|Survival After Radiofrequency Ablation of Colorectal Liver Metastases: 10 Year Experience|
|Allan E Siperstein, Eren Berber*, Naveen Ballem*, Rikesh T Parikh* |
Cleveland Clinic, Cleveland, OH
|OBJECTIVE(S): To assess factors affecting long term survival of patients undergoing radiofrequency ablation (RFA) of colorectal hepatic metastases; with attention to evolving chemotherapy regimens.|
METHODS: Prospective evaluation of 235 patients with colorectal metastases who were not candidates for resection and/or failed chemotherapy underwent laparoscopic RFA. Preoperative risk factors and pre/postoperative chemotherapy exposure were analyzed for survival benefit.
RESULTS: 234 patients underwent 292 RFA sessions from 1997-2006, an average of 8 months after initiation of chemotherapy. 23% had extrahepatic disease preoperatively. Patients averaged 2.8 lesions, with a dominant diameter of 3.9cm. Kaplan-Meier actuarial survival was 24 months, with actual 3yr & 5yr survival of 20.2% & 18.4% respectively. Median survival was improved for patients with ≤3 vs. > 3 lesions, (27 vs. 17 months, p=0.0018); dominant size <3 vs. >3cm, (28 vs. 20 months, p=0.07); CEA <200 vs. >200ng/ml, (26 vs. 16 months, p=0.003). Presence of extrahepatic disease(p=0.34) or type of pre/postoperative chemotherapy (5-FU-Leucovorin vs. FOLFOX/FOLFIRI vs. Bevacizumab)(p=0.11) did not alter median survival.
CONCLUSIONS: To our knowledge this is both the largest and longest follow up of RFA for colorectal metastases. The number and dominant size of metastases; and preoperative CEA value are strong predictors of survival. Despite classic teaching, extrahepatic disease did not adversely affect survival. In this group of patients who failed chemotherapy, newer treatment regimens (pre or postoperatively) had no survival benefit. The actual 5yr survival of 18.4% in these patients, versus near zero survival for chemotherapy alone, argues for a survival benefit of RFA.
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