Riccardo Antonio Lencioni MD, Presenter: Nothing to Disclose

To determine the long-term survival of patients with hepatic metastases from colorectal cancer who received percutaneous image-guided radiofrequency ablation (RFA).

From June 1, 1996 to January 1, 2004, 423 patients (234 males and 189 females; age range, 30-83 years; mean age, 66 years ± 10) with 1-4 hepatic colorectal metastases (overall number of lesions, 615) ranging 0.5-5 cm in diameter (mean, 2.7 cm ± 0.9) were treated with RFA at 12 centers. The centers were part of the tumor radiofrequency ablation Italian network (TRAIN) and adopted standardized diagnostic, staging, treatment, and follow-up protocols. All patients had metachronous lesions and were free from extrahepatic disease. Surgical option had been excluded or refused by the patient. RFA was performed under US or CT guidance by using 50- or 150-W generators and 14-G expandable multitined electrodes with 4-9 prongs (RITA Medical Systems, Mountain View, CA). Follow-up protocol included US and spiral CT examinations performed at 3 and 6-month intervals, respectively. The follow-up period ranged 1-78 months (mean, 19 months ± 15).

Complete tumor ablation was achieved in 373 (88.2%) of 423 patients after 503 treatment sessions. The primary effectiveness rate on a lesion-by-lesion basis was 85.4% (525 of 615 lesions). The overall survival by the Kaplan-Meier method was 85.6% at 1 year, 62.6% at 2 years, 46.8% at 3 years, 29.1% at 4 years, and 24.1% at 5 years. Median survival was 33 months. Survival was significantly longer in patients with single lesion ≤ 2.5 cm in diameter (55.7% at 5 years) than in patients with single lesion > 2.5 cm (13.1% at 5 years) or multiple lesions (11.3% at 5 years) (p = 0.0002, log-rank test). During the follow-up, recurrence of the treated tumor (i.e., local tumor progression) was observed in 132 (25.1%) of 525 lesions. The 1-, 2-, 3-, 4-, and 5-year local tumor progression rates in the patient-by-patient analysis were 21.5%, 31.1%, 32.0%, 34.1%, and 34.1%, respectively.

Long-term follow-up data show that RFA is an effective treatment for hepatic colorectal cancer metastases. Results is patients with small solitary lesions are equivalent to those reported for resection.

Lencioni, R, Tumor Radiofrequency Ablation Italian Network (TRAIN): Long-term Results in Epatic Colorectal Cancer Metastases.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4409096.html