| Research Abstract |
Only chemotherapy was a treatment of choice for advanced cancers. Surgical resection is invasive and cannot be used for debulking purpose. This study was planned to evaluate the usefulness of the combination of interventional radiology and systemic chemotherapy and to establish a new treatment strategy for advanced cancers. At the initial plan, it was planned to compare the combination of radiofrequency ablation and systemic chemotherapy with systemic chemotherapy alone. However, it was difficult to randomly assign patients with advanced cancers into two groups : those treated by the combination of radiofrequency ablation and systemic chemotherapy and those by systemic chemotherapy alone. Thus, the randomized controlled trial was not performed.
In liver metastasis from colorectal cancer, that is the main subjects in this study, only 10 to 30% of the patients are said to be candidates for surgical resection. Furthermore, patients who already underwent hepatectomy or elderly patients ofte
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nrefuse surgery. At our department, we have performed a multimodal treatment using radiofrequency ablation as a main element. Indication of RFA with curative intent was ; 1) unresectable lesions or refusal of surgery, 2) lesion number〓5 & size〓5cm, 3) no extrahepatic lesions, and 4) no extensive contact with major vessels. Indication of RFA with debulking intent was ; 1) most lesions were in the liver, and 2) chemotherapy had not been performed or had been effective. We put no restrictions on lesion location. The subjects were 135 consecutive patients with liver metastasis from colorectal cancer on whom RFA was performed. There were 85 males and 50 females. The age was 64.8±11.1 (mean±S.D.) years. Twelve of them were 81 years old or older. Maximum lesion size was 3.2±1.3cm. Lesion number was 4.1±4.8. A total of 107 patients (79%) had received other treatment before RFA : 77 had received systemic chemotherapy, 38 hepatectomy, 22 intra-arterial chemotherapy, and so on (some patients had received multiple treatments). A total of 82 patients were not candidates for surgical resection, because 46 had unresectable extrahepatic lesions (29 unresectable lung metastases [three others had resectable lung metastasis], 13 lymph node metastases, 10 peritoneal seeding, 7 local recurrence at the primary site, and so on), 7 comorbid cardiopulmonary diseases, 20 unresectable multiple liver metastases, 4 unresectable multiple recurrences after hepatectomy, and 3 unresectable recurrence at the site of surgical margin after hepatectomy (some patients had plural conditions). After the therapy, CT scan from the chest to the pelvis and serum tumor marker levels were checked every 3 months. Systemic chemotherapy was generally recommended since the introduction of FOLFOX and FOLFIRI. However, some patients refused chemotherapy and others accepted only oral chemotherapy using S-1. Overall survival after RFA in 135 patients with liver metastasis from colorectal cancer was 91% at 1-year, 64% at 3-years, 36% at 5-years, and 27% at 7-years.
12 patients had already survived over 5 years and 6 patients over 7 years. Encountered complications were GI tract penetration in 3 cases, hepatic infarction in 3, liver abscess in 2 and others in 3. There was no mortality.
Overall survival after RFA in 16 patients with liver metastasis from gastric cancer was 74% at 1-year, 52% at 2-years, 43% at 3, 4, and 5-years. Two patients survived over 5 years.
Resection has been said to be the treatment of choice for metastatic liver tumors. However, the multimodal therapy using RFA as a main element achieved a high survival and not a small number of patients had survived more than 5 years, although many patients in this study had disadvantageous conditions. Treatment strategy to find recurrence at an early stage and to repeat minimally invasive therapies would be useful for metastatic liver tumors. The multimodal treatment using RFA as a main therapy should be among the treatments of choice for liver metastasis. Less
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