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.

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.

Intrahepatic cholangiocellular carcinoma: stereotactic radiofrequency ablation vs. hepatic resection

2017 ◽  
Vol 55 (05) ◽  
pp. e28-e56
Author(s):  
E Braunwarth ◽  
P Schullian ◽  
M Haidu ◽  
F Primavesi ◽  
C Margreiter ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Hepatic Resection ◽  
Cholangiocellular Carcinoma ◽  
Intrahepatic Cholangiocellular Carcinoma

Survival analysis of PETCAM: A multicenter randomized controlled trial of PET/CT versus no PET/CT for patients with resectable liver colorectal adenocarcinoma metastases.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 390-390 ◽  
Author(s):  
Carol-anne Moulton ◽  
Mark Norman Levine ◽  
Calvin Law ◽  
Richard Hart ◽  
Leyo Ruo ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hepatic Resection ◽  
Health Care Cost ◽  
Controlled Trial ◽  
Strong Predictor ◽  
Multicenter Trial ◽  
Primary Objective ◽  
Curative Intent ◽  
Pet Ct ◽  
Multicenter Randomized Controlled Trial

390 Background: An increasing proportion of patients with liver CAM are undergoing hepatic resection with curative intent. Detection of occult metastastic disease is important in this setting, and PET/CT is used to identify patients with either inoperable, or limited resectable extrahepatic disease not identified with conventional imaging. We recently reported the results related to the primary objective of PETCAM, a randomized trial for patients with resectable liver CAM, where 7.6% had a change in management based on PET/CT (ASCO 2011). As a secondary objective, we examined whether patients undergoing PET/CT derived a survival benefit, as they may be considered to be better selected. Methods: PETCAM was a multicenter trial with 404 subjects randomized 2:1 to receive PET/CT or no PET/CT once they were assessed by a hepatobiliary surgeon to have resectable CAM. Subjects were followed over 4 years for overall survival (OS). As well as the intervention, we considered the SUV, Fong Score and other baseline factors as predictors for OS. Results: After a median 2.8 years of follow-up, 107 of the 404 (26%) study subjects had died. The 270 PET/CT subjects [and the 245 of these who underwent surgery] showed no statistically significant survival advantage over the 134 No PET/CT subjects [123 who underwent surgery] with a hazard ratio (HR) of 0.85, 95% confidence interval (CI): 0.57 to 1.3; p=0.41 [HR=0.81, 95% CI: 0.52 to 1.3; p=0.34]. Fong score was a strong predictor of OS for all patients (HR=1.4, 95% CI: 1.1 to 1.6), and for those who had surgery (HR=1.4, 95% CI, 1.1 to 1.7). In the PET/CT arm, SUV is strongly predictive of OS [HR per unit SUV increase =1.11, 95% CI: 1.05 to 1.18; p=0.0007. Conclusions: The addition of PET/CT had no effect on improving overall survival for patients who did or did not have hepatic resection for CAM. SUV is strongly predictive of survival for patients who had PET/CT, and Fong score is predictive of survival for all patients. The overall role of PET/CT in patients with resectable CAM appears limited and should be reevaluated in the current era of comparative effectiveness research and health care cost containment.

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

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.

Burden of metastatic hormone-sensitive prostate cancer to identify men more likely to benefit from early docetaxel.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 136-136 ◽  
Author(s):  
Gwenaelle Gravis ◽  
Jean-Marie Boher ◽  
Yu-Hui Chen ◽  
Glenn Liu ◽  
Karim Fizazi ◽  
...  
Keyword(s):  
Overall Survival ◽  
De Novo ◽  
Local Treatment ◽  
Local Therapy ◽  
High Volume ◽  
Curative Intent ◽  
Consistent Effect ◽  
Visceral Metastases ◽  
Definition Of

136 Background: Patients with a low burden of metastatic disease and who relapse after localized therapy with curative intent have a longer overall survival. It is unclear whether these patients benefit from early docetaxel (D). Methods: Patients in GETUG-AFU15 (N = 385, median follow-up 84 mo) and CHAARTED (N = 790, median follow up 54 mo) were randomized to ADT alone or ADT + D and outcomes described using the same definition of high volume (HV) and low volume (LV) disease. (HV: visceral metastases and/or 4 or more bone metastases with at least one outside the axis) and whether the patients had prior local therapy or not. Results: Table 1 details across both studies that de novo HV group treated with ADT alone has the shortest overall survival and D has a consistent effect in improving OS. In contrast, in both studies patients with LV disease had a much longer OS with no evidence that D improved OS. Conclusions: There was no apparent survival benefit in CHAARTED and GETUG-15 studies with D for LV whether patients had prior local treatment or not. Across both studies, early D had a consistent effect and improved OS in HV pts especially those with no prior local therapy. Partial Support and drug supply by Sanofi. Clinical trial information: NCT00104715, NCT00309985. [Table: see text]

scholarly journals A case of intrahepatic cholangiocellular carcinoma due to Thorotrast deposition, well-controlled by radiofrequency ablation therapy

Kanzo ◽  
2020 ◽  
Vol 61 (5) ◽  
pp. 262-269
Author(s):  
Nobuhito Taniki ◽  
Nobuhiro Nakamoto ◽  
Aya Yoshida ◽  
Po-Sung Chu ◽  
Akihiko Ikura ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Cholangiocellular Carcinoma ◽  
Ablation Therapy ◽  
Intrahepatic Cholangiocellular Carcinoma ◽  
Radiofrequency Ablation Therapy

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.

Sign in / Sign up

Export Citation Format

Share Document