RESUMEN
CONTEXT: Scanty reports have focused on FDG-PET after radiofrequency ablation (RFA), for recurrence of hepatic metastases. OBJECTIVE: To assess FDG-PET diagnostic accuracy on detection of recurrent hepatic lesions. METHODS: After a comprehensive search of PubMed and EMBASE, we performed a patient-based diagnostic meta-analysis of post-RFA FDG-PET. RESULTS: Across nine included articles, independent, random-effects sensitivity and specificity were 0.73(0.50-0.88) and 0.85(0.72-0.93), respectively. A symmetrical SROC curve was produced with no significant heterogeneity. Specificity was optimal for surgical RFA and colorectal origin of metastases. CONCLUSION: Synthesis of published evidence suggests PET/CT as an appropriate tool for optimizing post-ablation follow-up.
Asunto(s)
Neoplasias Colorrectales/cirugía , Fluorodesoxiglucosa F18 , Neoplasias Hepáticas/cirugía , Imagen Multimodal , Recurrencia Local de Neoplasia/diagnóstico por imagen , Tomografía de Emisión de Positrones , Radiofármacos , Tomografía Computarizada por Rayos X , Área Bajo la Curva , Ablación por Catéter , Neoplasias Colorrectales/diagnóstico por imagen , Neoplasias Colorrectales/patología , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Recurrencia Local de Neoplasia/prevención & control , Curva ROC , RadiocirugiaRESUMEN
BACKGROUND: Despite the advent of combination chemotherapy regimens achieved within the last decade, long term survival of patients with unresectable metastatic disease from colorectal cancer remains poor. Thermal ablation procedures, including radiofrequency ablation (RFA), are considered feasible options in treating unresectable hepatic tumors either primary (hepatocellular carcinoma) or metastatic, the latter mainly arising from colorectal cancer. Percutaneous access is the least invasive RFA procedure. METHODS & RESULTS: A MEDLINE review unfolded a significant clinical heterogeneity among published series reporting on percutaneous RFA in hepatic metastatic disease from colorectal cancer, regarding study population, optimal time and treatment schemes pre- and post-RFA intervention. Notwithstanding, percutaneous RFA survival figures were consistently better than front line chemotherapy. Furthermore, a pooled analysis of larger series demonstrated a clear benefit in overall survival (HR 0.51, 95% CI 0.44 to 0.58). CONCLUSION: Albeit optimal indications are still pending, percutaneous RFA should nonetheless be considered a viable option in patients with unresectable metastatic disease, as it may prolong survival rates achieved with standard chemotherapy.