O-018 - Radiofrequency ablation (RFA) combined with chemotherapy for unresectable colorectal liver metastases (CRC LM): Long-term survival results of a rand...

Date 04 July 2015
Event WorldGI 2015
Session Oral and LBA abstracts
Topics Anti-Cancer Agents & Biologic Therapy
Supportive Care
Colon Cancer
Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter T. Ruers
Citation Annals of Oncology (2015) 26 (suppl_4): 108-116. 10.1093/annonc/mdv235
Authors T. Ruers1, B. Nordlinger2, E. Van Cutsem3, G. Poston4, C.J.A. Punt5, F. van Coevorden1, J.-. Pierie6, I. Borel Rinkes7, J. Ledermann8, W. Bechstein9, M.-. Lentz1, M. Mauer1, M. Lutz10
  • 1The Netherlands Cancer Institute - Antoni Van Leeuwenhoek ziekenhuis, Amsterdam/NL
  • 2Assistance Publique Hôpitaux de Paris, Boulogne-Billancourt/FR
  • 3University Hospitals Leuven, Leuven/BE
  • 4University Hospital Aintree, Liverpool/UK
  • 5University of Amsterdam, Amsterdam/NL
  • 6Leeuwarden Medical Center, Leeuwarden/NL
  • 7University Medical Centre Utrecht, Utrecht/NL
  • 8UCL Cancer Institute, London/UK
  • 9University Hospital Frankfurt/Main, Frankfurt/Main/DE
  • 10Caritasklinik St. Theresa, Saarbruecken/DE

Abstract

Introduction

This study evaluates the benefit of combining systemic chemotherapy (CT) with local tumour destruction by RFA in patients with unresectable CRC LM up to 9 lesions and without extrahepatic disease. Overall survival (OS) at 30 months and progression free survival (PFS) results were reported (Ann Oncol. 23(10): 2619-26, 2012). We now report on OS results, after a long-term median follow-up of 9.7 years.

Methods

Between 2002 and 2007, 119 pts were randomised between CT alone (59) or RFA + CT (60). In both arms, CT consisted of 6 months FOLFOX (oxaliplatin 85mg/m2 and LV5FU2) plus, since October 2005, bevacizumab. In the CT arm resection was allowed when unresectable disease was converted by CT to resectable disease. Primary objective was a 30-months OS rate > 38% for the combined treatment group. OS and PFS were secondary endpoints.

Results

In the RFA + CT arm, 56 pts (93.3%) received RFA which was combined with resection in 27 pts (45%), 1 pt had all metastases resected (ineligible), 2 pts were not treated at all, in 1 pt no local treatment data were available. 51 patients (85%) in the RFA + CT arm received CT compared to all 59 in the CT arm. 6 pts in the CT arm eventually underwent hepatic resection. The primary endpoint was met; 30-months OS rate was 61.7% (95% CI: 48.2-73.9) for combined treatment. However, 30-month OS for systemic treatment only was 57.6% (95% CI: 44.1-70.4), higher than anticipated.

At a median follow-up of 9.7 years, 92 deaths were reported, 53 in the CT arm and 39 in the RFA + CT arm. Causes of death in the CT arm were progressive disease (49 pts), and unknown for 4 pts, and in the RFA + CT arm, progressive disease (35 pts), other causes (2 pts) and unknown (2 pts). There was a significant difference in OS in favor of the RFA + CT arm (HR = 0.58, 95% CI: 0.38-0.88, p = 0.01). Observed median OS was 45.6 months (95% CI: 30.3–67.8) in the RFA + CT arm vs. 40.5 months (95% CI: 27.5 - 47.7) in the CT arm.

Conclusion

This is the first study that prospectively investigated the efficacy of RFA +CT in pts with unresectable CRC LM. In this phase II trial, RFA + CT was associated with improved long-term OS compared to CT alone.