340 RADIOFREQUENCY ABLATION HAS COMPARABLE OVERALL SURVIVAL TO PHOTODYNAMIC THERAPY IN THE TREATMENT OF CHOLANGIOCARCINOMA AND AMPULLARY CARCINOMA

463 Background: Hepatocellular carcinoma (HCC) is an increasingly common and highly morbid malignancy worldwide, including the US. For early stage patients ablative strategies are important potentially curative treatment options. Stereotactic body radiotherapy (SBRT) has emerged as a promising non-surgical ablative therapy, although it is technically demanding and its comparison with radiofrequency ablation (RFA) remains confined to a single institution retrospective review. We queried the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to assess RFA and SBRT use in the US. Methods: We identified patients greater than 65 years old who were diagnosed from 2004-11 with stage I or II HCC and treated with RFA or SBRT. Survival analysis was conducted using Kaplan-Meier curves and log rank test. Factors associated with overall survival (OS) and early ( ≤ 90 day) hospital admission post-treatment were identified using propensity score (PS) adjusted multivariate analysis. Results: 825 patients were identified, 747 treated with RFA and 78 SBRT. 22 pts received both treatments and were excluded from this analysis. The mean Charlson comorbidity index was 1.0±1.1. Median age was 74, range 66-90. Patients who received RFA were more likely to live in the West and have liver decompensation. Patients who received SBRT were more likely to be white and treated in the Midwest. After using PS matching there were 78 in each cohort. In these patients, mean overall survival (OS) was 2.25 and 2.04 yrs for RFA and SBRT, p = 0.06. Younger age, lack of liver decompensation, treatment in the West, and liver transplantation were associated with longer OS, HR 0.96, p = 0.05; HR 0.37, p = 0.002; HR 0.57, p = 0.04; HR 0.18, p = 0.008, respectively. 90 day hospitalization rates did not differ between treatments; only liver decompensation was predictive of hospitalization, OR 3.33, p = 0.032. Conclusions: In a national cohort of early stage HCC patients, treatment with RFA vs SBRT resulted in no significant difference in OS. SBRT appears to be a comparable ablative strategy to RFA in this population. This highlights the need for a randomized trial comparing these two modalities.

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Evaluation of hepatectomy, radiofrequency ablation, and transarterial chemoembolization for the local treatment of liver metastases in gastric cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.200 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 200-200

Author(s):

Lin Chen ◽

Jiyang Li ◽

Jianxin Cui ◽

Hongqing Xi ◽

Aizhen Cai ◽

...

Keyword(s):

Overall Survival ◽

Radiofrequency Ablation ◽

Survival Rate ◽

Liver Metastases ◽

Transarterial Chemoembolization ◽

Local Treatment ◽

R0 Resection ◽

Curative Gastrectomy ◽

Group A ◽

Group B

200 Background: The optimal local treatment for liver metastases remains controversial. Except for hepatectomy, radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) are both effective and low risk treatment modality with more expanded indications in patients with liver metastases. Thus, the aim of this study is to evaluate the efficacy of different methods for the local treatment of GCLM. Methods: From January 2006 to December 2015, 97 consecutive patients were eligible and included in a prospective database. They all received multidisciplinary treatments based on curative gastrectomy and local treatments (hepatectomy, RFA and TACE) for liver metastases. The 97 patients enrolled in a cohort study were divided into two groups, Group A (37 patients, curative hepatectomy with or without other local treatments) and Group B (60 patients, palliative RFA and/or TACE).The primary endpoints were overall survival (OS) and 5-year survival rate. Results: Baseline characteristics in the two groups were comparable. Correlation analysis found that interval time of metachronous, neutrophil to lymphocyte ratio and body mass index were not significantly linear associated with survival, with ρ = 0.051, ρ = 0.014 and ρ = 0.056, respectively. The overall survival time between the two groups were 94.1 months and 57.2 months, with 1-year, 3-year and 5-year survival rate 83.3%, 50.0% and 30.6% in Group A, respectively; and 83.7%, 28.6% and 18.4% in Group B, respectively (P = 0.049). Furthermore, subgroup analyses proved that among these three local treatments, hepatectomy was the most effective method (P = 0.014), with significantly difference from RFA (P = 0.001). Nevertheless, combination with RFA and/or TACE did not improve patients’ benefits (P = 0.062). And TACE has a similar (P = 0.227) efficacy with RFA, but significantly less costs. Conclusions: Hepatectomy is the optimal local treatment for liver metastases when the surgical R0 resection was intended. And it is not necessary to combine with other local treatments. As palliative local treatment, TACE is an acceptable method with relatively high cost-effective.

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