The impact of treatment intent on overall survival after radiofrequency ablation of colorectal cancer liver metastases: The Royal Marsden Hospital experience.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 622-622
Author(s):  
Khurum Hayat Khan ◽  
Anita Wale ◽  
James McCall ◽  
Nevin Wijesekera ◽  
Nasir Khan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Liver Metastases ◽  
Hepatic Resection ◽  
Survival Outcomes ◽  
Curative Intent ◽  
Palliative Intent ◽  
Palliative Procedure ◽  
Treatment Intent

622 Background: 50% of patients with colorectal cancer will develop liver metastases (CLM), for many patients this will be the first and only site of metastatic disease. A minority of the patients will undergo surgical resection with curative intent, the remainder may be offered treatment with chemotherapy and local ablative techniques. Radiofrequency ablation (RFA) is increasingly used to treat patients deemed unsuitable for surgery, as an adjunct to or holding procedure before hepatic resection or for patients with recurrent disease. In addition some centres use RFA in the palliative setting. The aim of this study was to determine survival outcomes according to RFA treatment intent in patients with CLM. Methods: Clinical characteristics and survival outcomes of all patients with CLM treated with RFA between 2005-2011 were recorded. Patients were grouped according to the intent with which they underwent their first RFA procedure, namely "curative intent", "holding intent" or "palliative intent". Overall survival was compared between the groups using Kaplan-Meier survival analysis and Log Rank testing. Results: A total of seventy eight pts with CLM (M:F= 44:34), age (median=66, range 43-65 years), who underwent their first RFA procedure between 2005 and 2011 were identified. Thirty pts underwent RFA as a curative procedure (38%), 18 (23%) as a “holding procedure” before hepatic resection and 30 (38%) as a palliative procedure. The median OS for all patients was 25 months after first RFA treatment. Log Rank test showed survival was significantly different according to treatment intent; patients who underwent RFA as a holding procedure before hepatic resection had improved survival over those who underwent RFA with curative intent, who in turn had improved survival over those who underwent RFA with palliative intent (47 vs. 32 vs. 16 months, p = <0.001). Conclusions: Our study demonstrates that patients do best if RFA is used as neo-adjuvant treatment prior to hepatic resection, compared to when it is used as curative or palliative procedure. Careful selection of pts is required to optimise outcomes for the pts receiving RFA.

Outcomes of isolated distant lymph node metastases in colorectal cancer.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 84-84
Author(s):  
Vinod Kalapurackal Mathai ◽  
Soe Yu Aung ◽  
Vanessa Wong ◽  
Catherine Dunn ◽  
Jeremy David Shapiro ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Locoregional Therapy ◽  
Curative Intent ◽  
Palliative Intent ◽  
Radical Treatment ◽  
Node Metastases ◽  
Systemic Therapies

84 Background: The optimal management of isolated distant lymph node metastases (IDLNM) in metastatic colorectal cancer (mCRC) is not clearly established. Small case series and prior data from the TRACC (Treatment of Recurrent and Advanced Colorectal Cancer) registry support the use of radical treatment with curative intent (local resection, chemo-radiation or stereotactic radiotherapy), which may lead to better outcomes in mCRC patients with IDLNM. Aims: This study investigates the clinical characteristics and outcomes of mCRC patients with IDLNM treated with systemic therapies plus locoregional therapy with curative intent versus systemic therapies with palliative intent. Methods: Clinical data were collected and reviewed from the TRACC registry, a prospective, comprehensive registry for mCRC from multiple tertiary hospitals across Australia from 01/07/2009 to 30/06/2020. Clinicopathological characteristics, treatment modalities and survival outcomes were analyzed in patients with IDLNM and compared to patients with other organ metastases. Fisher exact test was used for significance tests and Kaplan Meier curves for survival analyses. Results: Of 3408 mCRC patients with a median follow-up of 38.0 months, 93 (2.7%) were found to have IDLNM. Compared to mCRC with other organ metastases, patients with IDLNM were younger (mean age: 62.1 vs 65.6 years, p=0.0200), more likely to have metachronous disease (57.0% vs 38.9%, p=0.0005), be KRAS wild-type (74.6% vs 53.9%, p=0.0012) and BRAF mutant (12.9% vs 6.2%, p=0.0100). There was no overall survival difference between with IDLNM and those with other organ metastases (median OS 27.24 vs 25.92 months, p=0.2300). Twenty-four patients (25.8%) with IDLNM received treatment with curative intent, with a trend towards improved overall survival compared to those with other organ metastases treated with curative intent (73.5 vs 62.7 months, p=0.8200). Amongst mCRC patients with IDLNM, those who received treatment with curative intent had a significantly better overall survival than those treated with palliative intent (73.5months vs 23.2 months, p=0.0070). Conclusions: Our findings suggest that there are differences in the patterns of presentation of IDLNM and other organ metastases. Radical treatment with curative intent options should be considered for mCRC patients with IDLNM where appropriate.

