The expanded role of palliative procedures with minimally invasive tumor ablation techniques

Abstract

19548 Background: To effectively and appropriately manage the debilitating symptoms of advanced cancer, physicians must balance the potential promise of palliative interventions against requirements to avoid toxic or futile therapy. Ablative technologies are increasingly used for the local destruction of tumors. This study examines the outcomes of ablative procedures performed with palliative intent. Methods: Minimally invasive ablative procedures (microwave and radiofrequency) to explicitly palliate symptoms of advanced cancer were identified from all procedures performed. Patients were observed for >90 days or until death. Results: There were 175 palliative ablative procedures performed in 129 patients from 1999 to 2004. Ablations were performed most commonly for pain (90%) caused by metastatic (90%), locally advanced (5%), and locally recurrent (5%) disease. Primary malignancies treated were lung (31%), colorectal (14%), renal (11%), breast (9%), sarcoma (9%) and other (26%). Symptom improvement or resolution within 30 days was achieved in 69% (89/129). Median duration of symptom control was 315 days. Recurrence of the primary symptom occurred in 46% (59/129) while treatment of additional symptoms was needed in 22% (29/129). Palliative ablative procedures were associated with postoperative morbidity (25%) and mortality (7%). A postoperative complication reduced the probability of symptom improvement to 25% (p<0.001). Effective symptom relief was associated with improved overall survival (median 408 days vs. 161 days, p<0.001). Conclusions: In carefully selected patients, relief of symptoms following palliative ablative procedures can be expected, but new or recurrent symptoms limit durability. As observed in other palliative procedures, potential benefits are minimized by postoperative complications. Optimal management for these patients with advanced cancer, who are often not suitable candidates for operation, requires the highest level of multidisciplinary care. No significant financial relationships to disclose.