Comparison of effectiveness and safety of microwave ablation of colorectal liver metastases adjacent versus nonadjacent to the diaphragm Journal Article
| Authors: | Dimopoulos, M. P.; Sotirchos, V. S.; Dunnejaffe, C.; Petre, E. N.; Moussa, A.; Soares, K.; Solomon, S. B.; Sofocleous, C. T. |
| Article Title: | Comparison of effectiveness and safety of microwave ablation of colorectal liver metastases adjacent versus nonadjacent to the diaphragm |
| Abstract: | Purpose: To compare the effectiveness and safety of percutaneous microwave ablation (MWA) for colorectal liver metastasis (CLM) adjacent versus nonadjacent to the diaphragm. Materials and Methods: This was a retrospective analysis of a prospectively created MWA database, from 2 prospective clinical trials for patients with CLM treated in a single tertiary center from 2012 to 2023. CLM adjacent to the diaphragm was defined as a tumor located <1 cm from the diaphragm. Minimal ablation margin (MM) was calculated with 3-dimensional software using postablation contrast-enhanced computed tomography (CT). Adverse events were assessed with Common Terminology Criteria for Adverse Events (CTCAE) v5.0 classification for 6 months. Results: Two hundred nine CLMs underwent 191 MWA sessions in 143 patients. Mean tumor diameter was 1.52 cm (SD ± 0.53). Eighty-three of 209 (39.7%) CLMs were adjacent to the diaphragm. There was no difference in local tumor progression–free survival (LTPFS) between CLMs adjacent and nonadjacent to the diaphragm (hazard ratio [HR], 0.65; 95% CI, 0.37–1.16; P = .15). MMs of 5–10 mm and >10 mm were documented in 49.3% versus 46.8% (P = .83) and 21.6% versus 12.6% (P = .16) for CLMs adjacent versus nonadjacent to the diaphragm, respectively. Twelve-month LTPFS was similar between groups (HR, 0.65; 95% CI, 0.37–1.16; P = .15) without local tumor progression for MM of >10 mm. There were 3 Grade IV adverse events: 1 diaphragmatic perforation, 1 liver abscess, and 1 biloma. Pneumothorax was associated with location adjacent to the diaphragm (P < .001) and transpulmonary approach (P < .001). Median length of hospital stay was 2 days (interquartile range [IQR], 1–3 days) for patients who needed thoracostomy (n = 20, 9.6%) compared with 1 day (IQR, 1–8 days) for those who did not, without long-term sequelae. Conclusions: MWA of CLM adjacent to the diaphragm is effective and safe, without difference in success and 12-month LTPFS. Pneumothorax was associated with location adjacent to the diaphragm and thoracostomy that resulted in longer hospitalization without long-term sequelae. © 2024 SIR |
| Keywords: | adult; controlled study; treatment response; middle aged; major clinical study; cancer localization; cancer growth; positron emission tomography; progression free survival; computer assisted tomography; cohort analysis; retrospective study; risk assessment; length of stay; pneumothorax; contrast enhancement; cancer size; observational study; liver abscess; diaphragm; thoracostomy; comparative effectiveness; perforation; biloma; Common Terminology Criteria for Adverse Events; colorectal liver metastasis; human; male; female; article; tertiary care center; diaphragm injury; microwave thermotherapy; tumor margin |
| Journal Title: | Journal of Vascular and Interventional Radiology |
| Volume: | 35 |
| Issue: | 12 |
| ISSN: | 1051-0443 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2024-12-01 |
| Start Page: | 1814 |
| End Page: | 1822 |
| Language: | English |
| DOI: | 10.1016/j.jvir.2024.08.016 |
| PUBMED: | 39187125 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Constantinos T. Sofocleous -- Source: Scopus |
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