Metastasis was treated by upfront microwave ablation (MWA) and adjuvant systemic therapy (six cycles of FOLFIRI plus Bevacizumab). A. Axial contrast-enhanced T1-weighted MR image obtained before treatment shows 32x29x37-mm target lesion in segment V (arrow). B. Ultrasound image obtained during ultrasound-guided MWA shows hyperechogenicity around target lesion, corresponding with heat energy from ablation antennas. C. Axial contrast-enhanced T1-weighted MR image obtained 1 month after MWA shows 56x49x52-mm r

December 28, 2022 — According to an accepted manuscript published in ARRS’ American Journal of Roentgenology (AJR), upfront ablation plus adjuvant systemic therapy improves progression-free survival (PFS) of patients with colorectal liver oligometastases (CLOM) and low tumor burden score (TBS), supporting ablation as an alternative to surgical resection.

Clarifying that upfront thermal ablation performed 2-4 weeks before starting systemic therapy achieved significantly better PFS, compared with thermal ablation delayed 2-3 months after the star of therapy, “the findings will help guide the optimal clinical implementation of thermal ablation for patients with CLOM who are not candidates for surgical resection,” wrote corresponding author Ping Liang, MD, PhD, from the department of interventional ultrasound at Fifth Medical Center of Chinese PLA General Hospital in Beijing.

Of 543 total patients (346 men, 197 women; mean age, 58.1 years) with CLOM across nine institutions, 322 patients delayed thermal ablation, whereas 118 underwent thermal ablation upfront—in combination with systemic therapy—between October 2009 and December 2020. Analyses included all patients using crude data, as well a patient subset using propensity-score matching (PSM) for balanced baseline variables. Based on number and size of liver metastases, patients were then classified as having a low or high TBS. PFS was the primary outcome; secondary outcomes included overall survival.

Ultimately, in this multicenter retrospective study of patients with CLOM, after application of PSM, median PFS was 1.1 years and 2.0 years in patients who underwent delayed and upfront ablation, respectively, in combination with systemic therapy.

“In subgroup analysis,” the authors of this AJR accepted manuscript added, “the difference between the two timings for thermal ablation was observed in patients with low TBS, but not in patients with high TBS.”

For more information: www.arrs.org


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