Skip to main content
Top
Published in: CardioVascular and Interventional Radiology 4/2017

01-04-2017 | Clinical Investigation

Radiofrequency Ablation Combined with Hepatic Arterial Chemoembolization Using Degradable Starch Microsphere Mixed with Mitomycin C for the Treatment of Liver Metastasis from Colorectal Cancer: A Prospective Multicenter Study

Authors: Koichiro Yamakado, Yasutaka Inaba, Yozo Sato, Taku Yasumoto, Sadao Hayashi, Takashi Yamanaka, Koji Nobata, Haruyuki Takaki, Atsuhiro Nakatsuka

Published in: CardioVascular and Interventional Radiology | Issue 4/2017

Login to get access

Abstract

Purpose

This phase II prospective study investigates possible benefits of radiofrequency ablation (RFA) combined with hepatic arterial chemoembolization using degradable starch microsphere (DSM) mixed with mitomycin C (MMC) in non-surgical candidates with colorectal liver metastases.

Materials and Methods

This study, approved by the respective institutional review board, included non-surgical candidates with 3 or fewer liver tumors of 3 cm or smaller, or a single lesion 5 cm or smaller. Percutaneous RFA was performed immediately after chemoembolization using DSM-MMC. Primary and secondary endpoints were the local tumor control rate, safety, and 2-year recurrence-free and overall survival rates.

Results

This study examined 25 patients (22 males, 3 females) with 38 tumors of mean maximum diameter of 2.2 ± 0.9 cm (standard deviation) (range 1.0–4.2 cm). Their mean age was 70.2 ± 8.2 years (range 55–82 years). Local tumor progression developed in 3 tumors (7.9%, 3/38) of 3 patients (12%, 3/25) during the mean follow-up of 34.9 ± 9.2 months (range 18.3–50.1 months). The 2-year local tumor control rates were 92.0% [95% confidence interval (CI), 81.4–100%] on a patient basis and 94.6% (95% CI, 87.3–100%) on a tumor basis. The respective 2-year overall and recurrence-free survival rates were 88.0% (95% CI, 75.3–98.5%) and 63.3% (95% CI, 44.2–82.5%), with median survival time of 48.4 months. Fever was the only adverse event requiring treatments in 2 patients (8%).

