We thank Takao et al for their interest in our article,1 and the feedback given. Their treatment results of radiofrequency ablation (RFA) for pulmonary metastases from colorectal cancer are similar to the results we reported demonstrating reproducibility in experienced hands. It is important to note that Takao et al highlighted the difficulties of randomizing patients between surgical metastasectomy and RFA for resectable colorectal pulmonary metastases, with patients preferring the nonsurgical treatment approach. The benefits of RFA are obvious, with limited morbidity and quicker recovery times. Consequently, Takao et al converted their trial into a single-arm phase 2 trial of RFA for patients with isolated, resectable colorectal pulmonary metastases and are expecting favorable long-term survival results. Clearly, the results, when available, are likely to be superior to any reported results of RFA for colorectal pulmonary metastases in the literature now given that the setting for which RFA is used is largely for patients with unresectable disease. However, it would be interesting to examine the local recurrence rates and the progression-free survival in their trial and compare them with results from pulmonary metastasectomy. We still advocate surgery as first-line therapy prior to RFA for the management of patients with resectable pulmonary metastases in our center and reserve RFA for patients who refuse surgery or are too frail to tolerate it. Ablation has clearly taken a step forward as part of an interdisciplinary approach to oncological care. RFA is practiced by surgeons and radiologists who have an interest in interventional oncology. It is becoming an acceptable nonsurgical alternative local therapy to treat metastatic cancer. Combining RFA with systemic treatment addresses occult microscopic disease and also allows us to deal with residual disease that would potentially achieve quantifiable gains over systemic treatment alone, which lacks the lethal punch to address the bulky tumor mass.
Terence C. Chua BScMed (Hons), MBBS*, David L. Morris MD, PhD*, * Hepatobiliary and Surgical Oncology Unit, University of New South Wales, Department of Surgery, St. George Hospital, Kogarah, New South Wales, Australia.