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. 2022 Jan 29;14(3):693.
doi: 10.3390/cancers14030693.

Biopsy and Margins Optimize Outcomes after Thermal Ablation of Colorectal Liver Metastases

Nikiforos Vasiniotis Kamarinos  1 , Efsevia Vakiani  2 , Mithat Gonen  3 , Nancy E Kemeny  4 , Carlie Sigel  2 , Leonard B Saltz  4 , Karen T Brown  1 , Anne M Covey  1 , Joseph P Erinjeri  1 , Lynn A Brody  1 , Etay Ziv  1 , Hooman Yarmohammadi  1 , Henry Kunin  1 , Afsar Barlas  5 , Elena N Petre  1 , Peter T Kingham  6 , Michael I D'Angelica  6 , Katia Manova-Todorova  5 , Stephen B Solomon  1 , Constantinos T Sofocleous  1
Affiliations

Biopsy and Margins Optimize Outcomes after Thermal Ablation of Colorectal Liver Metastases

Nikiforos Vasiniotis Kamarinos et al. Cancers (Basel). .

Abstract

Background: Thermal ablation is a definitive local treatment for selected colorectal liver metastases (CLM) that can be ablated with adequate margins. A critical limitation has been local tumor progression (LTP).

Methods: This prospective, single-group, phase 2 study enrolled patients with CLM < 5 cm in maximum diameter, at a tertiary cancer center between November 2009 and February 2019. Biopsy of the ablation zone center and margin was performed immediately after ablation. Viable tumor in tissue biopsy and ablation margins < 5 mm were assessed as predictors of 12-month LTP.

Results: We enrolled 107 patients with 182 CLMs. Mean tumor size was 2.0 (range, 0.6-4.6) cm. Microwave ablation was used in 51% and radiofrequency ablation in 49% of tumors. The 12- and 24-month cumulative incidence of LTP was 22% (95% confidence interval [CI]: 17, 29) and 29% (95% CI: 23, 36), respectively. LTP at 12 months was 7% (95% CI: 3, 14) for the biopsy tumor-negative ablation zone with margins ≥ 5 mm vs. 63% (95% CI: 35, 85) for the biopsy-positive ablation zone with margins < 5 mm (p < 0.001).

Conclusions: Biopsy-proven complete tumor ablation with margins of at least 5 mm achieves optimal local tumor control for CLM, regardless of the ablation modality used.

Keywords: ablation margin assessment; colorectal liver metastases; post-ablation biopsy; thermal ablation.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Application of inclusion/exclusion criteria for determining the study group.
Figure 2
Figure 2
Kaplan–Meier curve of local tumor progression free survival stratified by post-ablation biopsy result (N: Negative or P: Positive) and ablation margin size.
Figure 3
Figure 3
Cumulative incidence of local tumor progression over time stratified by post-ablation biopsy result (N: Negative or P: Positive) and ablation margin size.
See this image and copyright information in PMC

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