Local tumor progression after radiofrequency ablation of colorectal liver metastases: evaluation of ablative margin and three-dimensional volumetric analysis.

PURPOSE Detection of local tumor progression (LTP) after radiofrequency (RF) ablation of colorectal cancer liver metastases may facilitate repeat intervention with potential benefits for patient survival. Ablative margins 1 month after RF ablation may predict LTP, and repeated three-dimensional (3D) volumetric analysis of coagulation volume after ablation may provide earlier detection of LTP versus conventional morphologic criteria. MATERIALS AND METHODS Seven patients with LTP and four patients without LTP after a follow-up of at least 24 months were identified. Multidetector computed tomography (CT) was performed at 1 and 3 months after RF ablation and then at 3-month intervals until 24 months. Ablative margins were determined from preablation tumor diameter and the corresponding coagulation diameter 1 month after ablation. Postablation coagulation volume was measured from 81 follow-up multidetector CT images using a seeding-based semiautomatic 3D method. RESULTS LTP was detected at a median of 9 months (range, 6-21 months) after RF ablation. A coagulation diameter smaller than the preoperative tumor diameter was associated with LTP. Increase in coagulation volume was found in six of seven patients at the time of diagnosis of LTP by conventional morphologic criteria. CONCLUSION Three-dimensional volumetric analysis of postablation coagulation volume is feasible for detection of LTP after RF ablation of colorectal cancer liver metastases. No advantage in early detection of LTP was found for 3D volumetric analysis compared with conventional morphologic criteria in this preliminary study. These findings may reflect a type II error caused by the limited sample size.

[1]  W. Oyen,et al.  Efficacy of fluorine-18-deoxyglucose positron emission tomography in detecting tumor recurrence after local ablative therapy for liver metastases: a prospective study. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[2]  P. Petrow,et al.  Hepatic tumors treated with percutaneous radio-frequency ablation: CT and MR imaging follow-up. , 2002, Radiology.

[3]  C. McArdle,et al.  Growth rate of hepatic metastases in colorectal carcinoma , 1988, The British journal of surgery.

[4]  P. Lavin,et al.  Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable determinant of outcome. , 1998, Annals of surgery.

[5]  J. McCall,et al.  Risk of Dissemination With Biopsy of Colorectal Liver Metastases , 2003, Diseases of the colon and rectum.

[6]  Solveig Pettersen,et al.  Increased activity of matrix metalloproteinase 2 and 9 after hepatic radiofrequency ablation. , 2006, The Journal of surgical research.

[7]  E F Halpern,et al.  Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. , 2001, Radiology.

[8]  Allan Siperstein,et al.  Local Recurrence After Laparoscopic Radiofrequency Thermal Ablation of Hepatic Tumors , 2000, Annals of Surgical Oncology.

[9]  M. van Glabbeke,et al.  New guidelines to evaluate the response to treatment in solid tumors , 2000, Journal of the National Cancer Institute.

[10]  E. Berber,et al.  Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: a prospective study. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  J. Belghiti,et al.  Liver Resection for Benign Disease and for Liver and Biliary Tumors , 2007 .

[12]  Guy Marchal,et al.  Local Recurrence After Hepatic Radiofrequency Coagulation: Multivariate Meta-Analysis and Review of Contributing Factors , 2005, Annals of surgery.

[13]  H. Bismuth,et al.  A comparison of percutaneous cryosurgery and percutaneous radiofrequency for unresectable hepatic malignancies. , 2002, Archives of surgery.

[14]  C. Christophi,et al.  Altered growth patterns of colorectal liver metastases after thermal ablation. , 2006, Surgery.

[15]  E. Geissler,et al.  Thermoablation of colorectal liver metastases promotes proliferation of residual intrahepatic neoplastic cells. , 2005, Surgery.

[16]  Gerald Antoch,et al.  Detection of residual tumor after radiofrequency ablation of liver metastasis with dual-modality PET/CT: initial results , 2005, European Radiology.

[17]  Kemal Tuncali,et al.  Liver metastases: 3D shape-based analysis of CT scans for detection of local recurrence after radiofrequency ablation. , 2006, Radiology.

[18]  S. Rogers,et al.  Use of CT Hounsfield unit density to identify ablated tumor after laparoscopic radiofrequency ablation of hepatic tumorsrid=""id=""Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Atlanta, Georgia, USA, 29 March–1 April 2000 , 2000, Surgical Endoscopy.

[19]  S Nahum Goldberg,et al.  Image-guided tumor ablation: standardization of terminology and reporting criteria. , 2005, Radiology.

[20]  T Mala,et al.  Hepatic radiofrequency ablation using perfusion electrodes in a pig model: effect of the Pringle manoeuvre. , 2006, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[21]  L. Blumgart,et al.  Surgery of the liver and biliary tract , 1994 .

[22]  G. Dodd,et al.  Tumor recurrence after radiofrequency thermal ablation of hepatic tumors: spectrum of findings on dual-phase contrast-enhanced CT. , 2001, AJR. American journal of roentgenology.

[23]  T. John,et al.  Biopsy of resectable colorectal liver metastases causes tumour dissemination and adversely affects survival after liver resection , 2005, The British journal of surgery.