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Open Access Highly Accessed Research article

Selection criteria for radiofrequency ablation for colorectal liver metastases in the era of effective systemic therapy: a clinical score based proposal

Axel Stang1*, Karl Jürgen Oldhafer2, Hauke Weilert3, Handan Keles3 and Marcello Donati4

Author Affiliations

1 Department of Hematology and Oncology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291 Hamburg, Germany

2 Department of Surgery, Asklepios Hospital Barmbek, Rübenkamp 220, 22291 Hamburg, Germany

3 Department of Hematology and Oncology, Asklepios Hospital Altona, Paul-Ehrlich Straße 1, 22763 Hamburg, Germany

4 Department of Surgery General and Oncologic Unit, Vittorio-Emanuele University Hospital, 95123 Catania, Italy

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BMC Cancer 2014, 14:500  doi:10.1186/1471-2407-14-500

Published: 9 July 2014

Abstract

Background

At present, there are no widely accepted criteria for the use of radiofrequency ablation (RFA) for the treatment of colorectal liver metastases (CLM) in the context of effective modern-agent therapies. We aimed to define selection criteria for patients with liver-limited CLM who may benefit from adding RFA to systemic therapy with respect to long-term disease control.

Methods

Between 2002 and 2007, 88 consecutive patients received RFA for liver-only CLM during partial remission (PR), stable disease (SD), or progressive disease (PD) after systemic therapy. At a median follow-up of 8.2 years (range 5.2-11.1 years), clinical data were correlated to overall survival (OS) and recurrence-free survival (RFS).

Results

Poor OS and RFS correlated significantly with PD to systemic therapy before RFA (HR 5.46; p < 0.0001; and HR 6.46; p < 0.0001), number of ≥4 CLM (HR 3.13; p = 0.0005; and HR 1.77; p = 0.0389), and carcinoembryonic antigen (CEA) level of ≥100 ng/ml (HR 1.67; p = 0.032; and HR 1.67; p = 0.044). The presence of four criteria (PR, ≤3 CLM, ≤3 cm maximum size, and CEA ≤100 ng/ml) selected a subgroup (n = 23) with significantly higher probabilities for OS and RFS at 5 years (39% and 22%,respectively) compared to those without any or up 3 of these criteria (0-27% and 0-9%, p < 0.001, respectively).

Conclusions

A score based on four criteria (response to systemic therapy, ≤3 CLM, ≤3 cm size, low CEA value) may allow to select patients with liver-only CLM for whom additional use of RFA most likely adds benefit in an attempt to achieve long-term disease control. Almost one-fourth of patients fulfilling these four criteria may achieve 5-year survival without disease recurrence following effective systemic plus local RFA treatment.

Keywords:
Colorectal cancer; Liver metastases; Radiofrequency ablation; Multimodality treatment; Prognostic factors; Clinical score