liver resection, lung or other sites radiofrequency ablation, patients can have significantly improved overall survival. Within a multidisplinary tumorboard, RFA can extend the limits of treatment modalities in unresectable metastatic colorectal cancer, and promise survival advantages in highly selective patients when compared to chemotherapy.