Neoadjuvant TACE before laser induced thermotherapy (LITT) in the treatment of non-colorectal non-breast cancer liver metastases: feasibility and survival rates.

Abstract

PURPOSE:

To evaluate safety, feasibility and overall survival rates for transarterial chemoembolization (TACE) alone or combined with MR-guided laser-induced-thermotherapy (LITT) in liver metastases of non-colorectal and non-breast cancer origin.

METHODS AND MATERIALS:

Included were patients with unresectable non-colorectal non-breast cancer liver metastases with progression under systemic chemotherapy. Excluded were patients with Karnofsky score ≤ 70, respiratory, renal and cardiovascular failure, and general TACE contraindications. TACE using Mitomycin alone, Mitomycin-Gemcitabine or Mitomycin-Gemcitabine-Cisplatin was performed to all patients. After TACE 146 metastases were ablated with MR-guided LITT. To be eligible for LITT metastases should be < 5 cm in size and ≤ 5 in number. Tumor response was evaluated using MRI according to RECIST. Survival was evaluated using Kaplan-Meier analysis.

RESULTS:

A total of 110 patients (mean age 59.2 years) with 371 metastases received TACE (mean 5.4 sessions/patient, n=110) with 76 (69%) receiving LITT (mean 1.6 session/patient) afterwards. TACE resulted in a mean decrease of mean maximum diameter of 52% ± 26.6 and volume change of -68.5% ± 22.9 in the 25 patients (23%) with partial response. Stable disease (n=59, 54%). Progressive disease (n=26, 23%). The RECIST outcome after LITT showed complete response (n=13, 17%), partial response (n=1, 1%), stable situation (n=41, 54%) and progressive disease (n=21, 28%). The mean time to progression (TTP) was 8.6 months. Median survival of all patients was 21.1 months.

CONCLUSION:

TACE with different protocols alone and in combination with LITT is a feasible palliative treatment option resulting in a median survival of 21.1 months for unresectable liver metastases of non-colorectal and non-breast cancer origin.

• Authors: Thomas J Vogl, Martin Kreutzträger, Tatjana Gruber-Rouh, Katrin Eichler, Nour-Eldin A Nour-Eldin, Stephan Zangos, Nagy N N Naguib
• Journal: European journal of radiology (Eur J Radiol) Vol. 83 Issue 10 Pg. 1804-10 (Oct 2014) ISSN: 1872-7727 [Electronic] Ireland
• PMID: 25082479 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Chemical References

• Antineoplastic Agents
• Contrast Media
• Gadolinium DTPA

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents (administration & dosage)
• Chemoembolization, Therapeutic (methods)
• Combined Modality Therapy
• Contrast Media
• Disease Progression
• Female
• Gadolinium DTPA
• Humans
• Hyperthermia, Induced (methods)
• Laser Therapy (methods)
• Liver Neoplasms (secondary, therapy)
• Magnetic Resonance Imaging, Interventional
• Male
• Middle Aged
• Neoadjuvant Therapy
• Palliative Care
• Retrospective Studies
• Survival Rate