Radiofrequency ablation for the treatment of recurrent gynecological malignancies

Abstract

Objectives: To evaluate the safety and efficacy of radiofrequency ablation (RFA) and microwave ablation (MWA) for the treatment of isolated lesions in patients with recurrent gynecological malignancy. Methods: All patients with a gynecologic malignancy treated with RFA or MWA from 2007 to 2020 were evaluated. Ablations were performed using standardized technique under conscious sedation with CT or US image guidance by interventiomal radiology (IR). The primary endpoint was objective response rate (ORR). Secondary endpoints included response duration (DOR), clinical benefit rate (CBR), progression free survival (PFS), and safety. Deauville criteria was used to assess treatment response. Results: Thirty-two patients (17 ovarian, 7 endometrial, 8 cervical) were identified to have received ablative therapy for treatment of oligometastatic recurrences. Patients received a median of 2 (range 1-12) prior lines of chemotherapy. Of the 32 patients, 15 (47%) received concurrent systemic therapy at time of ablation (Table 1). Median PFS for the entire cohort was 7.3 (1.4-64.7) months. PFS was not significantly improved by concurrent systemic treatment (HR = 1.7, 95% CI: 0.79-3.83). Fourteen patients had complete response (CR), 2 had partial response (PR), and 6 had stable disease at time of initial follow-up imaging (median 3 months). CBR was 63% (n=20) at 16 weeks. No major complications occurred with only two patients reporting pain or weakness at the site of ablation. Conclusions: RFA and MWA is safe, well-tolerated, and demonstrated meaningful responses with 63% of patients experiencing clinical benefit at 16 weeks. Ablative therapy can be considered for the treatment of isolated lesions in patients with recurrent gynecologic malignancies. To evaluate the safety and efficacy of radiofrequency ablation (RFA) and microwave ablation (MWA) for the treatment of isolated lesions in patients with recurrent gynecological malignancy. All patients with a gynecologic malignancy treated with RFA or MWA from 2007 to 2020 were evaluated. Ablations were performed using standardized technique under conscious sedation with CT or US image guidance by interventiomal radiology (IR). The primary endpoint was objective response rate (ORR). Secondary endpoints included response duration (DOR), clinical benefit rate (CBR), progression free survival (PFS), and safety. Deauville criteria was used to assess treatment response. Thirty-two patients (17 ovarian, 7 endometrial, 8 cervical) were identified to have received ablative therapy for treatment of oligometastatic recurrences. Patients received a median of 2 (range 1-12) prior lines of chemotherapy. Of the 32 patients, 15 (47%) received concurrent systemic therapy at time of ablation (Table 1). Median PFS for the entire cohort was 7.3 (1.4-64.7) months. PFS was not significantly improved by concurrent systemic treatment (HR = 1.7, 95% CI: 0.79-3.83). Fourteen patients had complete response (CR), 2 had partial response (PR), and 6 had stable disease at time of initial follow-up imaging (median 3 months). CBR was 63% (n=20) at 16 weeks. No major complications occurred with only two patients reporting pain or weakness at the site of ablation. RFA and MWA is safe, well-tolerated, and demonstrated meaningful responses with 63% of patients experiencing clinical benefit at 16 weeks. Ablative therapy can be considered for the treatment of isolated lesions in patients with recurrent gynecologic malignancies.