Transcript Slides

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.
Treatment for Colon Cancer Liver Metastases
• Surgery (10-25%)
• Chemotherapy:
systemic / Local
• IR Treatment
-Ablation
-RFA, Cryo, other
- Radioembolization
- Chemoembolization
[email protected]
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.
How does RF work?
•
•
•
•
•
•
Pt becomes electrical circuit.
Generator produces AC at 300-500 kHz (RF range).
Ionic agitation.
Frictional heating.
Protein denaturation, desiccation, coagulation necrosis.
Impedance rises.
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.
Ablation Needle/Electrode: Shape of Burn
[email protected]
Ablation Changes under the Microscope
[email protected]
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 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
*
“Radiofrequency Ablation of Recurrent Colorectal
Cancer Hepatic Metastases After Hepatectomy.”
Patients that have tumor recurrence in their liver
after surgery have limited therapy options.
Those with less than 3 tumors under 5 cm each
may benefit from ablation.
“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: Modified clinical risk score (CRS)
•
•
•
•
Tumor Size (>3 cm).
Disease Free Interval (<12 months).
Number of tumors > 1.
LN + primary.
CRS
0-2
2 year
survival
74%
1 year
No Tumor
66%
3-4
42%
22%
Follow-up Imaging: Success /No LTP
4 weeks
PRE
24 months
47 months
Repeat Ablation Treats Tumor Coming Back
LTP-free
survival
Median
(months)
1-year rate
Primary
10
50%
25
64%
After 1 RF
*Assisted
Repeated RF
(*includes all the ablations performed for the same target tumor
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
p<0.01
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
CRS
Median
1-
2-
3-year
0-2
35 mos
98%
73%
45%
3-4
21 mos
69%
42%
28%
p=0.03
Ablation with local chemotherapy
Median survival
HAIC
No HAIC
Overall Survival
Not reached
25 months
LTP-free Survival
14 months
10 months
p
0.19
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