Abstract
PurposeTo evaluate the efficacy and safety of percutaneous radiofrequency ablation (RFA) for subcapsular colorectal cancer liver metastases (CLMs).Materials and MethodsWith the approval of the Institutional Review Board, the clinical data of CLM patients who underwent percutaneous RFA for the first time from August 2010 to August 2020 were continuously collected. All CLMs were divided into subcapsular and non-capsular groups. Baseline characteristic data, technical effectiveness, minimal ablative margin, complications, local tumor progression (LTP), and overall survival (OS) between the two groups were analyzed using the t-test or chi-square test. A Cox regression model was used to evaluate the prognostic factors of LTP.ResultsOne hundred and ninety-nine patients (124 males; mean age, 60.2 years) with 402 CLMs (221 subcapsular; mean size, 16.0 mm) were enrolled in the study. Technical effectiveness was achieved in 93.5% (376/402) of CLMs, with a major complication rate of 5.5%. Compared with non-subcapsular tumors, the minimal ablative margin achieved in subcapsular CLM was smaller (χ2 = -8.047, P < 0.001). With a median follow-up time of 23 months (range, 3−96 months), 37.1% of the tumors had LTP. The estimated cumulative OS at 1, 3, and 5 years was 96.1%, 66.0%, and 44.2%, respectively. There were no statistically significant differences between the two groups in terms of technical effectiveness (χ2 = 0.484, P = 0.487), major complications (χ2 = 0.082, P = 0.775), local tumor progression-free survival (LTPFS) (χ2 = 0.881, P = 0.348), and OS (χ2 = 2.874, P = 0.090). Minimal ablative margin, tumor size (≥20 mm), and technical effectiveness were predictors of LTP (all P < 0.05).ConclusionRFA is a safe and effective technique for local tumor control of subcapsular CLMs.
Highlights
Colorectal cancer (CRC) is the third most common cause of cancer death in the United States [1], and more than 25% of patients develop liver metastases during the course of the disease [2]
Technical effectiveness was achieved in 93.5% (376/402) of cancer liver metastases (CLMs), with a major complication rate of 5.5%
Compared with non-subcapsular tumors, the minimal ablative margin achieved in subcapsular CLM was smaller (c2 = -8.047, P < 0.001)
Summary
Colorectal cancer (CRC) is the third most common cause of cancer death in the United States [1], and more than 25% of patients develop liver metastases during the course of the disease [2]. RFA, the most common percutaneous local thermal ablation technique, has not been completely suitable for the treatment of subcapsular tumors. This may be due to the limited treatment window and the tendency to be affected by structures, such as ribs and diaphragms, resulting in technical difficulties in electrode placement and an increased risk of major complications such as tumor seeding [5, 6], bleeding, and thermal damage to adjacent crucial structures (such as the liver dome, abdominal wall, gallbladder, and intestine) [7,8,9]. The location of the subcapsular tumor is still considered a relative contraindication for thermal ablation [7]
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