Korean J Radiol.  2020 Mar;21(3):316-324. 10.3348/kjr.2019.0647.

Percutaneous Radiofrequency Ablation for Metachronous Hepatic Metastases after Curative Resection of Pancreatic Adenocarcinoma

• Lee SJ
• Kim JH
• Kim SY
• Won HJ
• Shin YM
• Kim PN

• KMID: 2470755
• DOI: http://doi.org/10.3348/kjr.2019.0647

Abstract

OBJECTIVE
To retrospectively evaluate the safety and efficacy of percutaneous radiofrequency ablation (RFA) in patients with metachronous hepatic metastases arising from pancreatic adenocarcinoma who had previously received curative surgery.
MATERIALS AND METHODS
Between 2002 and 2017, percutaneous RFA was performed on 94 metachronous hepatic metastases (median diameter, 1.5 cm) arising from pancreatic cancer in 60 patients (mean age, 60.5 years). Patients were included if they had fewer than five metastases, a maximum tumor diameter of ≤ 5 cm, and disease confined to the liver or stable extrahepatic disease. For comparisons during the same period, we included 66 patients who received chemotherapy only and met the same eligibility criteria described.
RESULTS
Technical success was achieved in all hepatic metastasis without any procedure-related mortality. During follow-up, local tumor progression of treated lesions was observed in 38.3% of the tumors. Overall median survival and 3-year survival rates were 12 months and 0%, respectively from initial RFA, and 14.7 months and 2.1%, respectively from the first diagnosis of liver metastasis. Multivariate analysis showed that a large tumor diameter of > 1.5 cm, a late TNM stage (≥ IIB) before curative surgery, a time from surgery to recurrence of < 1 year, and the presence of extrahepatic metastasis, were all prognostic of reduced overall survival after RFA. Median overall (12 months vs. 9.1 months, p = 0.094) and progression-free survival (5 months vs. 3.3 months, p = 0.068) were higher in the RFA group than in the chemotherapy group with borderline statistical difference.
CONCLUSION
RFA is safe and may offer successful local tumor control in patients with metachronous hepatic metastases arising from pancreatic adenocarcinoma. Patients with a small diameter tumor, early TNM stage before curative surgery, late hepatic recurrence, and liver-only metastasis benefit most from RFA treatment. RFA provided better survival outcomes than chemotherapy for this specific group with borderline statistical difference.

Keyword

Pancreatic adenocarcinoma; Metachronous hepatic metastasis; Radiofrequency ablation

MeSH Terms

Adenocarcinoma*
Catheter Ablation*
Diagnosis
Disease-Free Survival
Drug Therapy
Follow-Up Studies
Humans
Liver
Mortality
Multivariate Analysis
Neoplasm Metastasis*
Pancreatic Neoplasms
Recurrence
Retrospective Studies
Survival Rate

Figure

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  Fig. 1 Patient selection flow chart. RFA = radiofrequency ablation

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  Fig. 2 Cumulative local tumor progression rates after RFA of tumors ≤ 1.5 cm and > 1.5 cm in diameter.

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  Fig. 3 Survival rates between RFA group and chemotherapy group. Overall survival from date of diagnosis of hepatic metastases (A) and from date of initial RFA (B) in 60 patients. C. Median overall survival from initial treatment was higher in RFA group (12 months) than in chemotherapy group (9.1 months), but difference was not statistically significant (p = 0.094). D. Median progression-free survival from initial treatment was higher in RFA group (5 months) than in chemotherapy group (3.3 months), but difference was marginally significant (p = 0.068).

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