Colorectal Liver Metastasis: Overview of Treatment Paradigm Highlighting the Role of Ablation

Venkat, Shree; Mohan, Pradeep; Gandhi, Ripal

doi:10.2214/ajr.17.18574

Cited by 25 publications

(18 citation statements)

References 58 publications

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“…83,84 Following ablation, repeat imaging should be performed at 4 to 8 weeks as repeat ablation or resection may be an option for patients with early detection of local recurrence. 85…”

Section: Ablationmentioning

confidence: 99%

“…Ablation treatment is typically monitored by temperature readouts or changes in impedance. 85 Several retrospective studies have noted the median overall survival to range from 22 to 74 months, with 5-year overall survival ranging from 14.3 to 48.5% and local recurrence ranging from 15.2 to 69% following RFA. 90 The CLOCC (Chemotherapy þ Local Ablation versus Chemotherapy) trial, a randomized phase II trial, is the only randomized trial performed to date that assessed the efficacy of RFA for CRLM.…”

Section: Ablation Approachmentioning

confidence: 99%

“…The size of the ablation zone can be altered by changing the number of antennae activated simultaneously and by varying the power and time. 85,92,96 While a randomized trial comparing RFA versus MWA for the treatment of CRLMs has not been performed, retrospective studies suggest superior oncological outcomes for MWA. In one matched-cohort analysis that included 254 tumors from 134 patients, 2-year ablation-site recurrence was significantly lower for tumors treated with MWA (7 vs. 18%; p ¼ 0.01).…”

Section: Microwave Ablationmentioning

confidence: 99%

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The Contemporary Role of Resection and Ablation in Colorectal Cancer Liver Metastases

Eskander

Aquina

Ejaz

et al. 2020

Digestive Disease Interventions

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Advances in the field of surgical oncology have turned metastatic colorectal cancer of the liver from a lethal disease to a chronic disease and have ushered in a new era of multimodal therapy for this challenging illness. A better understanding of tumor behavior and more effective systemic therapy have led to the increased use of neoadjuvant therapy. Surgical resection remains the gold standard for treatment but without the size, distribution, and margin restrictions of the past. Lesions are considered resectable if they can safely be removed with tumor-free margins and a sufficient liver remnant. Minimally invasive liver resections are a safe alternative to open surgery and may offer some advantages. Techniques such as portal vein embolization, association of liver partition with portal vein ligation for staged hepatectomy, and radioembolization can be used to grow the liver remnant and allow for resection. If resection is not possible, nonresectional ablation therapy, including radiofrequency and microwave ablation, can be performed alone or in conjunction with resection. This article presents the most up-to-date literature on resection and ablation, with a discussion of current controversies and future directions.

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“…83,84 Following ablation, repeat imaging should be performed at 4 to 8 weeks as repeat ablation or resection may be an option for patients with early detection of local recurrence. 85…”

Section: Ablationmentioning

confidence: 99%

Section: Ablation Approachmentioning

confidence: 99%

Section: Microwave Ablationmentioning

confidence: 99%

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The Contemporary Role of Resection and Ablation in Colorectal Cancer Liver Metastases

Eskander

Aquina

Ejaz

et al. 2020

Digestive Disease Interventions

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“…[8,9] Importantly, the abovementioned practical and theoretical advantages are driving greater adoption of MWA over RFA, not only for HCC but also for liver metastases. [10,11] e interventional radiology staff at our institution unanimously switched from RFA to MWA in December 2014. e availability of data on patient outcomes after ablation with these newer MWA devices (first FDA approved in 2014) is currently limited.…”

Section: Introductionmentioning

confidence: 99%

Early Outcomes with Single-antenna High-powered Percutaneous Microwave Ablation for Primary and Secondary Hepatic Malignancies: Safety, Effectiveness, and Predictors of Ablative Failure