Conclusions

This combination therapy is safe, exhibiting strong anticancer effects on colorectal liver metastasis, which might contribute to patient survival.
Literature
1.
go back to reference House MG, Ito H, Gönen M, Fong Y, Allen PJ, DeMatteo RP, Brennan MF, Blumgart LH, Jarnagin WR, D’Angelica MI. Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1600 patients during two decades at a single institution. J Am Coll Surg. 2010;210:744–5.CrossRefPubMed House MG, Ito H, Gönen M, Fong Y, Allen PJ, DeMatteo RP, Brennan MF, Blumgart LH, Jarnagin WR, D’Angelica MI. Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1600 patients during two decades at a single institution. J Am Coll Surg. 2010;210:744–5.CrossRefPubMed
2.
go back to reference Kopetz S, Chang GJ, Overman MJ, Eng C, Sargent DJ, Larson DW, Grothey A, Vauthey JN, Nagorney DM, McWilliams RR. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol. 2009;27:3677–83.CrossRefPubMedPubMedCentral Kopetz S, Chang GJ, Overman MJ, Eng C, Sargent DJ, Larson DW, Grothey A, Vauthey JN, Nagorney DM, McWilliams RR. Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy. J Clin Oncol. 2009;27:3677–83.CrossRefPubMedPubMedCentral
3.
go back to reference Mitry E, Fields AL, Bleiberg H, Labianca R, Portier G, Tu D, Nitti D, Torri V, Elias D, O’Callaghan C, Langer B, Martignoni G, Bouché O, Lazorthes F, Van Cutsem E, Bedenne L, Moore MJ, Rougier P. Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: a pooled analysis of two randomized trials. J Clin Oncol. 2008;26:4906–11.CrossRefPubMed Mitry E, Fields AL, Bleiberg H, Labianca R, Portier G, Tu D, Nitti D, Torri V, Elias D, O’Callaghan C, Langer B, Martignoni G, Bouché O, Lazorthes F, Van Cutsem E, Bedenne L, Moore MJ, Rougier P. Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: a pooled analysis of two randomized trials. J Clin Oncol. 2008;26:4906–11.CrossRefPubMed
4.
go back to reference Tanis E, Nordlinger B, Mauer M, Sorbye H, van Coevorden F, Gruenberger T, Schlag PM, Punt CJ, Ledermann J, Ruers TJ. Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983. Eur J Cancer. 2014;50:912–9.CrossRefPubMed Tanis E, Nordlinger B, Mauer M, Sorbye H, van Coevorden F, Gruenberger T, Schlag PM, Punt CJ, Ledermann J, Ruers TJ. Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983. Eur J Cancer. 2014;50:912–9.CrossRefPubMed
5.
go back to reference Lee H, Heo JS, Cho YB, Yun SH, Kim HC, Lee WY, Choi SH, Choi DW. Hepatectomy versus radiofrequency ablation for colorectal liver metastasis: a propensity score analysis. World J Gastroenterol. 2015;21:3300–7.PubMedPubMedCentral Lee H, Heo JS, Cho YB, Yun SH, Kim HC, Lee WY, Choi SH, Choi DW. Hepatectomy versus radiofrequency ablation for colorectal liver metastasis: a propensity score analysis. World J Gastroenterol. 2015;21:3300–7.PubMedPubMedCentral
6.
go back to reference White RR, Avital I, Sofocleous CT, Brown KT, Brody LA, Covey A, Getrajdman GI, Jarnagin WR, Dematteo RP, Fong Y, Blumgart LH, D’Angelica M. Rates and patterns of recurrence for percutaneous radiofrequency ablation and open wedge resection for solitary colorectal liver metastasis. J Gastrointest Surg. 2007;11:256–63.CrossRefPubMed White RR, Avital I, Sofocleous CT, Brown KT, Brody LA, Covey A, Getrajdman GI, Jarnagin WR, Dematteo RP, Fong Y, Blumgart LH, D’Angelica M. Rates and patterns of recurrence for percutaneous radiofrequency ablation and open wedge resection for solitary colorectal liver metastasis. J Gastrointest Surg. 2007;11:256–63.CrossRefPubMed
7.
go back to reference Aloia TA, Vauthey JN, Loyer EM, et al. Solitary colorectal liver metastasis: resection determines outcome. Arch Surg. 2006;141(5):460–6.CrossRefPubMed Aloia TA, Vauthey JN, Loyer EM, et al. Solitary colorectal liver metastasis: resection determines outcome. Arch Surg. 2006;141(5):460–6.CrossRefPubMed
8.
go back to reference Saltz LB, Clarke S, Diaz-Rubio E, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as fibas-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol. 2008;26(12):2013–9.CrossRefPubMed Saltz LB, Clarke S, Diaz-Rubio E, et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as fibas-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol. 2008;26(12):2013–9.CrossRefPubMed
9.
go back to reference Tol J, Koopman M, Cats A, et al. Chemotherapy, bevacizumab, and cetuximab in metastatic colorectal cancer. N Engl J Med. 2009;360(6):563–72.CrossRefPubMed Tol J, Koopman M, Cats A, et al. Chemotherapy, bevacizumab, and cetuximab in metastatic colorectal cancer. N Engl J Med. 2009;360(6):563–72.CrossRefPubMed
10.
go back to reference Van CE, Kohne CH, Hitre E, et al. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med. 2009;360(14):1408–17.CrossRef Van CE, Kohne CH, Hitre E, et al. Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med. 2009;360(14):1408–17.CrossRef