Treatment of colorectal liver metastasis: Comparison of radiofrequency ablation and hepatic resection.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 637-637
Author(s):  
Min Yong Yoon ◽  
Hyung Ook Kim
Keyword(s):  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Liver Metastases ◽  
Hepatic Resection ◽  
Recurrence Rate ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Disease Stage ◽  
Resection Group ◽  
Serum Carcinoembryonic Antigen

637 Background: Hepatic resection is the mainstay of management for colorectal liver metastases. But, the treatment for colorectal liver metastases requires a multidisciplinary therapeutic strategy. The aim of this study was to compare recurrence and survival rates for patients treated with hepatic resection or radiofrequency ablation (RFA) for colorectal liver metastases. Methods: Between July 2002 and September 2010, 52 patients underwent hepatic resection and 58 underwent RFA for synchronous or metachronous colorectal liver metastases. A retrospective analysis was performed. Patients with extrahepatic metastases were excluded. Results: The two groups had similar mean age, comorbid medical conditions, primary disease stage, and number of tumors. Preoperative median serum carcinoembryonic antigen (CEA) level was significantly higher in the resection group (13.8 ng/mL vs. 3.1 ng/mL; p = 0.001). Median diameter of main tumors was significantly greater in resection group (4.1 cm vs. 2.0 cm; p = 0.002). Recurrence rate after treatment was 46.2% (24/52) in the resection group and 70.7% (41/58) in the RFA group. Marginal recurrence after resection or RFA was observed in 7.6% (4/52) and 46.6% (27/58), respectively (p = 0.003). Median recurrence free survival (28.0 vs. 12.0 months; p = 0.007) and median overall survival (43.0 vs. 26.0 months; p = 0.023) were significantly longer in the resection group. Conclusions: Hepatic resection is the treatment of choice for colorectal liver metastases. RFA for colorectal liver metastases was associated with higher marginal recurrence rate and shorter recurrence free and overall survival.

Use and impact of bevacizumab in patients undergoing liver resection for metastatic colorectal cancer in routine clinical practice.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 698-698
Author(s):  
Edmond Michael Kwan ◽  
Belinda Lee ◽  
Hui-Li Wong ◽  
Margaret Lee ◽  
Rachel Wong ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Liver Metastases ◽  
Metastatic Colorectal Cancer ◽  
Survival Outcomes ◽  
Perioperative Chemotherapy ◽  
Palliative Intent ◽  
Clinical Dilemma ◽  
The Impact ◽  
Proven Benefit