Kapoor

Nisiewicz

Jayavarapu

et al. 2020

JCIS

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Objective: Microwave ablation (MWA) of liver malignancies has gained much traction over the past 5 years. However, MWA carries relatively higher rates of residual disease compared to resection. Likelihood of MWA success is multifactorial and newer devices with more reliable ablation zones are being developed to overcome these drawbacks. This manuscript is a review of our first 100 liver ablations with the newer single antenna high powered MWA system. Materials and Methods: Retrospective chart review of patients that underwent MWA for either primary or secondary hepatic malignancies between March 2015 and July 2016 was conducted. The complete ablation rates, rate of new lesions, complications, and short-term survival were analyzed. Multiple statistical tests, including multivariate regression, were used to assess risk factors for local residual and recurrent disease. Results: Fifty-three patients (median age 61 ± 9 years, 39 males) underwent 100 MWAs. Of the 100 lesions ablated, 76 were hepatocellular cancers (HCCs) and 24 were metastases. Median lesion size was 16 ± 9 mm. Seventy- five of these patients had multifocal disease targeted in the same session. Seventy patients had cirrhosis (median model for end-stage liver disease score 9 ± 3; Child-Pugh B and C in 42%). An 83% complete lesion ablation rate was seen on follow-up imaging with liver protocol magnetic resonance imaging/computed tomography (median follow-up of 1 year). The minor complication rate was 9.4% with no major complications or 30-day mortality. Despite this, evidence of new foci of hepatic disease was found in 47% of patients, the majority (80%) of which were in HCC patients (P < 0.01) and most of these new lesions were in a different hepatic segment (64%). Degree of cirrhosis (P < 0.01), presence of non-alcoholic steatohepatitis (NASH) (P = 0.01) and lesion’s subcapsular location (P = 0.03) was significant predictors of residual disease. With the subset analysis of only HCC lesions larger than 1 cm, only the presence of NASH remained significant. Conclusion: The single probe high power MWA of malignant hepatic lesions is safe and effective with minimal morbidity. Degree of cirrhosis, NASH, and subcapsular location was associated with an increased rate of residual disease on short-term follow-up.

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“…4 These findings were confirmed by several papers that developed a solid awareness about the advantages and the efficacy of thermal ablation (►Table 1). 2,[5][6][7][8][9][10] Further combined approaches such as ablations performed between staged hepatectomies or after neoadjuvant chemotherapy [11][12][13][14][15] have expanded and consolidated their role in the management of CRLMs.…”

mentioning

confidence: 99%

Thermal Ablations for Colorectal Liver Metastases

et al. 2019

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Approximately 25% of colorectal cancers patients will develop hepatic metastases in the course of their disease. Surgical resection of hepatic metastases remains the first treatment choice for these patients, when feasible. However, only approximately 30% of metastatic lesions are resectable at the time of diagnosis. Thermal ablations have played an increasing role over the last few decades in the palliative and curative setting of colorectal liver metastases (CRLMs) in nonsurgical candidates with a liver-predominant disease. Several different techniques have been used to perform image-guided thermal ablations in the liver, including radiofrequency ablation, microwave ablation, cryoablation, and laser thermal ablation. We review the current ablation techniques, image-guidance modalities, indications, and debated topics of image-guided thermal ablation in CRLMs. Moreover, recent results from clinical trials are discussed along with future trends in liver thermal ablations.

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Colorectal Liver Metastasis: Overview of Treatment Paradigm Highlighting the Role of Ablation

Cited by 25 publications

References 58 publications

The Contemporary Role of Resection and Ablation in Colorectal Cancer Liver Metastases

The Contemporary Role of Resection and Ablation in Colorectal Cancer Liver Metastases

Early Outcomes with Single-antenna High-powered Percutaneous Microwave Ablation for Primary and Secondary Hepatic Malignancies: Safety, Effectiveness, and Predictors of Ablative Failure

Thermal Ablations for Colorectal Liver Metastases

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