Long-term results of percutaneous radiofrequency ablation of pulmonary metastases: a single institution experience

作者：Fanucchi Olivia^*; Ambrogi Marcello Carlo; Aprile Vittorio; Cioni Roberto; Cappelli Carla; Melfi Franca; Massimetti Gabrilele; Mussi Alfredo

来源：Interactive Cardiovascular and Thoracic Surgery, 2016, 23(1): 57-64.

DOI：10.1093/icvts/ivw089

• Lung metastases
• Radiofrequency ablation
• Minimally invasive therapy
• High-risk patients
• Non-surgical patients
• Percutaneous ablation

OBJECTIVES: Surgical resection of pulmonary metastases is considered as a therapeutic procedure in selected cases. However, many patients are unable to tolerate surgical intervention due to comorbidities and/or poor pulmonary reserve, also related to repeated parenchymal resections. Considering this scenario, we decided to investigate the role of radiofrequency ablation (RFA).
METHODS: The outcomes of all patients that underwent RFA for lung metastases, during the period 2003-2013, were analysed. The primary end-points were overall survival (OS) and local progression-free survival (LPFS). Secondary end-point was the analysis of possible risk factors affecting OS and LPFS.
RESULTS: Ninety-nine RFAs were performed on 61 patients (38 men, 23 women, median age of 74 years). Fourteen patients were treated for two or more lesions, for a total of 86 lesions. Twelve lesions were treated up to three times. The median lesion diameter was 2 cm. The majority of patients were affected by lung metastases from colorectal cancer (47.5%). All procedures were successfully completed. One death occurred, whereas the morbidity rate was 11% (8% pneumothorax requiring chest drainage). At a median follow-up of 28 months, the 1-, 3-, 5-year OS (LPFS) rates were 94.8% (86.3%), 49.0% (70.3%) and 44.5% (68.3%), respectively. No significant correlation was found, using univariate and multivariate analysis, between OS and age, gender, histology of primary cancer (colon versus others), type of approach (computed tomography versus ultrasonography guidance), number of treated lesions (1 vs > 1), disease-free interval (from primary tumour to first lung metastases) (1-35 vs > 35 months), previous lung resections (yes versus no), whereas a tendency towards better OS was observed, by applying univariate analysis, for a lesion of < 3 cm (P = 0.051) and for the presence of local disease 1 month after treatment (P = 0.056), however, without a statistically significant difference. With regard to LPFS, lesion dimensions (P = 0.005) and the presence of local disease 1 month after treatment (P < 0.001) were found to be significant risk factors, in both univariate and multivariate analyses.
CONCLUSIONS: RFA appears as a feasible and safe procedure, with an acceptable morbidity, offering the possibility to safely repeat the treatment on the same lesion. RFA can be considered a valid option for the local control of lung metastases, in patients not eligible for surgery, especially those with lesions smaller than 3 cm.

• 出版日期2016-7