Living Longer: Colon Cancer Patients Gain Time With Radiofrequency Ablation Treatment

1. Living Longer: Colon Cancer Patients Gain Time With Radiofrequency Ablation Treatment CT Sofocleous, EN Petre, M Gonen, KT Brown, RH Thornton, AM Covey, LA Brody, W Alago, M D'Angelica, SB Solomon, Y Fong, NE Kemeny.Memorial Sloan-Kettering Cancer Center, New York, NY Abstract 107: “Radiofrequency Ablation of Recurrent Colorectal Cancer Hepatic Metastases After Hepatectomy” @ www.SIRmeeting. 35th Annual Scientific Meeting March 13–18, 2010, Tampa, FL.

2. Facts about Colon Cancer • Second leading cause of cancer-related death in the United States. • 150,000 new patients diagnosed each year. • Half of these patients will have cancer spread to their liver (liver metastases) at some point during the course of their disease. • Surgery is considered the best treatment for liver metastases but the majority of the patients are not candidates for surgery.  • “In those (<25%) who undergo surgery, recurrence (a new spot of cancer coming back) is a serious problem. • Traditionally chemotherapy has been the only therapy.

3. Treatment for Colon Cancer Liver Metastases Surgery (10-25%) Chemotherapy: systemic / Local IR Treatment -Ablation -RFA, Cryo, other - Radioembolization - Chemoembolization sofoclec@mskcc.org

4. Interventional Treatment NO CUTS Minimally Invasive: Needles, Catheters Imaging Guidance FEWER complications/ Side effects Fast Recovery. GO HOME SAME DAY!

6. Radiofrequency Ablation A special Needle (electrode is placed and destroys the tumor locally in the liver with minimal effect on the surrounding normal tissue.

7. How does RF work? • Pt becomes electrical circuit. • Generator produces AC at 300-500 kHz (RF range). • Ionic agitation. • Frictional heating. • Protein denaturation, desiccation, coagulation necrosis. • Impedance rises.

8. Thermal Ablation Cooking with Heat • Heat induced cell death: • 48 oC: in 45 min. • 50-52 oC: after 4-6 min. • > 60 oC: Instantaneous cell death. • 100-110 oC: Vaporization, carbonization, charring.

9. Ablation Needle/Electrode: Shape of Burn sofoclec@mskcc.org

10. Ablation Changes under the Microscope sofoclec@mskcc.org

11. Who is a Good Patient For Ablation • Small Number of Tumors • Small Size of Tumor • Treatment of new tumors or enlarging Tumors after surgery or chemotherapy • Traditionally Ablation has been offered to Patients that cannot have Surgery • Ideal: Solitary Tumor < 3 cm

12. 2010: Surgery vs. Ablation for CLM

13. Patients that have tumor recurrence in their liver after surgery have limited therapy options. Those with less than 3 tumors under 5 cm each may benefit from ablation. “Radiofrequency Ablation of Recurrent Colorectal Cancer Hepatic Metastases After Hepatectomy.”

14. “Radiofrequency Ablation of Recurrent Colorectal Cancer Hepatic Metastases After Hepatectomy.” • We ablated 71 CLM that developed after liver surgery in 56 patients. We calculated: • Successful ablation: Burn size covering the entire tumor on 4-6 week post-treatment CT • Complications • Cancer coming back at the site of ablation: local tumor progression (LTP) and • Overall patient survival

15. Risk Factors: Modified clinical risk score (CRS) • Tumor Size (>3 cm). • Disease Free Interval (<12 months). • Number of tumors > 1. • LN + primary.

16. Follow-up Imaging: Success /No LTP 4 weeks 24 months 47 months PRE

17. Repeat Ablation Treats Tumor Coming Back (*includes all the ablations performed for the same target tumor

18. Tumor-free Interval by CRS p<0.01

19. Overall Patients Survival after RF Additional Length of Life after Failure of Surgery

20. Overall Survival by CRS p=0.03

21. Ablation with local chemotherapy

22. Conclusion: • RF ablation can treat colon cancer liver metastases that come back after surgery. • This can significantly prolong life of patients with limited treatment options. • The combination of a low clinical risk score, surveillance with imaging and repeat ablation to treat LTP are associated with better outcomes