Living Longer: Colon Cancer Patients Gain Time With Radiofrequency Ablation Treatment

CT Sofocleous, EN Petre, M Gonen, KT Brown, RH Thornton,

AM Covey, LA Brody, W Alago, M D'Angelica, SB Solomon, Y Fong,

NE Kemeny. Memorial Sloan-Kettering Cancer Center, New York, NY

Abstract 107: “Radiofrequency Ablation of Recurrent

Colorectal Cancer Hepatic Metastases After Hepatectomy” @

www.SIRmeeting.

35th Annual Scientific Meeting March 13–18, 2010, Tampa, FL.

Facts about Colon Cancer

• Second leading cause of cancer-related death in the United States.

• 150,000 new patients diagnosed each year.

• Half of these patients will have cancer spread to their liver (liver metastases) at some point during the course of their disease.

• Surgery is considered the best treatment for liver metastases but the majority of the patients are not candidates for surgery. 

• “In those (<25%) who undergo surgery, recurrence (a new spot of cancer coming back) is a serious problem.

• Traditionally chemotherapy has been the only therapy.

sofoclec@mskcc.org

Treatment for Colon Cancer Liver Metastases

• Surgery (10-25%) • Chemotherapy:

systemic / Local

• IR Treatment

-Ablation-RFA, Cryo, other

- Radioembolization

- Chemoembolization

Interventional Treatment

• NO CUTS

• Minimally Invasive: • Needles, Catheters

Imaging Guidance

• FEWER complications/ Side effects

• Fast Recovery. • GO HOME SAME DAY!

Radiofrequency Ablation

A special Needle (electrode is placed and destroys

the tumor locally in the liver with minimal effect on

the surrounding normal tissue.

• Pt becomes electrical circuit.• Generator produces AC at 300-500 kHz (RF range).• Ionic agitation.• Frictional heating.• Protein denaturation, desiccation, coagulation necrosis.• Impedance rises.

How does RF work?

Thermal Ablation Cooking with Heat

• Heat induced cell death: – 48 oC: in 45 min. – 50-52 oC: after 4-6 min.– > 60 oC: Instantaneous cell death.– 100-110 oC: Vaporization, carbonization, charring.

sofoclec@mskcc.org

Ablation Needle/Electrode: Shape of BurnAblation Needle/Electrode: Shape of Burn

sofoclec@mskcc.org

Ablation Changes under the MicroscopeAblation Changes under the Microscope

Who is a Good Patient For Ablation

• Small Number of Tumors • Small Size of Tumor• Treatment of new tumors or enlarging Tumors

after surgery or chemotherapy• Traditionally Ablation has been offered to Patients

that cannot have Surgery

• Ideal: Solitary Tumor < 3 cm

2010: Surgery vs. Ablation for CLM2010: Surgery vs. Ablation for CLM

Surgery RFA

Mortality 0-6% <0.5%

Morbidity 17-56% 8-10%

LOS 13 days 2 days

LTP 3.8-44% 2-60 (10.7) %

OS

5 year

31-58 % 14-55 %*

unresectable patients *

Patients that have tumor recurrence in their liver Patients that have tumor recurrence in their liver after surgery have limited therapy options. after surgery have limited therapy options.

Those with less than 3 tumors under 5 cm each Those with less than 3 tumors under 5 cm each may benefit from ablation.may benefit from ablation.

““Radiofrequency Ablation of Recurrent Colorectal Cancer Hepatic Metastases After Hepatectomy.”

“Radiofrequency Ablation of Recurrent Colorectal Cancer Hepatic Metastases After Hepatectomy.”

• We ablated 71 CLM that developed after liver surgery in 56 patients. We calculated:

• Successful ablation: Burn size covering the entire tumor on 4-6 week post-treatment CT

• Complications • Cancer coming back at the site of ablation: local

tumor progression (LTP) and • Overall patient survival

Risk Factors: Risk Factors: Modified clinical risk score (CRS)Modified clinical risk score (CRS)

• Tumor Size (>3 cm).• Disease Free Interval (<12 months).• Number of tumors > 1. • LN + primary.

CRS 2 year survival

1 yearNo Tumor

0-2 74% 66%

3-4 42% 22%

Follow-up Imaging: Success /No LTP

PRE4 weeks 24 months 47 months

Repeat Ablation Treats Tumor Coming Back

LTP-free survival

Median(months)

1-year rate

Primary

After 1 RF

10 50%

*Assisted

Repeated RF

25 64%

(*includes all the ablations performed for the same target tumor

p<0.01

Tumor-free Interval by CRS

CRS Median 1- 2- 3-years

0-2 16 mos 66% 48% 48%

3-4 5 mos 22% 0 0

Overall Patients Survival after RF

Median 1- 2- 3-yr

31 mos 91% 66% 41%

Additional Length of Life after Failure of Surgery

Overall Survival by CRS

p=0.03

CRS Median 1- 2- 3-year

0-2 35 mos 98% 73% 45%

3-4 21 mos 69% 42% 28%

Median survival HAIC No HAIC p

Overall Survival Not reached 25 months

LTP-free Survival 14 months 10 months 0.19

Ablation with local chemotherapy

Conclusion:

• RF ablation can treat colon cancer liver metastases that come back after surgery.

• This can significantly prolong life of patients with limited treatment options.

• The combination of a low clinical risk score,

surveillance with imaging and repeat ablation to

treat LTP are associated with better outcomes

SIR 2005 New Orleans