Biopsy and Margins Optimize Outcomes after Thermal Ablation of Colorectal Liver Metastases

被引:21
作者
Vasiniotis Kamarinos, Nikiforos [1 ,7 ]
Vakiani, Efsevia [2 ]
Gonen, Mithat [3 ]
Kemeny, Nancy E. [4 ]
Sigel, Carlie [2 ]
Saltz, Leonard B. [4 ]
Brown, Karen T. [1 ,8 ]
Covey, Anne M. [1 ]
Erinjeri, Joseph P. [1 ]
Brody, Lynn A. [1 ]
Ziv, Etay [1 ]
Yarmohammadi, Hooman [1 ]
Kunin, Henry [1 ]
Barlas, Afsar [5 ]
Petre, Elena N. [1 ]
Kingham, Peter T. [6 ]
D'Angelica, Michael I. [6 ]
Manova-Todorova, Katia [5 ]
Solomon, Stephen B. [1 ]
Sofocleous, Constantinos T. [1 ]
机构
[1] Mem Sloan Kettering Canc Ctr, Dept Radiol, Intervent Oncol IR Serv, New York, NY 10065 USA
[2] Mem Sloan Kettering Canc Ctr, Dept Pathol, New York, NY 10065 USA
[3] Mem Sloan Kettering Canc Ctr, Dept Epidemiol & Biostat, New York, NY 10065 USA
[4] Mem Sloan Kettering Canc Ctr, Dept Med, New York, NY 10065 USA
[5] Mem Sloan Kettering Canc Ctr, Mol Cytol, New York, NY 10065 USA
[6] Mem Sloan Kettering Canc Ctr, Dept Surg, New York, NY 10065 USA
[7] Mercy Hlth, Dept Internal Med, Philadelphia, PA 19143 USA
[8] Univ Utah Hosp, Intervent Radiol Serv, Dept Radiol & Imaging Sci, Salt Lake City, UT 84132 USA
基金
美国国家卫生研究院;
关键词
thermal ablation; colorectal liver metastases; post-ablation biopsy; ablation margin assessment; LOCAL TUMOR PROGRESSION; PERCUTANEOUS RADIOFREQUENCY ABLATION; MICROWAVE ABLATION; HEPATIC RESECTION; COLON-CANCER; SURVIVAL; IMPACT; ZONE;
D O I
10.3390/cancers14030693
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Simple Summary Thermal ablation (TA) is a non-surgical treatment of cancer that has been used with success in the treatment of colorectal liver metastases (CLM). TA consists of burning the cancer and a rim of surrounding tissue (margin) with a special needle placed in the tumor under image guidance. Despite the technological evolution of TA, tumor progression/recurrence rates remain higher than expected. We present a method that combines tissue and imaging tests performed immediately after ablation to determine whether there is complete tumor destruction or remaining live cancer cells that can cause tumor progression/recurrence. This information can provide guidance for additional treatments for patients with evidence of residual cancer, i.e.,: additional TA at the same or subsequent sitting, or additional chemotherapy and short-interval imaging follow-up to detect recurrence. The presented method proposes a clinical practice paradigm change that can improve clinical outcomes in a large population of patients with CLM treated by TA. Background: Thermal ablation is a definitive local treatment for selected colorectal liver metastases (CLM) that can be ablated with adequate margins. A critical limitation has been local tumor progression (LTP). Methods: This prospective, single-group, phase 2 study enrolled patients with CLM < 5 cm in maximum diameter, at a tertiary cancer center between November 2009 and February 2019. Biopsy of the ablation zone center and margin was performed immediately after ablation. Viable tumor in tissue biopsy and ablation margins < 5 mm were assessed as predictors of 12-month LTP. Results: We enrolled 107 patients with 182 CLMs. Mean tumor size was 2.0 (range, 0.6-4.6) cm. Microwave ablation was used in 51% and radiofrequency ablation in 49% of tumors. The 12- and 24-month cumulative incidence of LTP was 22% (95% confidence interval [CI]: 17, 29) and 29% (95% CI: 23, 36), respectively. LTP at 12 months was 7% (95% CI: 3, 14) for the biopsy tumor-negative ablation zone with margins >= 5 mm vs. 63% (95% CI: 35, 85) for the biopsy-positive ablation zone with margins < 5 mm (p < 0.001). Conclusions: Biopsy-proven complete tumor ablation with margins of at least 5 mm achieves optimal local tumor control for CLM, regardless of the ablation modality used.
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页数:14
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