CardioVascular and Interventional Radiology

, Volume 41, Issue 11, pp 1727–1734 | Cite as

Pulmonary Thermal Ablation Enables Long Chemotherapy-Free Survival in Metastatic Colorectal Cancer Patients

  • Mariane Fonck
  • Jean-Thomas Perez
  • Vittorio Catena
  • Yves Becouarn
  • Laurent Cany
  • Eric Brudieux
  • Laure Vayre
  • Patrick Texereau
  • Valérie Le Brun-Ly
  • Véronique Verger
  • Véronique Brouste
  • Dominique Bechade
  • Xavier Buy
  • Jean PalussièreEmail author
Clinical Investigation



Chemotherapy (ct) is the preferred treatment option in metastatic colorectal cancer (mCRC). The objective of the study was to determine the overall survival (OS), disease-free survival (DFS) and ct-free survival (CFS) of pulmonary thermal ablation (TA) and its place in the treatment of mCRC.

Patients and methods

All consecutive patients treated (over 11 years) with percutaneous TA for lung metastasis of colorectal origin were reviewed. All sequences of treatments were considered. We determined the OS, DFS and CFS of pulmonary TA.


Two hundred and nine patients underwent 323 TA procedures for 630 lung metastases. Majority of the metastases (71.5%) were unilateral with a median diameter of 10 mm (2–46). A single metastasis was treated in 95 patients (45.5%), and 2–8 in 114 patients (54.5%). One hundred and thirty-two patients (63.2%) had only a single procedure, 77 patients (36.8%) had 2–5 procedures. Following the first TA (n = 209), 125 patients (59.8%) resumed ct. Sixty-four out of the 126 patients presenting lung progression were treated again with TA. The median CFS was 12.2 months (95% CI: 10.3–17.7). Patients with no extra-pulmonary metastases showed a statistically better CFS than those who had extra-pulmonary metastases with a median of 20.9 and 9.2 months, respectively (p < 0.001). Median follow-up and OS were 50 and 67.6 months, respectively.


This study demonstrates, for the first time, that TA enables a CFS of 12.2 months that extended to 20.9 months in patients who presented with lung-only metastases. TA is a viable option for a pause in the therapy of mCRCs.


Lung metastases Colorectal cancer Radiofrequency ablation Thermal ablation 



Chemotherapy-free survival


Confidence interval




Computed tomography


Disease-free survival


Metastatic colorectal cancer


Overall survival


Positron emission tomography-computed tomography


Radiofrequency ablation


Quality of life


Thermal ablation



The authors would like to thank Dr. Ravi Nookala of Institut Bergonié for the medical writing service.

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest.


