Siperstein AE et al. (2007) Survival after radiofrequency ablation of colorectal liver metastases: 10-year experience. Ann Surg 246: 559–567

About a quarter of patients with colorectal cancer develop liver metastases within 5 years of diagnosis. Of these, only 8–27% are suitable for surgical resection. Without treatment, most patients have a dismal prognosis, with median survival ranging from 6 to 12 months; survival can be extended to 20 months with optimum chemotherapy regimens, and to 21 months with multimodality therapy. Siperstein et al. prospectively evaluated the long-term therapeutic impact of laparoscopic radiofrequency ablation (RFA) in 234 patients with metastatic colorectal adenocarcinoma who underwent RFA during the period 1997–2006. The median time from diagnosis of metastatic disease to RFA was 8 months, during which period disease management with chemotherapy was attempted in most patients.

Patients had an average of 2.8 lesions with an average diameter of 3.9 cm. Survival at 3 and 5 years was 20.2% and 18.4%, respectively. Having fewer than three lesions that were 3 cm or less in size and a low chorioembryonic antigen level (<200 ng/ml) before treatment were factors strongly predictive of survival. The presence of extrahepatic disease before RFA had no effect on survival. The type of preoperative or postoperative chemotherapy did not influence median survival, although a significant survival advantage was noted in patients who received postoperative chemotherapy (P = 0.02).

The authors conclude that RFA confers a clear survival benefit to patients with colorectal cancer whose liver metastases are judged to be inoperable, do not respond to systemic chemotherapy, or both. As the use of RFA increases and the technology improves, they predict that more patients will benefit from this approach.