While the five-year survival rate following resection of hepatic metastases from colorectal cancer is 25 to 40 percent, patients with unresectable primary or metastatic hepatic tumors rarely survive. Only 10 to 15 percent of hepatic metastases and up to 15 percent of hepatocellular carcinomas are surgically resectable. Most tumors are too large or are multifocal, or there are technical barriers to removal. Wong and colleagues investigated the use of radiofrequency ablation (RFA), a high-frequency alternating current that causes thermal coagulation and protein denaturation, in the treatment of surgically unresectable hepatic tumors.
The authors treated 122 hepatic tumors in 40 patients. Most tumors (77 percent) were metastases from colorectal cancer. The patients' average age was 63 years, and 65 percent of them were men. The procedures were performed by laparotomy and were combined with hepatic resection in 19 patients. All patients were followed by computed tomographic scan every three to six months for an average of 9.5 months.
Nine patients died of progressive malignancy, but 20 (50 percent) survived with no detectable disease, and 11 survived with recurrent disease. Local recurrence was more common in patients with larger tumors. Eight patients developed complications such as wound infection or chest problems, but no major injuries or complications were attributed to the procedure.
Although this is a small pilot study, the authors conclude that RFA offers hope of prolonged survival or even cure in patients with hepatic tumors that are currently judged to be surgically unresectable.
editor's note: Why should a family physician want to know about an experimental therapy for advanced colorectal cancer? Because this is a common disease, and we play a vital role in its management at all stages of the condition. Approximately 30 percent of the 150,000 new cases of colorectal cancer that occur each year will have distant metastases at diagnosis. As we work with these patients and their families, we must be aware of potential new treatment options and provide pragmatic, expert advice as they seek subspecialist treatment. It is hoped that each advanced case we encounter will lead us to screen more patients in the hope of earlier detection (with associated 95 percent survival rates). Persuading patients to undergo colonoscopy or sigmoidoscopy plus occult blood screening is never easy, but perhaps more acceptable screening modalities will soon be available.—a.d.w.