  1. 1.
    de Baère T, Aupérin A, Deschamps F, Chevallier P, Gaubert Y, Boige V, et al. Radiofrequency ablation is a valid treatment option for lung metastases: experience in 566 patients with 1037 metastases. Ann Oncol. 2015;26(5):987–91.CrossRefGoogle Scholar
  2. 2.
    Yan TD, King J, Sjarif A, Glenn D, Steinke K, Morris DL. Percutaneous radiofrequency ablation of pulmonary metastases from colorectal carcinoma: prognostic determinants for survival. Ann Surg Oncol. 2006;13(11):1529–37.CrossRefGoogle Scholar
  3. 3.
    Van Cutsem E, Cervantes A, Adam R, Sobrero A, Van Krieken JH, Aderka D, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 2016;27(8):1386–422.CrossRefGoogle Scholar
  4. 4.
    Kasi PM, Grothey A. Chemotherapy Maintenance. Cancer J. 2016;22(3):199–204.CrossRefGoogle Scholar
  5. 5.
    Pfannschmidt J, Muley T, Hoffmann H, Dienemann H. Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: experiences in 167 patients. J Thorac Cardiovasc Surg. 2003;126(3):732–9.CrossRefGoogle Scholar
  6. 6.
    Kobayashi H, Mochizuki H, Sugihara K, Morita T, Kotake K, Teramoto T, et al. Characteristics of recurrence and surveillance tools after curative resection for colorectal cancer: a multicenter study. Surgery. 2007;141(1):67–75.CrossRefGoogle Scholar
  7. 7.
    de Baere T, Tselikas L, Yevich S, Boige V, Deschamps F, Ducreux M, et al. The role of image-guided therapy in the management of colorectal cancer metastatic disease. Eur J Cancer. 2017;75:231–42.CrossRefGoogle Scholar
  8. 8.
    Mouli SK, Kurilova I, Sofocleous CT, Lewandowski RJ. The role of percutaneous image-guided thermal ablation for the treatment of pulmonary malignancies. AJR Am J Roentgenol. 2017;209(4):740–51.CrossRefGoogle Scholar
  9. 9.
    Chua TC, Thornbury K, Saxena A, Liauw W, Glenn D, Zhao J, et al. Radiofrequency ablation as an adjunct to systemic chemotherapy for colorectal pulmonary metastases. Cancer. 2010;116(9):2106–14.PubMedGoogle Scholar
  10. 10.
    Ruers T, Van Coevorden F, Punt CJ, Pierie JE, Borel-Rinkes I, Ledermann JA, et al. European Organisation for Research and Treatment of Cancer (EORTC); Gastro-Intestinal Tract Cancer Group; Arbeitsgruppe Lebermetastasen und tumoren in der Chirurgischen Arbeitsgemeinschaft Onkologie (ALM-CAO); National Cancer Research Institute Colorectal Clinical Study Group (NCRI CCSG). Local Treatment of Unresectable Colorectal Liver Metastases: Results of a Randomized Phase II Trial. J Natl Cancer Inst. 2017;109(9).
  11. 11.
    Petre EN, Jia X, Thornton RH, Sofocleous CT, Alago W, Kemeny NE, et al. Treatment of pulmonary colorectal metastases by radiofrequency ablation. Clin Colorectal Cancer. 2013;12(1):37–44.CrossRefGoogle Scholar
  12. 12.
    Gillams A, Khan Z, Osborn P, Lees W. Survival after radiofrequency ablation in 122 patients with inoperable colorectal lung metastases. Cardiovasc Interv Radiol. 2013;36(3):724–30.CrossRefGoogle Scholar
  13. 13.
    Zabaleta J, Aguinagalde B, Lopez I, Fernandez-Monge A, Izquierdo JM, Emparanza JI. Survival after pulmonary metastasectomy in colorectal cancer patients: does a history of resected liver metastases worsen the prognosis? A literature review. Cancer Biol Med. 2017;14(3):281–6.CrossRefGoogle Scholar
  14. 14.
    Tournigand C, Cervantes A, Figer A, Lledo G, Flesch M, Buyse M, et al. OPTIMOX1: a randomized study of FOLFOX4 or FOLFOX7 with oxaliplatin in a stop-and-Go fashion in advanced colorectal cancer–a GERCOR study. J Clin Oncol. 2006;24(3):394–400.CrossRefGoogle Scholar
  15. 15.
    Chibaudel B, Maindrault-Goebel F, Lledo G, Mineur L, André T, Bennamoun M, et al. Can chemotherapy be discontinued in unresectable metastatic colorectal cancer? The GERCOR OPTIMOX2 Study. J Clin Oncol. 2009;27(34):5727–33.CrossRefGoogle Scholar
  16. 16.
    Wasan H, Meade AM, Adams R, Wilson R, Pugh C, Fisher D, et al. Intermittent chemotherapy plus either intermittent or continuous cetuximab for first-line treatment of patients with KRAS wild-type advanced colorectal cancer (COIN-B): a randomised phase 2 trial. Lancet Oncol. 2014;15(6):631–9.CrossRefGoogle Scholar
  17. 17.
    Simkens LHJ, van Tinteren H, May A, ten Tije AJ, Creemers G-JM, Loosveld OJL, et al. Maintenance treatment with capecitabine and bevacizumab in metastatic colorectal cancer (CAIRO3): a phase 3 randomised controlled trial of the Dutch Colorectal Cancer Group. Lancet. 2015;385(9980):1843–52.CrossRefGoogle Scholar
  18. 18.
    Chua TC, Sarkar A, Saxena A, Glenn D, Zhao J, Morris DL. Long-term outcome of image-guided percutaneous radiofrequency ablation of lung metastases: an open-labeled prospective trial of 148 patients. Ann Oncol. 2010;21(10):2017–22.CrossRefGoogle Scholar
  19. 19.
    Yamakado K, Inoue Y, Takao M, Takaki H, Nakatsuka A, Uraki J, et al. Long-term results of radiofrequency ablation in colorectal lung metastases: single center experience. Oncol Rep. 2009;22(4):885–91.CrossRefGoogle Scholar
  20. 20.
    Ferguson J, Alzahrani N, Zhao J, Glenn D, Power M, Liauw W, et al. Long term results of RFA to lung metastases from colorectal cancer in 157 patients. Eur J Surg Oncol. 2015;41(5):690–5.CrossRefGoogle Scholar
  21. 21.
    Ihara H, Gobara H, Hiraki T, Mitsuhashi T, Iguchi T, Fujiwara H, et al. Radiofrequency ablation of lung tumors using a multitined expandable electrode: impact of the electrode array diameter on local tumor progression. J Vasc Interv Radiol. 2016;27:87–95.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • Mariane Fonck
    • 1
  • Jean-Thomas Perez
    • 2
  • Vittorio Catena
    • 2
  • Yves Becouarn
    • 1
  • Laurent Cany
    • 3
  • Eric Brudieux
    • 4
  • Laure Vayre
    • 5
  • Patrick Texereau
    • 6
  • Valérie Le Brun-Ly
    • 7
  • Véronique Verger
    • 8
  • Véronique Brouste
    • 9
  • Dominique Bechade
    • 1
  • Xavier Buy
    • 2
  • Jean Palussière
    • 2
    Email author
  1. 1.Department of Medical OncologyInstitut BergoniéBordeauxFrance
  2. 2.Department of Interventional RadiologyInstitut BergoniéBordeauxFrance
  3. 3.Department of OncologyClinique FranchevillePérigueuxFrance
  4. 4.Department of OncologyCH Pôle de Santé du VilleneuvoisVilleneuve-Sur-LotFrance
  5. 5.Department of OncologyCH Brive Bd Docteur VerlhacBrive-La-GaillardeFrance
  6. 6.Department of OncologyCentre HospitalierMont-De-MarsanFrance
  7. 7.Department of OncologyCHU LimogesLimogesFrance
  8. 8.Department of OncologyCHI du pays de CognacCognacFrance
  9. 9.Department of Clinical and Epidemiological ResearchInstitut BergoniéBordeauxFrance

Personalised recommendations