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Kurilova I, Bendet A, Petre EN, Boas FE, Kaye E, Gonen M, Covey A, Brody LA, Brown KT, Kemeny NE, Yarmohammadi H, Ziv E, D'Angelica MI, Kingham TP, Cercek A, Solomon SB, Beets-Tan RGH, Sofocleous CT. Factors Associated With Local Tumor Control and Complications After Thermal Ablation of Colorectal Cancer Liver Metastases: A 15-year Retrospective Cohort Study. Clin Colorectal Cancer 2020; 20:e82-e95. [PMID: 33246789 DOI: 10.1016/j.clcc.2020.09.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/03/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The purpose of this study was to identify risk factors associated with local tumor progression-free survival (LTPFS) and complications after colorectal liver metastases (CLM) thermal ablation (TA). PATIENTS AND METHODS This retrospective analysis included 286 patients with 415 CLM undergoing TA (radiofrequency and microwave ablation) in 378 procedures from January 2003 to July 2017. Prior hepatic artery infusion (HAI), bevacizumab, pre-existing biliary dilatation, ablation modality, minimal ablation margin (MM), prior hepatectomy, CLM number, and size were analyzed as factors influencing complications and LTPFS. Statistical analysis included the Kaplan-Meier method, Cox proportional hazards model, competing risk analysis, univariate/multivariate logistic/exact logistic regressions, and the Fisher exact test. Complications were reported according to modified Society of Interventional Radiology guidelines. RESULTS The median follow-up was 31 months. There was no LTP for MM > 10 mm. Smaller tumor size, increased MM, and prior hepatectomy correlated with longer LTPFS. The major complications occurred following 28 (7%) of 378 procedures. There were no biliary complications in HAI-naive patients, versus 11% in HAI patients (P < .001), of which 7% were major. Biliary complications predictors in HAI patients included biliary dilatation, bevacizumab, and MM > 10 mm. In HAI patients, ablation with 6 to 10 mm and > 10 mm MM resulted in major biliary complication rates of 4% and 21% (P = .0011), with corresponding LTP rates of 24% and 0% (P = .0033). In HAI-naive patients, the LTP rates for 6 to 10 mm and > 10 mm MM were 27% and 0%, respectively. CONCLUSIONS No LTP was seen for MM > 10 mm. Biliary complications occurred only in HAI patients, especially in those with biliary dilatation, bevacizumab, and MM > 10 mm. In HAI patients, MM of 6 to 10 mm resulted in 76% local tumor control and 4% major biliary complications incidence.
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Affiliation(s)
- Ieva Kurilova
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Achiude Bendet
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elena N Petre
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Franz E Boas
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elena Kaye
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anne Covey
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lynn A Brody
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Karen T Brown
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy E Kemeny
- Department of Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hooman Yarmohammadi
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Etay Ziv
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael I D'Angelica
- Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T Peter Kingham
- Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Cercek
- Department of Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Steven B Solomon
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Constantinos T Sofocleous
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY.
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Shady W, Petre EN, Do KG, Gonen M, Yarmohammadi H, Brown KT, Kemeny NE, D'Angelica M, Kingham PT, Solomon SB, Sofocleous CT. Percutaneous Microwave versus Radiofrequency Ablation of Colorectal Liver Metastases: Ablation with Clear Margins (A0) Provides the Best Local Tumor Control. J Vasc Interv Radiol 2017; 29:268-275.e1. [PMID: 29203394 DOI: 10.1016/j.jvir.2017.08.021] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 08/26/2017] [Accepted: 08/29/2017] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To identify and compare predictors of local tumor progression (LTP)-free survival (LTPFS) after radiofrequency (RF) ablation and microwave (MW) ablation of colorectal liver metastases (CLMs). MATERIALS AND METHODS This is a retrospective review of CLMs ablated from November 2009 to April 2015 (110 patients). Margins were measured on contrast-enhanced computed tomography (CT) 6 weeks after ablation. Clinical and technical predictors of LTPFS were assessed using a competing risk model adjusted for clustering. RESULTS Technique effectiveness (complete ablation) was 93% (79/85) for RF ablation and 97% (58/60) for MW ablation (P = .47). The median follow-up period was significantly longer for RF ablation than for MW ablation (56 months vs. 29 months) (P < .001). There was no difference in the local tumor progression (LTP) rates between RF ablation and MW ablation (P = 0.84). Significant predictors of shorter LTPFS for RF ablation on univariate analysis were ablation margins 5 mm or smaller (P < .001) (hazard ratio [HR]: 14.6; 95% confidence interval [CI]: 5.2-40.9) and perivascular tumors (P = .021) (HR: 2.2; 95% CI: 1.1-4.3); both retained significance on multivariate analysis. Significant predictors of shorter LTPFS on univariate analysis for MW ablation were ablation margins 5 mm or smaller (P < .001) (subhazard ratio: 11.6; 95% CI: 3.1-42.7) and no history of prior liver resection (P < .013) (HR: 3.2; 95%: 1.3-7.8); both retained significance on multivariate analysis. There was no LTP for tumors ablated with margins over 10 mm (median LTPFS: not reached). Perivascular tumors were not predictive for MW ablation (P = .43). CONCLUSIONS Regardless of the thermal ablation modality used, margins larger than 5 mm are critical for local tumor control, with no LTP noted for margins over 10 mm. Unlike RF ablation, the efficiency of MW ablation was not affected for perivascular tumors.
