Does radiofrequency ablation of unresectable colorectal liver metastases prolong long-term survival?

Ten-year follow-up results of the randomized phase II EORTC 40004 CLOCC study, published in JNCI , demonstrated that the ablation by radiofrequency of unresectable liver metastases in colorectal cancer patients can prolong overall survival in these patients.

The study included 119 patients in 22 centers in Europe, randomized to receive either chemotherapy alone, or radiofrequency ablation with or without resection in addition to chemotherapy. Patients were eligible only when all liver lesions could be fully treated by either radiofrequency ablation alone or combined treatment that consisted of resection of resectable lesions and radiofrequency ablation of the remaining unresectable lesions. After 10 years of follow-up, results showed that patients with combined treatment had better overall survival than those with only chemotherapy:

Three, five and eight-year overall survival rates were, 56.9%, 43.1%, 35.9% respectively in the combined modality arm, and 55.2%, 30.3%, 8.9% respectively in the systemic treatment arm.

In addition, median progression-free survival was also improved in the combined arm at 16.8 months, compared to 9.9 months in the systemic arm. “Although common practice has been to perform tumour ablation through radiofrequency in these types of metastases, there was until now no science-based evidence to demonstrate the long-term benefit of this approach,” said Dr Théo Ruers, lead investigator for the study. “This study provides confirmation that patients not eligible for surgery can greatly benefit from a more vigorous treatment combining systemic and local intervention.”

The results of the study strongly suggest combining aggressive local tumour ablation with chemotherapy as standard of care for unresectable colorectal liver metastases can considerably change the outcome for these patients, improving overall survival.