Percutaneous radiofrequency ablation (RFA) of hepatic metastases in patients with metastatic breast cancer: An interim analysis

Abstract

613 Background: A subgroup of patients with metastatic breast cancer present hepatic metastasis without extrahepatic spread. Even with systemic therapy the survival outcome is very finite. Since in most of these cases surgical therapy is not considered minimally invasive therapies as radiofrequency ablation (RFA) are gaining an increasing importance. Methods: Between 1999 and 2003, 32 patients (median age 62 years, range 41 -76 years) with syn- (5/32) and metachronous (27/32) solitary liver metastases from breast cancer were treated by RFA (Starburst XL, RITA Medical Systems, Mountainview, CA USA) subsequently/parallel to chemo and/or hormonal therapy. All procedures were performed under CT-fluoroscopical guidance applying conscious sedation and local anaesthesia. Number of lesions, primary success rate, complications, total and disease free survival were recorded and analyzed. Follow-up (by clinical, laboratory, and imaging studies) was achieved over up to 44 months. Results: RFA was performed between 0 to 138 months (median 37 months) after diagnosis of the metastasis. In 32 patients, 73 metastases were treated by RFA successfully without any major adverse event. 13/32 (40 %) patients had a solitary metastasis, the rest had 2 to 5 metastases (8 had 2, 2 had 3, 5 had 4, and 4 had 5). The size of the metastases ranged from 3 to 85 mm with a median diameter of 20.3 mm. During follow-up of 1 to 44 months (median 17.2 months), 25 patients (79 %) remained desease-free in the liver, 1 patient (3 %) developed a local tumor recurrence, and 6 patients (18 %) new hepatic metastases. 9/32 (28 %) patients died 1 to 28 months after RFA due to extrahepatic tumor spread. Among the 7 patients who developed new lesions 6 underwent repeated RFA. Up to the present time of evaluation, the median survival after RFA has not been reached. Conclusion: RFA could be a valuable adjunct to the classic armamentarium of endocrine- and chemotherapy in hepatic metastasis of breast cancer and should be investigated in further comparative studies. No significant financial relationships to disclose.