Repeat ablation and single-session ablation in patients with multiple colorectal cancer liver metastases after chemotherapy failure.

BACKGROUND

The feasibility and safety of radiofrequency ablation (RFA) for oligometastatic colorectal liver metastases (CRLM) have been well established. However, the role of RFA in multiple metastases after first-line chemotherapy failure remains underexplored.

AIM: To assess long-term survival and factors affecting outcomes of RFA in patients with multiple refractory CRLM.

METHODS

A retrospective study was conducted on patients who underwent ablation of CRLM at our institution between January 2015 and June 2024. A total of 80 patients were included, with 42 individuals receiving single-session ablation and 38 underwent repeat ablation. Enhanced computed tomography imaging was utilized to evaluate procedural efficacy 24 hours post-RFA, followed by follow-up scans every 3-4 months. Progression-free survival (PFS) and overall survival (OS) rates were compared at endpoint using Kaplan-Meier curves. Cox regression was used to identify the factors associated with OS and PFS.

RESULTS

The technical success rate was recorded at 98.7%. At endpoint, 42 (52.5%) patients achieved tumor-free survival, while 28 (35%) remained alive with residual tumors present. No significant OS/PFS differences existed between single-session (median follow-up 29.5 months, median PFS 24.5 months) and repeat ablation (30 months, 14 months) cohorts (P > 0.05). Multivariate analysis showed that larger tumor size (P < 0.001) and older age (P = 0.01) were associated with worse OS. The median PFS was 13.5 months, with tumor size emerging as the only independent predictor (P = 0.04).

CONCLUSION

For patients with multiple refractory CRLM, both single-session ablation and repeat ablation can increase the proportion of patients achieving tumor-free status. However, careful consideration is necessary for ablation of metastases larger than 2.7 cm.