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Liver biopsy and resection vs rfa

alexinlv's picture
alexinlv
Posts: 185
Joined: Jul 2010

I got some eye opening info my last post regarding risks of liver biopsy and seeding.  I wanted to put it out again to see who else has thoughts and experiences.  Husbands 2nd recurrance in liver. Previous resection 4  lesions resected. I'm thinking no biopsy and resection is best best versus rfa.  Thoughts? Thx!, 

PatchAdams
Posts: 271
Joined: Nov 2011
SURVIVAL ANALYSIS   Thomas A. Aloia, MD; Jean-Nicolas Vauthey, MD; Evelyne M. Loyer, MD; Dario Ribero, MD; Timothy M. Pawlik, MD, MPH; Steven H. Wei, MS, PA-C; Steven A. Curley, MD; Daria Zorzi, MD; Eddie K. Abdalla, MD 

Univariate analysis of RFS showed that both tumor size and treatment modality were associated with the development of recurrence. The overall recurrence rate was not statistically different in patients with a tumor larger than 3 cm compared with tumors 3 cm or smaller in diameter (62% vs 48%, respectively; P = .06), but those with tumors larger than 3 cm had recurrence sooner after treatment (median RFS, 19 months vs 32 months, respectively; P = .02). Patients treated with RFA were significantly more likely than patients treated with HR to have recurrence (77% vs 52%, respectively; P = .01) and had a shorter median RFS (18 months vs 31 months, respectively; P = .006) regardless of tumor size. Tumors larger than 3 cm (odds ratio = 1.90), primary tumors located in the rectum (odds ratio = 1.67), and treatment with RFA (odds ratio = 2.29) were associated with a significant increased risk for recurrence in multivariate analyses (Table 3). For HR as compared with RFA, the 5-year RFS rates (40% vs 0%, respectively; P = .006) and DFS rates (50% vs 0%, respectively; P = .001) were significantly higher (Figure 2). In addition, 3- and 5-year OS rates were higher after HR (79% and 71%, respectively) compared with RFA (57% and 27%, respectively) (P<.001).

Eddie K. Abdalla, MD, FACS, Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Unit 444, PO Box 301402, Houston, TX 77230-1402 (eabdalla@mdanderson.org).

 

RFS = recurrence free status

DFS = disease free status

OS = Oversall survival  status

OUTCOME FOR PATIENTS WITH SOLITARY CLM 3 CM OR SMALLER

A separate assessment of intrahepatic and distant recurrence patterns and survival rates for the 79 study patients with tumors 3 cm or smaller indicates that both LR and OS rates significantly differed between patients treated with RFA and HR. Of the 63 patients with tumors 3 cm or smaller treated with HR, only 2 patients (3%) recurred at the resection margin. In contrast, 5 (31%) of the 16 patients treated with RFA with metastasis smaller than 3 cm had recurrence at the RFA site (P = .001) (Figure 1). Thus, the 5-year LRFS rate for patients treated with HR was higher than after treatment with RFA (97% vs 66%, respectively;P<.001) (Figure 3). For patients with small tumors, RFA was also associated with a marked decrease in 5-year OS rates compared with HR (18% vs 72%, respectively; P = .006) (Figure 3). A trend in DFS rate difference was noted, but it was not statistically significant (P = .15).

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