title: Radiofrequency ablation is a valid treatment option for lung metastases: experience in 566 patients with 1037 metastases.
abstract: BACKGROUND
  Minimal invasive methods are needed as an alternative to surgery for treatment of lung metastases.
  
  
  METHODS
  The prospective database of two cancer centers including all consecutive patients treated with radiofrequency ablation (RFA) for lung metastasis over 8 years was reviewed. RFA was carried out under general anesthesia, with computed tomography guidance using a 15-gauge multitined expandable electrodes RF needle.
  
  
  RESULTS
  Five hundred sixty-six patients including 290 men (51%), 62.7 ± 13.2 years old with primary tumor to the colon (34%), rectum (18%), kidney (12%), soft tissue (9%) and miscellaneous (27%) received 642 RFA for 1037 lung metastases. Fifty-three percent of patients had 1 metastasis, 25% had 2, 14% had 3, 5% had 4 and 4% had 5-8. Metastases were unilateral (75%), or bilateral (25%). The median diameter [extremes] of metastases was 15 mm (4-70). Twenty-two percent of patients had extrapulmonary disease amenable to local therapy including 49 liver, 16 bone and 60 miscellaneous metastases. Median follow-up was 35.5 months. Median overall survival (OS) was 62 months. Four-year local efficacy was 89%. Four-year lung disease control rate was 44.1%, with patient retreated safely up to four times. Primary origin, disease-free interval, size and number of metastases were associated with OS in multivariate analysis. Progression at RFA site was associated with poor OS [P = 0.011, hazard ratio (HR): 1.69 (95% confidence interval 1.13-2.54)]. In the 293 colorectal cancer metastases, size >2 cm (HR = 2.10, P = 0.0027) and a number of metastases ≥3 (HR = 1.86, P = 0.011) remained significantly associated with OS. A prognostic score made of three groups based on the four above-mentioned prognostic factors demonstrated 3-year OS rates of respectively 82.2%, 69.5% and 53.6% (log-rank test, P ≤ 0.0001) among the three groups in the overall population, and of 81.3%, 72.8% and 57.9% (log-rank test, P = 0.005) in the colorectal cancer patients.
  
  
  CONCLUSIONS
  Radiofrequency is an option for treatment of small size lung metastases, namely the ones below 2-3 cm.
authors: Departments of Image Guided Therapy. Electronic address: debaere@igr.fr.
authors: T
authors: T
authors: de Baère
authors: Biostatistics, Gustave Roussy Cancer Campus, Villejuif.
authors: A
authors: A
authors: Aupérin
authors: Departments of Image Guided Therapy.
authors: F
authors: F
authors: Deschamps
authors: Department of Imaging, Hopital Archet 2, Nice.
authors: P
authors: P
authors: Chevallier
authors: Department of Imaging, Hopital de la Timone, Marseille.
authors: Y
authors: Y
authors: Gaubert
authors: Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif.
authors: V
authors: V
authors: Boige
authors: Departments of Medical Oncology.
authors: M
authors: M
authors: Fonck
authors: Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif.
authors: B
authors: B
authors: Escudier
authors: Imaging, Institut Bergonie, Bordeaux, France.
authors: J
authors: J
authors: Palussiére
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D016208:Databases, Factual; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D018579:Patient Selection; D015641:Radiography, Interventional; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
keywords: colorectal cancer; lung metastases; radiofrequency ablation; thermal ablation