Reuters Health Information (2004-10-26): Laser ablation of liver metastases extends breast cancer survival Clinical
Laser ablation of liver metastases extends breast cancer survival
Last Updated: 2004-10-26 9:45:26 -0400 (Reuters Health)
NEW YORK (Reuters Health) - A method for ablating
breast cancer metastases to the liver, which can be performed on an
outpatient basis, is as effective as resection for extending survival,
German researchers report.
The technique, magnetic resonance imaging-guided laser-induced
interstitial thermotherapy (LITT), extended survival a mean 4.9 years
after diagnosis in a series of 232 breast cancer patients with a total
of 578 liver metastases, researchers report in the November issue of
Radiology.
The question of whether such metastases should be removed surgically
is still under discussion, Dr. Martin G. Mack of University Hospital
Frankfurt and colleagues note. But recent small studies suggest
resection can significantly extend survival for some breast cancer
patients. While breast cancer that has spread to the liver generally
indicates advanced disease with a poor prognosis, they add, metastases
can be confined to the liver in from 5% to 12% of patients.
Average survival of breast cancer patients after diagnosis of liver
metastases is 4 to 8 months, Dr. Mack and colleagues note. With
systemic chemotherapy and hormonal treatment, the current "mainstay" of
treatment for these patients, they add, survival averages 4 to 17
months.
Inclusion criteria for the current study were five or fewer liver
metastases, none larger than 5 cm in diameter. The five major
indications for MR-guided LITT were recurrence of tumor after partial
resection (8.2%), general contraindications to surgery (2.6%),
metastases to both lobes of the liver (45.2%), or refusal of surgery
(25%).
Local tumor progression was seen in fewer than 5% of patients 6
months after LITT, while no additional local tumor growth was seen
after 6 months. Average survival after the first LITT treatment was 4.2
years, and the complication rate was low.
LITT is less invasive and less expensive than surgery, Dr. Mack and
colleagues note, and it does not preclude the simultaneous use of
chemotherapy or hormone therapy. "Furthermore, the release of growth
factors after resection has to be discussed, as well as the possibility
for potentiating intrahepatic growth of metastases," they add. Minimal
loss of liver parenchyma during LITT makes such effects unlikely with
this procedure, while the less-invasive technique will also not trigger
the temporary immune suppression seen with major surgery.
Bone metastases should not be a contraindication to the procedure,
the researchers add, because their study found no significant
difference in survival after LITT between patients with and without
these metastases.
"In summary, MR-guided LITT is a safe and effective treatment for
well-selected patients with liver metastases from breast cancer and is
improving the survival of the patients," they conclude. "A major
advantage of MR-guided LITT is that it can be easily performed with
local anesthesia in an outpatient setting and has a low complication
rate."
Radiology 2004;233:400-409.
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