11.
go back to reference Sanoff HK, Sargent DJ, Campbell ME, et al. Five-year data and prognostic factor analysis of oxaliplatin and irinotecan combinations for advanced colorectal cancer: N9741. J Clin Oncol. 2008;26(35):5721–7.CrossRefPubMedPubMedCentral Sanoff HK, Sargent DJ, Campbell ME, et al. Five-year data and prognostic factor analysis of oxaliplatin and irinotecan combinations for advanced colorectal cancer: N9741. J Clin Oncol. 2008;26(35):5721–7.CrossRefPubMedPubMedCentral
12.
go back to reference Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg. 2005;242(2):158–71.CrossRefPubMedPubMedCentral Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg. 2005;242(2):158–71.CrossRefPubMedPubMedCentral
13.
go back to reference Veltri A, Sacchetto P, Tosetti I, Pagano E, Fava C, Gandini G. Radiofrequency ablation of colorectal liver metastases: small size favorably predicts technique effectiveness and survival. Cardiovasc Intervent Radiol. 2008;31(5):948–56.CrossRefPubMed Veltri A, Sacchetto P, Tosetti I, Pagano E, Fava C, Gandini G. Radiofrequency ablation of colorectal liver metastases: small size favorably predicts technique effectiveness and survival. Cardiovasc Intervent Radiol. 2008;31(5):948–56.CrossRefPubMed
14.
go back to reference Solbiati L, Ahmed M, Cova L, Ierace T, Brioschi M, Goldberg SN. Small liver colorectal metastases treated with percutaneous radiofrequency ablation: local response rate and long-term survival with up to 10-year follow-up. Radiology. 2012;265(3):958–68.CrossRefPubMed Solbiati L, Ahmed M, Cova L, Ierace T, Brioschi M, Goldberg SN. Small liver colorectal metastases treated with percutaneous radiofrequency ablation: local response rate and long-term survival with up to 10-year follow-up. Radiology. 2012;265(3):958–68.CrossRefPubMed
15.
go back to reference Hamada A, Yamakado K, Nakatsuka A, Uraki J, Kashima M, Takaki H, Yamanaka T, Inoue Y, Kusunoki M, Takeda K. Radiofrequency ablation for colorectal liver metastases: prognostic factors in non-surgical candidates. Jpn J Radiol. 2012;30:567–74.CrossRefPubMed Hamada A, Yamakado K, Nakatsuka A, Uraki J, Kashima M, Takaki H, Yamanaka T, Inoue Y, Kusunoki M, Takeda K. Radiofrequency ablation for colorectal liver metastases: prognostic factors in non-surgical candidates. Jpn J Radiol. 2012;30:567–74.CrossRefPubMed
16.
go back to reference Wang X, Erinjeri JP, Jia X, Gonen M, Brown KT, Sofocleous CT, Getrajdman GI, Brody LA, Thornton RH, Maybody M, Covey AM, Siegelbaum RH, Alago W, Solomon SB. Margin size is an independent predictor of local tumor progression after ablation of colon cancer liver metastases. Cardiovasc Intervent Radiol. 2013;36:166–75.CrossRefPubMed Wang X, Erinjeri JP, Jia X, Gonen M, Brown KT, Sofocleous CT, Getrajdman GI, Brody LA, Thornton RH, Maybody M, Covey AM, Siegelbaum RH, Alago W, Solomon SB. Margin size is an independent predictor of local tumor progression after ablation of colon cancer liver metastases. Cardiovasc Intervent Radiol. 2013;36:166–75.CrossRefPubMed
17.
go back to reference Abitabile P, Hartl U, Lange J, Maurer CA. Radiofrequency ablation permits an effective treatment for colorectal liver metastasis. Eur J Surg Oncol. 2007;33(1):67–71.CrossRefPubMed Abitabile P, Hartl U, Lange J, Maurer CA. Radiofrequency ablation permits an effective treatment for colorectal liver metastasis. Eur J Surg Oncol. 2007;33(1):67–71.CrossRefPubMed
18.
go back to reference Nielsen K, van Tilborg AA, Meijerink MR, Macintosh MO, Zonderhuis BM, de Lange ES, Comans EF, Meijer S, van den Tol MP. Incidence and treatment of local site recurrences following RFA of colorectal liver metastases. World J Surg. 2013;37:1340–7.CrossRefPubMed Nielsen K, van Tilborg AA, Meijerink MR, Macintosh MO, Zonderhuis BM, de Lange ES, Comans EF, Meijer S, van den Tol MP. Incidence and treatment of local site recurrences following RFA of colorectal liver metastases. World J Surg. 2013;37:1340–7.CrossRefPubMed
19.
go back to reference Wong SL, Mangu PB, Choti MA, Crocenzi TS, Dodd GD 3rd, Dorfman GS, Eng C, Fong Y, Giusti AF, Lu D, Marsland TA, Michelson R, Poston GJ, Schrag D, Seidenfeld J, Benson AB 3rd. American Society of Clinical Oncology 2009 clinical evidence review on radiofrequency ablation of hepatic metastases from colorectal cancer. J Clin Oncol. 2010;28:493–508.CrossRefPubMed Wong SL, Mangu PB, Choti MA, Crocenzi TS, Dodd GD 3rd, Dorfman GS, Eng C, Fong Y, Giusti AF, Lu D, Marsland TA, Michelson R, Poston GJ, Schrag D, Seidenfeld J, Benson AB 3rd. American Society of Clinical Oncology 2009 clinical evidence review on radiofrequency ablation of hepatic metastases from colorectal cancer. J Clin Oncol. 2010;28:493–508.CrossRefPubMed
20.
