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Percutaneous Cryoablation of Metastatic Lesions from Colorectal Cancer: Efficacy and Feasibility with Survival and Cost-Effectiveness Observations.

Bang HJ, Littrup PJ, Currier BP, Goodrich DJ, Choi M, Heilbrun LK, Goodman AC - ISRN Minim Invasive Surg (2012)

Bottom Line: Estimates of MCA costs per LYG were compared to historical values for systemic therapies.Median overall-survival (OS) was 23.6 months with an estimated 3-year survival rate of ~30%.Even as an adjunct to systemic therapies, MCA appeared cost-effective, with apparent increased survival.

View Article: PubMed Central - PubMed

Affiliation: Wayne State University, Detroit, MI 48201, USA ; Department of Radiology, Wayne State University, 22473 Milner Street, St. Clair Shores, MI 48081, USA.

ABSTRACT

Purpose: To assess feasibility, complications, local tumor recurrences, overall survival (OS) and estimates of cost-effectiveness for multi-site cryoablation (MCA) of oligo-metastatic colorectal cancer (mCRC) in a prospective study.

Materials and methods: 111 CT and/or US-guided percutaneous MCA procedures were performed on 151 tumors in 59 oligo mCRC patients. Mean patient age was 63 years (range 21-92 years), consisting of 29 males and 30 females. Tumor location was grouped according to common metastatic sites. Median OS was determined using the Kaplan-Meier. Estimates of MCA costs per LYG were compared to historical values for systemic therapies.

Results: A mean 1.9 MCAs per patient were performed with a median clinical follow-up of 12 months. Major complication and local recurrence rates were 8% (9/111) and 12% (18/151), respectively. Median overall-survival (OS) was 23.6 months with an estimated 3-year survival rate of ~30%. Cryoablation remained cost effective with or without the presence of systemic therapies, with an adjunctive cost-effectiveness ratio (ACER) of $39,661-$85,580 per LYG.

Conclusions: Multi-site cryoablation had very low complication and local recurrence rates, and was able to provide local control even for diverse soft tissue locations. Even as an adjunct to systemic therapies, MCA appeared cost-effective, with apparent increased survival.

No MeSH data available.


Related in: MedlinePlus

The Kaplan-Meier estimate of overall survival (OS) in the 59 study eligible patients. The dashed lines represent the 95% confidence interval (CI) about each successive estimate of the survival rate. The median OS was 24.8 months (95% CI, 18.3–36.5 months) for patients who received chemotargeted therapy following their first MCA procedure, and 23.5 months (95% CI, 14.2–34.1 months) for patients who only received best supportive care following first MCA. The 2- and 3-year OS rate for the chemo-targeted group was 52% (95% CI, 29%–75%) and 33% (95% CI, 9%–56%), respectively. For the BSC only group, the 2- and 3-year OS rate was 44% (95% CI, 25%–63%) and 22% (95% CI, 3%–41%), respectively.
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Figure 5: The Kaplan-Meier estimate of overall survival (OS) in the 59 study eligible patients. The dashed lines represent the 95% confidence interval (CI) about each successive estimate of the survival rate. The median OS was 24.8 months (95% CI, 18.3–36.5 months) for patients who received chemotargeted therapy following their first MCA procedure, and 23.5 months (95% CI, 14.2–34.1 months) for patients who only received best supportive care following first MCA. The 2- and 3-year OS rate for the chemo-targeted group was 52% (95% CI, 29%–75%) and 33% (95% CI, 9%–56%), respectively. For the BSC only group, the 2- and 3-year OS rate was 44% (95% CI, 25%–63%) and 22% (95% CI, 3%–41%), respectively.

Mentions: The Kaplan-Meier survival curve is shown in Figure 4. The median survival time from patients undergoing cryoablation procedures was 23.6 months from the time of the procedure. Projected three-year survival rate was determined to be ~30% for our MCA patients. Figure 5 displays the median survival for patients who received either chemotargeted therapy after MCA versus those who only received best supportive care. The chemotargeted group displayed a median survival of 24.8 months with a 3-year OS rate of 33%, while the BSC group had a median survival of 23.5 months and a 3-year OS rate of 22%.


Percutaneous Cryoablation of Metastatic Lesions from Colorectal Cancer: Efficacy and Feasibility with Survival and Cost-Effectiveness Observations.

Bang HJ, Littrup PJ, Currier BP, Goodrich DJ, Choi M, Heilbrun LK, Goodman AC - ISRN Minim Invasive Surg (2012)

The Kaplan-Meier estimate of overall survival (OS) in the 59 study eligible patients. The dashed lines represent the 95% confidence interval (CI) about each successive estimate of the survival rate. The median OS was 24.8 months (95% CI, 18.3–36.5 months) for patients who received chemotargeted therapy following their first MCA procedure, and 23.5 months (95% CI, 14.2–34.1 months) for patients who only received best supportive care following first MCA. The 2- and 3-year OS rate for the chemo-targeted group was 52% (95% CI, 29%–75%) and 33% (95% CI, 9%–56%), respectively. For the BSC only group, the 2- and 3-year OS rate was 44% (95% CI, 25%–63%) and 22% (95% CI, 3%–41%), respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4301442&req=5

Figure 5: The Kaplan-Meier estimate of overall survival (OS) in the 59 study eligible patients. The dashed lines represent the 95% confidence interval (CI) about each successive estimate of the survival rate. The median OS was 24.8 months (95% CI, 18.3–36.5 months) for patients who received chemotargeted therapy following their first MCA procedure, and 23.5 months (95% CI, 14.2–34.1 months) for patients who only received best supportive care following first MCA. The 2- and 3-year OS rate for the chemo-targeted group was 52% (95% CI, 29%–75%) and 33% (95% CI, 9%–56%), respectively. For the BSC only group, the 2- and 3-year OS rate was 44% (95% CI, 25%–63%) and 22% (95% CI, 3%–41%), respectively.
Mentions: The Kaplan-Meier survival curve is shown in Figure 4. The median survival time from patients undergoing cryoablation procedures was 23.6 months from the time of the procedure. Projected three-year survival rate was determined to be ~30% for our MCA patients. Figure 5 displays the median survival for patients who received either chemotargeted therapy after MCA versus those who only received best supportive care. The chemotargeted group displayed a median survival of 24.8 months with a 3-year OS rate of 33%, while the BSC group had a median survival of 23.5 months and a 3-year OS rate of 22%.

Bottom Line: Estimates of MCA costs per LYG were compared to historical values for systemic therapies.Median overall-survival (OS) was 23.6 months with an estimated 3-year survival rate of ~30%.Even as an adjunct to systemic therapies, MCA appeared cost-effective, with apparent increased survival.

View Article: PubMed Central - PubMed

Affiliation: Wayne State University, Detroit, MI 48201, USA ; Department of Radiology, Wayne State University, 22473 Milner Street, St. Clair Shores, MI 48081, USA.

ABSTRACT

Purpose: To assess feasibility, complications, local tumor recurrences, overall survival (OS) and estimates of cost-effectiveness for multi-site cryoablation (MCA) of oligo-metastatic colorectal cancer (mCRC) in a prospective study.

Materials and methods: 111 CT and/or US-guided percutaneous MCA procedures were performed on 151 tumors in 59 oligo mCRC patients. Mean patient age was 63 years (range 21-92 years), consisting of 29 males and 30 females. Tumor location was grouped according to common metastatic sites. Median OS was determined using the Kaplan-Meier. Estimates of MCA costs per LYG were compared to historical values for systemic therapies.

Results: A mean 1.9 MCAs per patient were performed with a median clinical follow-up of 12 months. Major complication and local recurrence rates were 8% (9/111) and 12% (18/151), respectively. Median overall-survival (OS) was 23.6 months with an estimated 3-year survival rate of ~30%. Cryoablation remained cost effective with or without the presence of systemic therapies, with an adjunctive cost-effectiveness ratio (ACER) of $39,661-$85,580 per LYG.

Conclusions: Multi-site cryoablation had very low complication and local recurrence rates, and was able to provide local control even for diverse soft tissue locations. Even as an adjunct to systemic therapies, MCA appeared cost-effective, with apparent increased survival.

No MeSH data available.


Related in: MedlinePlus