Multidisciplinary Treatment With Repeated Thermal Ablation for Multisite Metastatic Colon Cancer in an Elderly...

Patients with stage IV colorectal cancer and multiple distant metastases are generally treated with systemic chemotherapy. However, treatment options may be limited in elderly patients with severe comorbidities or poor performance status. We report a case of long-term disease-free survival after repeated thermal ablation for metastatic colon cancer in an elderly patient who became unfit for further chemotherapy and conventional surgery.

An 81-year-old woman with a history of myocardial infarction and cerebral infarction, who was receiving antithrombotic therapy, was diagnosed with cecal colon cancer with lymph node metastases, six liver metastases, and a giant ovarian metastasis. The tumor was RAS-mutant, BRAF-wild-type, and microsatellite stable. She received three courses of bevacizumab plus capecitabine and oxaliplatin, resulting in stable disease. She subsequently underwent right hemicolectomy, right oophorectomy, left lateral sectionectomy of the liver, and microwave ablation for two liver metastases. Approximately one month after surgery, recurrent cerebral infarction occurred, and her performance status deteriorated from 1 to 3. She declined further chemotherapy and major surgery. Three recurrent liver metastases and one lung metastasis were subsequently treated with percutaneous thermal ablation. Five years after treatment initiation and three years after the final local treatment, she remains alive without disease.

This case illustrates that repeated thermal ablation may provide durable local disease control in carefully selected patients with metastatic colon cancer who are unfit for further chemotherapy or invasive surgery.