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Thermal ablation of unresectable liver tumors: Factors associated with partial ablation and the impact on long-term survival

BACKGROUND: Thermal ablation procedures, including radiofrequency ablation (RFA) or laser-induced interstitial thermotherapy (LITT), are now well established in the treatment of malignant unresectable hepatic tumors. But the impact of partial ablation (PA) on long-term survival following computed to...

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Detalles Bibliográficos
Autores principales: Wiggermann, Philipp, Puls, Ralf, Vasilj, Andrej, Sieroń, Dominik, Schreyer, Andreas G., Jung, Ernst-Michael, Wawrzynek, Wojciech, Stroszczynski, Christian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560593/
https://www.ncbi.nlm.nih.gov/pubmed/22293882
http://dx.doi.org/10.12659/MSM.882463
Descripción
Sumario:BACKGROUND: Thermal ablation procedures, including radiofrequency ablation (RFA) or laser-induced interstitial thermotherapy (LITT), are now well established in the treatment of malignant unresectable hepatic tumors. But the impact of partial ablation (PA) on long-term survival following computed tomography (CT)-guided radiofrequency ablation and laser- induced interstitial thermotherapy of unresectable malignant liver lesions and the associated risk factors of PA remain partially unknown. MATERIAL/METHODS: This study included 254 liver tumors in 91 consecutive patients (66 men and 25 women; age 60.9±10.4 years; mean tumor size 25±14 mm [range 5–70 mm]) who underwent thermal ablation (RFA or LITT) between January 2000 and December 2007. Mean follow-up period was 21.1 month (range 1–69 months). Survival rate and local progression-free survival (PFS) were calculated for patients with complete ablation (CA) vs. patients with partial ablation (PA) to assess the impact on long-term survival. RESULTS: Median survival after CA was 47 months compared to 25 months after PA (P=0.04). The corresponding 5-year survival rates were 44% vs. 20%. Median PFS for CA was 11 months compared to 7 months for PA (P=0.118). The sole statistically significant risk factor for PA was tumor size (>30 mm; P=0.0003). Sustained complete ablation was achieved in 71% of lesions ≤30 mm vs. 47% of lesions >30 mm. CONCLUSIONS: We conclude that achievement of complete ablation is a highly important predictor of long-term survival and that tumor size is by far the most important predictor of the likelihood of achieving complete ablation.