698 Background: In metastatic colorectal cancer (mCRC) patients with isolated liver metastases, surgical resection offers the greatest likelihood of cure. Whilst for mCRC patients treated with palliative intent the addition of bevacizumab to the chemotherapy backbone is of proven benefit, whether to use bevacizumab in the resectable or potentially resectable population is a clinical dilemma. Methods: Consecutive patients who underwent resection of liver metastases were identified from a prospective Australian mCRC registry that captures comprehensive data on patient and tumor characteristics (including resectability), treatment and outcome. The use of bevacizumab in this setting was examined and the impact on outcomes was explored. Results: From a total mCRC population of 1,700 patients, 543 patients with liver-only mCRC were identified, of which 217 patients (40%) underwent liver resection. Perioperative chemotherapy was administered to 185 patients (85.3%), with bevacizumab added to chemotherapy in 73 (39.5%) patients. There was a trend for bevacizumab treated patients to be younger (median age 60.4 vs 65.1 years, p = 0.07) and fitter (mean Charlson score 2.22 vs 2.64, p = 0.054). Patients that received bevacizumab with perioperative chemotherapy were considerably less likely to have disease regarded as resectable at diagnosis (39 of 73 (53.4%) vs 95 of 112 (84.8%), p =<.01). At 5 years, overall survival was similar for bevacizumab treated and non-treated patients (61.4% vs. 59.2%, HR 0.83, p=0.52). There were no deaths within 30 days of surgery in any patients. Conclusions: Despite limited evidence to support the use of bevacizumab in patients with resectable or potentially resectable liver-only mCRC, clinicians are not infrequently utilising this approach, particularly in younger and fitter patients and those not considered to have resectable disease at diagnosis. The addition of bevacizumab did not appear to impact survival outcomes. A multivariate analysis is underway to better define the impact of bevacizumab on survival outcomes.

Retrospective Review of Efficacy of Radiofrequency Ablation for Treatment of Colorectal Cancer Liver Metastases from a Canadian Perspective

2014 ◽  
Vol 65 (1) ◽  
pp. 77-85 ◽  
Author(s):  
Benjamin Y.M. Kwan ◽  
Ania Z. Kielar ◽  
Robert H. El-Maraghi ◽  
Lourdes M. Garcia
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Statistical Analysis ◽  
Radiofrequency Ablation ◽  
Local Recurrence ◽  
Liver Metastases ◽  
Recurrence Free Survival ◽  
Colorectal Cancer Liver Metastases ◽  
Free Survival ◽  
Canadian Perspective

Purpose A retrospective single-center review of ultrasound-guided radiofrequency ablation (RFA) treatment of colorectal cancer liver metastases was performed. This study reviews the primary and secondary technical effectiveness, overall survival of patients, recurrence-free survival, tumour-free survival, rates of local recurrence, and postprocedural RFA complications. Technical effectiveness and rates of complication with respect to tumour location and size were evaluated. Our results were compared with similar studies from Europe and North America. Methods A total of 63 patients (109 tumours) treated with RFA between February 2004 and December 2009 were reviewed. Average and median follow-up time was 19.4 and 16.5 months, respectively (range, 1–54 months). Data from patient charts, pathology, and Picture Archiving and Communication System was integrated into an Excel database. Statistical Analysis Software was used for statistical analysis. Results Primary and secondary technical effectiveness of percutaneous and intraoperative RFA were 90.8% and 92.7%, respectively. Average (SE) tumour-free survival was 14.4 ± 1.4 months (range, 1–43 months), and average (SE) recurrence-free survival was 33.5 ± 2.3 months (range, 2–50 months). Local recurrence was seen in 31.2% of treated tumours (range, 2–50 months) (34/109). Overall survival was 89.4% at 1 year, 70.0% at 2 years, and 38.1% at 3 years, with an average (SE) overall survival of 37.0 ± 2.8 months. There were 14 postprocedural complications. There was no statistically significant difference in technical effectiveness for small tumours (1–2 cm) vs intermediate ones (3–5 cm). There was no difference in technical effectiveness for peripheral vs parenchymal tumours. Conclusions This study demonstrated good-quality outcomes for RFA treatment of colorectal cancer liver metastases from a Canadian perspective and compared favorably with published studies.

scholarly journals Long-term cancer survivors treated with multiple courses of repeat radiation therapy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sebastian M. Christ ◽  
Maiwand Ahmadsei ◽  
Lotte Wilke ◽  
Anja Kühnis ◽  
Matea Pavic ◽  
...  
Keyword(s):  
Overall Survival ◽  
Median Overall Survival ◽  
Anatomical Site ◽  
Curative Intent ◽  
Palliative Intent ◽  
Number Of Patients ◽  
Treatment Intent ◽  
Long Term Survivors ◽  
Median Interval

