Karin Nielsen1, Hester J Scheffer2, José H Volders3, Maurice J D L van der Vorst4,5, Aukje A J M van Tilborg2, Emile Fi Comans2, E S M de Lange-de Klerk6, Colin Sietses3, Sybren Meijer7, Martijn R Meijerink2, M Petrousjka van den Tol8. 1. Department of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. k.nielsen@vumc.nl. 2. Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. 3. Department of Surgery, Gelderse Vallei Hospital, Postbus 9025, 6716 RP, Ede, The Netherlands. 4. Department of Medical Oncology, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. 5. Department of Medical Oncology, Rijnstate Hospital, Marga Klompélaan 6, 6836 TA, Arnhem, The Netherlands. 6. Department of Epidemiology and Biostatistics, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. 7. Department of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. 8. Department of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. mp.vandentol@vumc.nl.
Abstract
INTRODUCTION: Systemic chemotherapy is able to convert colorectal liver metastases (CRLM) that are initially unsuitable for local treatment into locally treatable disease. Surgical resection further improves survival in these patients. Our aim was to evaluate disease-free survival (DFS), overall survival, and morbidity for patients with CRLM treated with RFA following effective downstaging by chemotherapy, and to identify factors associated with recurrence and survival. MATERIALS AND METHODS: Included patients had liver-dominant CRLM initially unsuitable for local treatment but eligible for RFA or RFA with resection after downstaging by systemic chemotherapy. Chemotherapeutic regimens consisted predominantly of CapOx, with or without bevacizumab. Follow-up was conducted with PET-CT or thoraco-pelvic CT. RESULTS: Fifty-one patients had a total of 325 CRLM (median = 7). Following chemotherapy, 183 lesions were still visible on CT (median = 3). Twenty-six patients were treated with RFA combined with resection. During surgery, 309 CRLM were retrieved on intraoperative ultrasound (median = 5). Median survival was 49 months and was associated with extrahepatic disease at time of presentation and recurrences after treatment. Estimated cumulative survival at 1, 3 and 4 years was 90, 63 and 45 %, respectively. Median DFS was 6 months. Twelve patients remained free of recurrence after a mean follow-up of 32.6 months. CONCLUSION: RFA of CRLM after conversion chemotherapy provides potential local control and a good overall survival. To prevent undertreatment, the involvement of a multidisciplinary team in follow-up imaging and assessment of local treatment possibilities after palliative chemotherapy for liver-dominant CRLM should always be considered.
INTRODUCTION: Systemic chemotherapy is able to convert colorectal liver metastases (CRLM) that are initially unsuitable for local treatment into locally treatable disease. Surgical resection further improves survival in these patients. Our aim was to evaluate disease-free survival (DFS), overall survival, and morbidity for patients with CRLM treated with RFA following effective downstaging by chemotherapy, and to identify factors associated with recurrence and survival. MATERIALS AND METHODS: Included patients had liver-dominant CRLM initially unsuitable for local treatment but eligible for RFA or RFA with resection after downstaging by systemic chemotherapy. Chemotherapeutic regimens consisted predominantly of CapOx, with or without bevacizumab. Follow-up was conducted with PET-CT or thoraco-pelvic CT. RESULTS: Fifty-one patients had a total of 325 CRLM (median = 7). Following chemotherapy, 183 lesions were still visible on CT (median = 3). Twenty-six patients were treated with RFA combined with resection. During surgery, 309 CRLM were retrieved on intraoperative ultrasound (median = 5). Median survival was 49 months and was associated with extrahepatic disease at time of presentation and recurrences after treatment. Estimated cumulative survival at 1, 3 and 4 years was 90, 63 and 45 %, respectively. Median DFS was 6 months. Twelve patients remained free of recurrence after a mean follow-up of 32.6 months. CONCLUSION: RFA of CRLM after conversion chemotherapy provides potential local control and a good overall survival. To prevent undertreatment, the involvement of a multidisciplinary team in follow-up imaging and assessment of local treatment possibilities after palliative chemotherapy for liver-dominant CRLM should always be considered.
Authors: A A J M Van Tilborg; M R Meijerink; C Sietses; J H T M Van Waesberghe; M O Mackintosh; S Meijer; C Van Kuijk; P Van Den Tol Journal: Br J Radiol Date: 2010-12-15 Impact factor: 3.039
Authors: Karin Nielsen; Aukje A J M van Tilborg; Martijn R Meijerink; Matessa O Macintosh; Babs M Zonderhuis; Elly S M de Lange; Emile F I Comans; Sybren Meijer; M Petrousjka van den Tol Journal: World J Surg Date: 2013-06 Impact factor: 3.352
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Authors: Klaas M Govaert; Charlotte S van Kessel; Martijn Lolkema; Theo J M Ruers; Inne H M Borel Rinkes Journal: Curr Colorectal Cancer Rep Date: 2012-03-17
Authors: Francesco De Cobelli; Paolo Marra; Francesca Ratti; Alessandro Ambrosi; Michele Colombo; Anna Damascelli; Claudio Sallemi; Simone Gusmini; Marco Salvioni; Pietro Diana; Federica Cipriani; Massimo Venturini; Luca Aldrighetti; Alessandro Del Maschio Journal: Med Oncol Date: 2017-02-20 Impact factor: 3.064