Liver Metastases: Neoadjuvant Downsizing with Transarterial Chemoembolization before Laser-Induced Thermotherapy

Vogl, Thomas J.; Mack, Martin G.; Balzer, J. O.; Engelmann, K.; Straub, Roland; Eichler, Katrin; Woitaschek, Dirk; Zangos, Stephan

doi:10.1148/radiol.2292021329

Cited by 119 publications

(58 citation statements)

References 48 publications

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“…), RFA was more recently adopted as the most commonly applied ablation method. Other interstitial local ablative approaches have also been applied to liver metas-tases, including therapeutic high-intensity ultrasound ablation [64,65], laser thermotherapy [66,67], and yttrium-90 seed implants [68], but these have not gained widespread acceptance. More recently, thermal ablation using microwave emitting devices has been gaining in popularity [69,70].…”

Section: Combined Local Therapy: Resection Plus Rfamentioning

confidence: 99%

Expanding Criteria for Resectability of Colorectal Liver Metastases

2008

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After completing this course, the reader will be able to:1. Identify the criteria for hepatic resection of colorectal metastases.2. Describe strategies for expanding the number of patients who may potentially benefit from hepatic resection.3. List the factors associated with poor prognosis following hepatic resection.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTSurgical resection is the treatment of choice in patients with colorectal liver metastases, with 5-year survival rates reported in the range of 40%-58%. Over the past 10 years, there has been an impetus to expand the criteria for defining resectability for patients with colorectal metastases. In the past, such features as the number of metastases (three to four), the size of the tumor lesion, and a mandatory 1-cm margin of resection dictated who was "resectable." More recently, the criteria for resectability have been expanded to include any patient in whom all disease can be removed with a negative margin and who has adequate hepatic volume/reserve. Specifically, instead of resectability being defined by what is removed, decisions concerning resectability now center around what will remain after resection. Under this new paradigm, the number of patients with resectable disease can be expanded by increasing/preserving hepatic reserve (e.g., portal vein embolization, two-stage hepatectomy), combining resection with ablation, and decreasing tumor size (preoperative chemotherapy). The criteria for resectability have also expanded to include patients with extrahepatic disease. Rather than being an absolute contraindication to surgery, patients with both intra-and extrahepatic disease should potentially be considered for resection based on strict selection criteria. The expansion of criteria for resectability of colorectal liver metastases requires a much more nuanced and sophisticated approach to the patient with advanced disease. A therapeutic approach that includes all aspects of multidisciplinary and multimodality care is required to select and treat this complex group of patients. The Oncologist 2008;13:51-64

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Section: Combined Local Therapy: Resection Plus Rfamentioning

confidence: 99%

Expanding Criteria for Resectability of Colorectal Liver Metastases

2008

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“…[57][58][59] This suggests that sequential TACE with preoperative PVE could also be potentially beneficial in patients with colorectal metastases. To date, however, no study has reported the using of sequential TACE with preoperative PVE in this category of patients.…”

Section: Sequential Tace and Pvementioning

confidence: 99%

Induction of Tumor Growth After Preoperative Portal Vein Embolization: Is It a Real Problem?

et al. 2008

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Although preoperative portal vein embolization (PVE) is an effective means to increase future remnant liver (FRL) volume, little has been published on possible adverse effects. This review discusses the clinical and experimental evidence regarding the effect of PVE on tumor growth in both embolized and nonembolized liver lobes, as well as potential strategies to control tumor progression after PVE. A literature review was performed using MEDLINE with keywords related to experimental and clinical studies concerning PVE, portal vein ligation (PVL), and tumor growth. Cross-references and references from reviews were also checked. Clinical and experimental data suggest that tumor progression can occur after preoperative PVE in embolized and nonembolized liver segments. Clinical evidence indicating possible tumor progression in patients with colorectal metastases or with primary liver tumors is based on studies with small sample size. Although multiple studies demonstrated tumor progression, evidence concerning a direct increase in tumor growth rate as a result of PVE is circumstantial. Three possible mechanisms influencing tumor growth after PVE can be recognized, namely changes in cytokines or growth factors, alteration in hepatic blood supply and an enhanced cellular host response promoting local tumor growth after PVE. Post-PVE chemotherapy and sequential transcatheter arterial chemoembolization (TACE) before PVE have been proposed to reduce tumor mass after PVE. We conclude that tumor progression can occur after PVE in patients with colorectal metastases as well as in patients with primary liver tumors. However, further research is needed in order to rate this risk of tumor progression after PVE.Preoperative portal vein embolization (PVE) is an accepted intervention in patients requiring major liver resection in whom the estimated future remnant liver (FRL) is too small to allow safe resection.1,2 PVE induces atrophy of the embolized, tumor-bearing liver lobe while compensatory hypertrophy of the nonembolized lobe occurs, thereby increasing FRL volume and function.

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“…TACE achieves downsizing of metastases so that patients become eligible for thermal ablation. 23,24 If the metastasis progresses beyond the inclusion criteria for ablation, TACE can provide an alternative. We applied this combined approach to 162 patients with metastatic lesions larger than 5cm.…”

Section: Discussionmentioning

confidence: 99%

“…In cases of disease progression, TACE was continued or systemic chemotherapy was applied. 25 Systemic and transarterial chemotherapy can be applied simultaneously or can replace one another. Systemic treatment is required if extrahepatic metastases are present.…”

Section: Discussionmentioning

confidence: 99%

Regional Chemotherapy via Transarterial Chemoembolisation in Colorectal Liver Metastases

Vogl¹,

Zangos²,

Jakob³

et al. 2008

European Oncology &Amp; Haematology

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Liver Metastases: Neoadjuvant Downsizing with Transarterial Chemoembolization before Laser-Induced Thermotherapy

Abstract: With repeated TACE, reduction in size of primary unresectable hepatic metastases is achieved in 50.6% of cases and allows local ablative treatments such as MR imaging-guided LITT.

Cited by 119 publications

References 48 publications

Expanding Criteria for Resectability of Colorectal Liver Metastases

Expanding Criteria for Resectability of Colorectal Liver Metastases

Induction of Tumor Growth After Preoperative Portal Vein Embolization: Is It a Real Problem?

Regional Chemotherapy via Transarterial Chemoembolisation in Colorectal Liver Metastases

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