title: Radiofrequency Ablation to Improve Survival After Conversion Chemotherapy for Colorectal Liver Metastases.
abstract: Systemic chemotherapy is able to convert colorectal liver metastases (CRLM) that are initially unsuitable for local treatment into locally treatable disease. Surgical resection further improves survival in these patients. Our aim was to evaluate disease-free survival (DFS), overall survival, and morbidity for patients with CRLM treated with RFA following effective downstaging by chemotherapy, and to identify factors associated with recurrence and survival.
  
  
  
  Included patients had liver-dominant CRLM initially unsuitable for local treatment but eligible for RFA or RFA with resection after downstaging by systemic chemotherapy. Chemotherapeutic regimens consisted predominantly of CapOx, with or without bevacizumab. Follow-up was conducted with PET-CT or thoraco-pelvic CT.
  
  
  
  Fifty-one patients had a total of 325 CRLM (median = 7). Following chemotherapy, 183 lesions were still visible on CT (median = 3). Twenty-six patients were treated with RFA combined with resection. During surgery, 309 CRLM were retrieved on intraoperative ultrasound (median = 5). Median survival was 49 months and was associated with extrahepatic disease at time of presentation and recurrences after treatment. Estimated cumulative survival at 1, 3 and 4 years was 90, 63 and 45 %, respectively. Median DFS was 6 months. Twelve patients remained free of recurrence after a mean follow-up of 32.6 months.
  
  
  
  RFA of CRLM after conversion chemotherapy provides potential local control and a good overall survival. To prevent undertreatment, the involvement of a multidisciplinary team in follow-up imaging and assessment of local treatment possibilities after palliative chemotherapy for liver-dominant CRLM should always be considered.
authors.affiliation: Department of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. k.nielsen@vumc.nl.
authors.forename: Karin
authors.initials: K
authors.lastname: Nielsen
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Hester J
authors.initials: HJ
authors.lastname: Scheffer
authors.affiliation: Department of Surgery, Gelderse Vallei Hospital, Postbus 9025, 6716 RP, Ede, The Netherlands.
authors.forename: José H
authors.initials: JH
authors.lastname: Volders
authors.affiliation: Department of Medical Oncology, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.|Department of Medical Oncology, Rijnstate Hospital, Marga Klompélaan 6, 6836 TA, Arnhem, The Netherlands.
authors.forename: Maurice J D L
authors.initials: MJ
authors.lastname: van der Vorst
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Aukje A J M
authors.initials: AA
authors.lastname: van Tilborg
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Emile Fi
authors.initials: EF
authors.lastname: Comans
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: E S M
authors.initials: ES
authors.lastname: de Lange-de Klerk
authors.affiliation: Department of Surgery, Gelderse Vallei Hospital, Postbus 9025, 6716 RP, Ede, The Netherlands.
authors.forename: Colin
authors.initials: C
authors.lastname: Sietses
authors.affiliation: Department of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Sybren
authors.initials: S
authors.lastname: Meijer
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Martijn R
authors.initials: MR
authors.lastname: Meijerink
authors.affiliation: Department of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. mp.vandentol@vumc.nl.
authors.forename: M Petrousjka
authors.initials: MP
authors.lastname: van den Tol
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage; D000069287:Capecitabine / Q000008:administration & dosage; D017115:Catheter Ablation; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000068258:Bevacizumab; D000069287:Capecitabine