Long-Term Outcomes in Percutaneous Radiofrequency Ablation for Histologically Proven Colorectal Lung Metastasis

Jim Zhong,Bobby Bhartia,James Lenton,Tze Min Wah,Nilanjan Chaudhuri,Richard Milton,Ebrahim Palkhi,Jonathan Smith,Kevin Wang,Helen Ng

doi:10.1007/s00270-020-02623-1

Abstract

IntroductionTo evaluate the long-term outcome of image-guided radiofrequency ablation (RFA) when treating histologically confirmed colorectal lung metastasis in terms of overall survival (OS), progression-free survival (PFS) and local tumour control (LTC).Materials and MethodsRetrospective single-centre study. Consecutive RFA treatments of histologically proven lung colorectal metastases between 01/01/2008 and 31/12/14. The primary outcome was patient survival (OS and PFS). Secondary outcomes were local tumour progression (LTP) and complications. Prognostic factors associated with OS/ PFS were determined by univariate and multivariate analyses.ResultsSixty patients (39 males: 21 females; median age 69 years) and 125 colorectal lung metastases were treated. Eighty percent (n = 48) also underwent lung surgery for lung metastases. Mean metastasis size (cm) was 1.4 ± 0.6 (range 0.3–4.0). Median number of RFA sessions was 1 (1–4). During follow-up (median 45.5 months), 45 patients died (75%). The estimated OS and PFS survival rates at 1, 3, 5, 7, 9 years were 96.7%, 74.7%, 44.1%, 27.5%, 16.3% (median OS, 52 months) and 66.7%, 31.2%, 25.9%, 21.2% and 5.9% (median PFS, 19 months). The LTC rate was 90% with 6 patients developing LTP with 1-, 2-, 3- and 4-year LTP rates of 3.3%, 8.3%, 10.0% and 10.0%. Progression-free interval < 1 year (P = 0.002, HR = 0.375) and total number of pulmonary metastases (≥ 3) treated (P = 0.037, HR = 0.480) were independent negative prognostic factors. Thirty-day mortality rate was 0% with no intra-procedural deaths.ConclusionThe long-term OS and PFS following RFA for the treatment of histologically confirmed colorectal lung metastases demonstrate comparable oncological durability to surgery.

Highlights

To evaluate the long-term outcome of imageguided radiofrequency ablation (RFA) when treating histologically confirmed colorectal lung metastasis in terms of overall survival (OS), progression-free survival (PFS) and local tumour control (LTC)
RFA of lung metastases offers a minimally invasive, repeatable treatment, with better preservation of lung function treatment when compared to surgical resection [8]
The lung metastases treatment decisions were made by the local multidisciplinary team (MDT) which included thoracic surgery and interventional oncology

Summary

Introduction

To evaluate the long-term outcome of imageguided radiofrequency ablation (RFA) when treating histologically confirmed colorectal lung metastasis in terms of overall survival (OS), progression-free survival (PFS) and local tumour control (LTC). Localised resection of lung metastases is the widely recognised standard of care for patients with oligometastatic disease from colorectal cancer despite the lack of randomised control trial (RCT) data comparing treatment options [4]. Percutaneous image-guided thermal ablation with radiofrequency ablation (RFA) has been widely used in the last decade and is established as a potential alternative to surgical resection [5, 6]. It is the most suitable for patients with small (\ 2 cm) lung metastases and in those who may not be a surgical candidate due to their comorbidities [5, 7]. Long-term survival data on RFA remain limited when compared to the surgical literature, making it difficult to draw definitive conclusions on the long-term oncological durability of the treatment [10]

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