title: Radiofrequency ablation of colorectal liver metastases downstaged by chemotherapy.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) continues to evolve, improving the potentials of this technique. It is now a widely used procedure in the treatment of patients with unresectable colorectal liver metastases, increasing the number of potentially curable patients.
  
  
  OBJECTIVE
  To evaluate the long-term survival of patients treated by RFA for colorectal liver metastases after downstaging by systemic chemotherapy.
  
  
  METHODS
  In a retrospective review of our prospective colorectal liver metastasis RFA database, 36 patients (20 males, 16 females; median age 67 years) were identified during an 8-year period (1999-2007). All patients were initially unsuitable for local treatment, and referred to systemic chemotherapy by our multidisciplinary team. Multinodularity and/or location of tumor was the main cause of patients being unsuitable for local treatment. Chemotherapy mainly consisted of 5-fluorouracil and leucovorin combined with oxaliplatin or irinotecan. After downstaging with chemotherapy, patients were treated by RFA. Patients with extrahepatic disease were excluded from RFA treatment. Pre- and posttreatment evaluation was performed with multidetector computed tomography (MDCT) scans.
  
  
  RESULTS
  The median time from diagnosis of hepatic metastases to first RFA was 10 months. A total of 158 tumors were treated with RFA during the study period. Median follow-up period was 27 months. The estimated median survival time after diagnosis of hepatic metastasis was 39 months, with a 5-year survival rate of 34%.
  
  
  CONCLUSIONS
  In selected patients with colorectal liver metastases downstaged by chemotherapy, RFA is an important modality that may contribute to improved survival. Furthermore, all patients responding to systemic chemotherapy should be re-evaluated by a multidisciplinary team.
authors.affiliation: Department of Surgical Gastroenterology L, Aarhus University Hospital, Aarhus,Denmark. auknudsen@gmail.com
authors.forename: Anders Riegels
authors.initials: AR
authors.lastname: Knudsen
authors.forename: Anne-Sofia
authors.initials: AS
authors.lastname: Kannerup
authors.forename: Frank Viborg
authors.initials: FV
authors.lastname: Mortensen
authors.forename: Dennis Tønner
authors.initials: DT
authors.lastname: Nielsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D017115:Catheter Ablation / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D000077146:Irinotecan; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin