What is the success rate of radiofrequency ablation (RFA) in treating liver metastases (mets) in breast cancer patients?

Radiofrequency Ablation Success Rate for Liver Metastases in Breast Cancer

Radiofrequency ablation (RFA) for breast cancer liver metastases demonstrates technical success rates of 92-97% but variable long-term outcomes, with median survival ranging from 26-58 months depending on patient selection criteria. 1, 2

Technical Success and Local Control

• RFA achieves high technical success rates of 92-97% for breast cancer liver metastases, with primary technique effectiveness of 96% 2, 1
• Local tumor progression rates range from 7.8-25% of treated lesions during follow-up periods 3, 4
• Secondary technique effectiveness (accounting for retreatment of local recurrences) reaches approximately 86.5% 2

Survival Outcomes

• Median overall survival after RFA ranges from 26-58.6 months, with 5-year survival rates of 11-32% 1, 2, 4
• From initial diagnosis of liver metastases (before RFA), median survival is approximately 42 months 4
• Quality-adjusted survival appears improved over no intervention, particularly for smaller tumors (<3 cm) 5

Prognostic Factors Affecting Success

• Tumor size is a critical factor: Lesions <2.5-3 cm have significantly better outcomes than larger tumors 1, 4
  • Tumors <3 cm show local recurrence rates of 9.3% versus 8.3% for tumors >5 cm 3
• Positive estrogen receptor status is associated with improved survival after RFA 1
• Absence of extrahepatic disease (except isolated bone metastases) significantly improves survival 2, 1
• Ablation margin size >10 mm results in lower local tumor progression rates 1

Patient Selection Criteria

• Best candidates for RFA include patients with:
  • Tumor size <3 cm in diameter 1, 5
  • Single or limited number of liver metastases (typically <5) 2, 4
  • Disease confined to the liver or stable extrahepatic disease 4
  • Positive estrogen receptor status 1
  • No visceral extrahepatic disease (isolated bone metastases do not negatively impact outcomes) 2

Comparison to Other Treatment Approaches

• Surgical resection of liver metastases is associated with higher survival than RFA for larger tumors, but is often not feasible in many patients 5
• Less than half of patients with liver metastases are candidates for surgical resection, even after adjuvant chemotherapy 5
• RFA may provide better quality-adjusted survival than surgery for smaller tumors (<3 cm) 5
• Without any intervention, median survival for breast cancer patients with liver metastases ranges from 3-15 months 5, 6

Common Pitfalls and Considerations

• Tumor location near major vessels may limit complete ablation and increase risk of local recurrence 5
• New intrahepatic metastases develop in 53-55% of patients despite successful local control of treated lesions 1, 4
• RFA should be considered as an adjunct to systemic therapy rather than a standalone treatment 7
• The benefit of cytoreductive procedures like RFA may include immunologic benefits and increased effectiveness of chemotherapy by reducing tumor burden 5

Practical Application

• RFA is most appropriate for patients who have failed or had incomplete response to systemic therapy 4
• Regular follow-up with contrast-enhanced imaging is essential to detect local recurrence or new metastases 2, 4
• Multiple RFA sessions may be required for patients who develop new metastases during follow-up 1