go back to reference Kennedy TJ, Cassera MA, Khajanchee YS, Diwan TS, Hammill CW, Hansen PD. Laparoscopic radiofrequency ablation for the management of colorectal liver metastases: 10-year experience. J Surg Oncol. 2013;107(4):324–8.CrossRefPubMed Kennedy TJ, Cassera MA, Khajanchee YS, Diwan TS, Hammill CW, Hansen PD. Laparoscopic radiofrequency ablation for the management of colorectal liver metastases: 10-year experience. J Surg Oncol. 2013;107(4):324–8.CrossRefPubMed
21.
go back to reference Lee H, Heo JS, Cho YB, et al. Hepatectomy versus radiofrequency ablation for colorectal liver metastasis: a propensity score analysis. World J Gastroenterol. 2015;21(11):3300–7.PubMedPubMedCentral Lee H, Heo JS, Cho YB, et al. Hepatectomy versus radiofrequency ablation for colorectal liver metastasis: a propensity score analysis. World J Gastroenterol. 2015;21(11):3300–7.PubMedPubMedCentral
22.
go back to reference Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria: a 10-year update. J Vasc Interv Radiol. 2014;25(11):1691–705.CrossRefPubMed Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria: a 10-year update. J Vasc Interv Radiol. 2014;25(11):1691–705.CrossRefPubMed
23.
go back to reference Yamakado K, Nakatsuka A, Takaki H, et al. Early stage hepatocellular carcinoma: radiofrequency ablation combined with chemoembolization versus hepatectomy. Radiology. 2008;247(1):260–6.CrossRefPubMed Yamakado K, Nakatsuka A, Takaki H, et al. Early stage hepatocellular carcinoma: radiofrequency ablation combined with chemoembolization versus hepatectomy. Radiology. 2008;247(1):260–6.CrossRefPubMed
24.
go back to reference Taguchi T. Phase I study of infusion of PJ-203 (degradable starch microspheres) into hepatic artery. PJ-2S03 Clinical Study Group. Gan To Kagaku Ryoho. 1993;20(12):1817–25.PubMed Taguchi T. Phase I study of infusion of PJ-203 (degradable starch microspheres) into hepatic artery. PJ-2S03 Clinical Study Group. Gan To Kagaku Ryoho. 1993;20(12):1817–25.PubMed
25.
go back to reference Taguchi T, Kondo M, Tanikawa K, Nakamura H, Okawa T, Ogawa N. Comparative clinical study in metastatic liver cancer between intra-arterial infusion of mitomycin C alone and intra-arterial infusion of mitomycin C combined with PJ-203 (degradable starch microspheres). Gan To Kagaku Ryoho. 1993;20(13):2027–35.PubMed Taguchi T, Kondo M, Tanikawa K, Nakamura H, Okawa T, Ogawa N. Comparative clinical study in metastatic liver cancer between intra-arterial infusion of mitomycin C alone and intra-arterial infusion of mitomycin C combined with PJ-203 (degradable starch microspheres). Gan To Kagaku Ryoho. 1993;20(13):2027–35.PubMed
26.
go back to reference Taguchi T, Tanikawa K, Sano K, et al. Multi-center cooperative phase II study of combined infusion of PJ-203 (degradable starch microspheres) into hepatic artery in metastatic liver cancer. Gan To Kagaku Ryoho. 1993;20(13):2015–25.PubMed Taguchi T, Tanikawa K, Sano K, et al. Multi-center cooperative phase II study of combined infusion of PJ-203 (degradable starch microspheres) into hepatic artery in metastatic liver cancer. Gan To Kagaku Ryoho. 1993;20(13):2015–25.PubMed
27.
go back to reference Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649–55.CrossRefPubMed Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649–55.CrossRefPubMed
28.
go back to reference Mainenti PP, Mancini M, Mainolfi C, et al. Detection of colo-rectal liver metastases: prospective comparison of contrast enhanced US, multidetector CT, PET/CT, and 1.5 Tesla MR with extracellular and reticuloendothelial cell specific contrast agents. Abdom Imaging. 2010;35:511–21.CrossRefPubMed Mainenti PP, Mancini M, Mainolfi C, et al. Detection of colo-rectal liver metastases: prospective comparison of contrast enhanced US, multidetector CT, PET/CT, and 1.5 Tesla MR with extracellular and reticuloendothelial cell specific contrast agents. Abdom Imaging. 2010;35:511–21.CrossRefPubMed
30.
go back to reference Omary RA, Bettmann MA, Cardella JF, et al. Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol. 2002;13(9 Pt 1):879–81.CrossRefPubMed Omary RA, Bettmann MA, Cardella JF, et al. Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol. 2002;13(9 Pt 1):879–81.CrossRefPubMed
Metadata
Title
Radiofrequency Ablation Combined with Hepatic Arterial Chemoembolization Using Degradable Starch Microsphere Mixed with Mitomycin C for the Treatment of Liver Metastasis from Colorectal Cancer: A Prospective Multicenter Study
Authors
Koichiro Yamakado
Yasutaka Inaba
Yozo Sato
Taku Yasumoto
Sadao Hayashi
Takashi Yamanaka
Koji Nobata
Haruyuki Takaki
Atsuhiro Nakatsuka
Publication date
01-04-2017
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 4/2017
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-016-1547-3

Other articles of this Issue 4/2017

CardioVascular and Interventional Radiology 4/2017 Go to the issue