Safety and efficacy of percutaneous liver ablation in gynecologic oncology patients with oligometastatic disease (543)

Abstract

<b>Objectives:</b> To describe the safety and efficacy of percutaneous liver ablation (PA) performed by interventional radiology (IR) in gynecologic oncology patients with liver-dominant oligometastatic disease. <b>Methods:</b> This retrospective cohort included all adult women (>21 years) with a gynecologic malignancy who underwent PA for liverdominant oligometastatic disease from August 2016 to June 2021 at our institution. Age, Charlson comorbidity index (CCI), diagnosis, performance status (PS), prior cancer therapies, technical details of PA, complications, tumor response (complete, stable disease, and progression), and recurrence were evaluated. Descriptive statistics were performed using SPSS v. 26. <b>Results:</b> Thirteen women (median age: 63 [range: 45-77]; median CCI: 8 [range: 6-11]; median PS=0 [range: 0-2]) were included who underwent 21 PAs. Eight patients (61.5%) had recurrent ovarian cancer, while five patients (38.5%) had recurrent endometrial cancer. All patients had liver-dominant, oligometastatic disease with treated tumors ranging from 1.3-4.5cm. The median number of procedures was one (range: 1-4). Three women had multiple procedures. Patients most commonly underwent microwave ablation (<i>n</i>=17/21; 81%) or cryoablation (<i>n</i>=4/21; 19%). Patients had received a median of three anticancer therapies (range: 1-6) prior to PA in addition to primary surgery, with the most common being chemotherapy. About 66.7% of PA procedures (<i>n</i>=14/21) resulted in a complete response to treatment. Three procedures (14.3%) resulted in stable disease. Thus, 17/21 procedures (81%) resulted in local control. Four patients (19%) had disease progression in the liver consisting of new metastases not targeted during the PA ablation procedure. Eight out of 13 patients (61.5%) had no further evidence of liver metastases during their disease or treatment course. There were two major complications: a grade 3 liver abscess requiring drain placement and IV antibiotics and a grade 3 pneumothorax requiring chest tube placement. Two minor complications included a perihepatic hematoma (grade 1) and an asymptomatic pneumothorax (grade 1). PA did not result in any complication with permanent sequelae or grade 4 or 5 adverse events. <b>Conclusions:</b> PA is an effective therapeutic option for gynecologic oncology patients with liver-dominant oligometastatic disease. More than 80% of procedures result in disease control, and two-thirds of procedures achieve a complete response with an acceptable safety profile. This image-guided, minimally-invasive procedure provides an additional tool for managing oligometastatic disease in the liver for appropriately-selected patients. A multi-disciplinary approach is crucial in treating these complex patients.