Abstract Introduction and background Through recent advances in cancer care, the number of long-term survivors has continuously increased. As a result, repetitive use of local radiotherapy for curative or palliative indications might have increased as well. This analysis aims to describe patterns of care and outcome of patients treated with multiple courses of repeat radiotherapy. Materials and methods All patients treated with radiotherapy between 2011 and 2019 at our department of Radiation Oncology were included into this analysis. A course of radiotherapy was defined as all treatment sessions to one anatomical site under one medical indication. Demographics, cancer and treatment characteristics and overall survival of patients having undergone multiple radiotherapy courses (minimum n = 5) were evaluated. Results The proportion of cancer patients treated with a minimum five courses of radiotherapy increased continuously from 0.9% in 2011 to 6.5% in 2019. In the 112 patients treated with a minimum of five radiotherapy courses, the primary tumor was lung in 41.9% (n = 47), malignant melanoma in 8.9% (n = 10) and breast in 8.0% (n = 9) of cases. A median interval of 3 years (maximum 8 years) elapsed between the first and the last radiotherapy course. The maximum number of courses in a single patient were n = 10. Treatment intent was curative or palliative in 46.4% and 53.6% for the first radiotherapy, respectively. The proportion of curative intent decreased to 11.6% at the 5th, and the last radiotherapy course was following a palliative intent in all patients. Five-year overall survival measured from the 1st radiotherapy course was 32.7%. Median overall survival was 3.3, 2.4, 1.3, and 0.6 years when measured from the 1st, the 1st palliative, the 5th and last course of radiotherapy, respectively. Discussion and conclusion A continuously increasing number of patients is treated with multiple courses of radiotherapy throughout their long-term cancer survivorship.

scholarly journals Aggressive local treatment for recurrent intrahepatic cholangiocarcinoma—Stereotactic radiofrequency ablation as a valuable addition to hepatic resection

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261136
Author(s):  
Eva Braunwarth ◽  
Peter Schullian ◽  
Moritz Kummann ◽  
Simon Reider ◽  
Daniel Putzer ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiofrequency Ablation ◽  
Treatment Group ◽  
Clinical Outcome ◽  
Hepatic Resection ◽  
Palliative Treatment ◽  
Local Treatment ◽  
Cholangiocellular Carcinoma ◽  
Curative Intent ◽  
Intrahepatic Cholangiocellular Carcinoma

Background To evaluate the efficacy, safety and overall clinical outcome of local treatment for recurrent intrahepatic cholangiocellular carcinoma after hepatic resection. Methods Between 2007 and 2019 72 consecutive patients underwent hepatic resection for primary intrahepatic cholangiocellular carcinoma. If amenable, recurrent tumors were aggressively treated by HR or stereotactic radiofrequency ablation with local curative intent. Endpoints consisted of morbidity and mortality, locoregional and de novo recurrence, disease free survival, and overall survival. Results After a median follow-up of 28 months, recurrence of intrahepatic cholangiocellular carcinoma was observed in 43 of 72 patients undergoing hepatic resection (60.3%). 16 patients were subsequently treated by hepatic resection (n = 5) and stereotactic radiofrequency ablation (n = 11) with local curative intention. The remaining 27 patients underwent palliative treatment for first recurrence. Overall survival of patients who underwent repeated aggressive liver-directed therapy was comparable to patients without recurrence (p = 0.938) and was better as compared to patients receiving palliative treatment (p = 0.018). The 5-year overall survival rates for patients without recurrence, the repeated liver-directed treatment group and the palliative treatment group were 54.3%, 47.7% and 12.3%, respectively. By adding stereotactic radiofrequency ablation as an alternative treatment option, the rate of curative re-treatment increased from 11.9% to 37.2%. Conclusion Repeated hepatic resection is often precluded due to patient morbidity or anatomical and functional limitations. Due to the application of stereotactic radiofrequency ablation in case of recurrent intrahepatic cholangiocellular carcinoma, the number of patients treated with curative intent can be increased. This leads to favorable clinical outcome as compared to palliative treatment of intrahepatic cholangiocellular carcinoma recurrence.

Radiofrequency ablation of liver metastases from colorectal cancer

2007 ◽  
Vol 28 (S 1) ◽  
Author(s):  
J Genov ◽  
N Grigorov ◽  
R Mitova ◽  
B Golemanov ◽  
L Dinkov ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Radiofrequency Ablation ◽  
Liver Metastases
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