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Affiliation(s)
- Waleed Shady
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065
| | - Elena N Petre
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065
| | - Kinh Gian Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065
| | - Hooman Yarmohammadi
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065
| | - Karen T Brown
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065
| | - Nancy E Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065
| | - Michael D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065
| | - Peter T Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065
| | - Stephen B Solomon
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065
| | - Constantinos T Sofocleous
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
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Shady W, Petre EN, Gonen M, Erinjeri JP, Brown KT, Covey AM, Alago W, Durack JC, Maybody M, Brody LA, Siegelbaum RH, D’Angelica MI, Jarnagin WR, Solomon SB, Kemeny NE, Sofocleous CT. Percutaneous Radiofrequency Ablation of Colorectal Cancer Liver Metastases: Factors Affecting Outcomes--A 10-year Experience at a Single Center. Radiology 2016; 278:601-11. [PMID: 26267832 PMCID: PMC4734163 DOI: 10.1148/radiol.2015142489] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To identify predictors of oncologic outcomes after percutaneous radiofrequency ablation (RFA) of colorectal cancer liver metastases (CLMs) and to describe and evaluate a modified clinical risk score (CRS) adapted for ablation as a patient stratification and prognostic tool. MATERIALS AND METHODS This study consisted of a HIPAA-compliant institutional review board-approved retrospective review of data in 162 patients with 233 CLMs treated with percutaneous RFA between December 2002 and December 2012. Contrast material-enhanced CT was used to assess technique effectiveness 4-8 weeks after RFA. Patients were followed up with contrast-enhanced CT every 2-4 months. Overall survival (OS) and local tumor progression-free survival (LTPFS) were calculated from the time of RFA by using the Kaplan-Meier method. Log-rank tests and Cox regression models were used for univariate and multivariate analysis to identify predictors of outcomes. RESULTS Technique effectiveness was 94% (218 of 233). Median LTPFS was 26 months. At univariate analysis, predictors of shorter LTPFS were tumor size greater than 3 cm (P < .001), ablation margin size of 5 mm or less (P < .001), high modified CRS (P = .009), male sex (P = .03), and no history of prior hepatectomy (P = .04) or hepatic arterial infusion chemotherapy (P = .01). At multivariate analysis, only tumor size greater than 3 cm (P = .01) and margin size of 5 mm or less (P < .001) were independent predictors of shorter LTPFS. Median and 5-year OS were 36 months and 31%. At univariate analysis, predictors of shorter OS were tumor size larger than 3 cm (P = .005), carcinoembryonic antigen level greater than 30 ng/mL (P = .003), high modified CRS (P = .02), and extrahepatic disease (EHD) (P < .001). At multivariate analysis, tumor size greater than 3 cm (P = .006) and more than one site of EHD (P < .001) were independent predictors of shorter OS. CONCLUSION Tumor size of less than 3 cm and ablation margins greater than 5 mm are essential for satisfactory local tumor control. Tumor size of more than 3 cm and the presence of more than one site of EHD are associated with shorter OS.
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Affiliation(s)
- Waleed Shady
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Elena N. Petre
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Mithat Gonen
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Joseph P. Erinjeri
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Karen T. Brown
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Anne M. Covey
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - William Alago
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Jeremy C. Durack
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Majid Maybody
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Lynn A. Brody
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Robert H. Siegelbaum
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Michael I. D’Angelica
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - William R. Jarnagin
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Stephen B. Solomon
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Nancy E. Kemeny
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Constantinos T. Sofocleous
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
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