Percutaneous microwave versus radiofrequency ablation of colorectal liver metastases: Ablation with clear margins (A0) provides the best local tumor control Journal Article

   

Authors:	Shady, W.; Petre, E. N.; Do, K. G.; Gonen, M.; Yarmohammadi, H.; Brown, K. T.; Kemeny, N. E.; D'Angelica, M.; Kingham, P. T.; Solomon, S. B.; Sofocleous, C. T.
Article Title:	Percutaneous microwave versus radiofrequency ablation of colorectal liver metastases: Ablation with clear margins (A0) provides the best local tumor control
Abstract:	Purpose: To identify and compare predictors of local tumor progression (LTP)-free survival (LTPFS) after radiofrequency (RF) ablation and microwave (MW) ablation of colorectal liver metastases (CLMs). Materials and Methods: This is a retrospective review of CLMs ablated from November 2009 to April 2015 (110 patients). Margins were measured on contrast-enhanced computed tomography (CT) 6 weeks after ablation. Clinical and technical predictors of LTPFS were assessed using a competing risk model adjusted for clustering. Results: Technique effectiveness (complete ablation) was 93% (79/85) for RF ablation and 97% (58/60) for MW ablation (P =.47). The median follow-up period was significantly longer for RF ablation than for MW ablation (56 months vs. 29 months) (P <.001). There was no difference in the local tumor progression (LTP) rates between RF ablation and MW ablation (P = 0.84). Significant predictors of shorter LTPFS for RF ablation on univariate analysis were ablation margins 5 mm or smaller (P <.001) (hazard ratio [HR]: 14.6; 95% confidence interval [CI]: 5.2–40.9) and perivascular tumors (P =.021) (HR: 2.2; 95% CI: 1.1–4.3); both retained significance on multivariate analysis. Significant predictors of shorter LTPFS on univariate analysis for MW ablation were ablation margins 5 mm or smaller (P <.001) (subhazard ratio: 11.6; 95% CI: 3.1–42.7) and no history of prior liver resection (P <.013) (HR: 3.2; 95%: 1.3–7.8); both retained significance on multivariate analysis. There was no LTP for tumors ablated with margins over 10 mm (median LTPFS: not reached). Perivascular tumors were not predictive for MW ablation (P =.43). Conclusions: Regardless of the thermal ablation modality used, margins larger than 5 mm are critical for local tumor control, with no LTP noted for margins over 10 mm. Unlike RF ablation, the efficiency of MW ablation was not affected for perivascular tumors. © 2017 SIR
Keywords:	adult; cancer survival; middle aged; cancer surgery; survival rate; major clinical study; follow up; computer assisted tomography; pain; delirium; retrospective study; lung embolism; pneumothorax; contrast enhancement; pleura effusion; bacteremia; tumor growth; cancer control; portal vein thrombosis; radiofrequency ablation; hematoma; comparative effectiveness; vein embolism; arteriovenous fistula; anuria; liver hematoma; subcutaneous emphysema; colorectal liver metastasis; human; male; female; priority journal; article; microwave thermotherapy; local tumor progression free survival; subcapsular hematoma
Journal Title:	Journal of Vascular and Interventional Radiology
Volume:	29
Issue:	2
ISSN:	1051-0443
Publisher:	Elsevier Science, Inc.
Date Published:	2018-02-01
Start Page:	268
End Page:	275.e1
Language:	English
DOI:	10.1016/j.jvir.2017.08.021
PROVIDER:	scopus
PMCID:	PMC5803367
PUBMED:	29203394
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85036507113&doi=10.1016%2fj.jvir.2017.08.021&partnerID=40&md5=4ddafb6c2abaa6702d3de3aa60b258e1
Notes:	Article -- Export Date: 1 March 2018 -- Source: Scopus