Microwave coagulation therapy for multiple hepatic metastases from colorectal carcinoma

Abstract

BACKGROUND Compared with other treatments, microwave coagulation is a relatively less invasive treatment for various kinds of solid tumors. Although its effectiveness in primary hepatocellular carcinoma has been shown, its effectiveness in the treatment of hepatic metastases from colorectal carcinoma has been unclear. The aim of this study was to evaluate its effectiveness in the treatment of multiple hepatic metastases from colorectal carcinoma by comparing this technique with that of hepatic resection. METHODS Thirty patients with multiple metastatic colorectal tumors in the liver who were potentially amenable to hepatic resection were randomly assigned to treatment with microwave coagulation (14 patients) or hepatectomy (16 patients). Tumors in the microwave group were coagulated after laparotomy at an output of 60–100 W for 2–20 minutes under the guide of ultrasonography, whereas tumors in the hepatectomy group were treated with lobectomy, segmentectomy, subsegmentectomy, and/or wedge resection. RESULTS One‐, 2‐, and 3‐year survival rates and mean survival times were 71%, 57%, 14%, and 27 months, respectively, in the microwave group, whereas they were 69%, 56%, 23%, and 25 months, respectively, in the hepatectomy group. The difference between these two groups was statistically not significant (P = 0.83). On the other hand, the amount of intraoperative blood loss in the microwave group (360 ± 230 mL) was smaller than that in the hepatectomy group (910 ± 490 mL, P < 0.05). Blood transfusion was necessary for 6 patients in the hepatectomy group, but it was not necessary in the microwave group. CONCLUSIONS Microwave coagulation therapy is suggested to be equally effective as hepatic resection in the treatment of multiple (two to nine) hepatic metastases from colorectal carcinoma, whereas its surgical invasiveness is less than that of hepatic resection. Cancer 2000;89:276–84. © 2000 American Cancer Society.

Microwave Ablation (MWA): Basics, Technique and Results in Primary and Metastatic Liver Neoplasms – Review Article

“…Patients with up to 5 liver metastases and a size of ≤ 4 cm are eligible candidates for local ablation. As previously mentioned, comparable survival results to surgical resection can be reached using different ablation techniques for colorectal cancer liver metastases [23]. In a retrospective analysis Eng et al treated 49 tumors (0.5 to 5.5 cm in size) in 33 patients who underwent intraoperative MWA of colorectal cancer liver metastases [49].…”

“…A study by Shibata et al compared the survival between surgical resection and MWA of colorectal cancer liver metastases. The 1-, 2-, and 3-year survival rates and mean survival times were 71 %, 57 %, 14 %, and 27 months, respectively, in the microwave group, whereas they were 69 %, 56 %, 23 %, and 25 months, respectively, in the hepatectomy group [23]. Complete tumor ablation near major vessels can be difficult to achieve.…”

Systematic review of 12 years of thermal ablative therapies of non-resectable colorectal cancer liver metastases

“…Of all the studies included in our systematic review, there was only one RCT in the MWA group 13 and one case-control prospective study in the CA group.…”

“…Outcomes of the included studies are demonstrated in Table 6, Table 8. 13,30,53,54 Not all the targeted outcomes were demonstrated or described in each of the included studies: The available data was collected. A compiled summary of the characteristics and outcomes of different modalities is shown in Table 9.…”

Liver tumor ablation: Percutaneous and open approaches

“…Image findings indicative of tumor necrosis include echogenic change on ultrasound, loss of contrast enhancement on CT, and decreased intensity on T2-weighted MRI. Table VIII outlines the outcomes from studies [158,159,221] evaluating MWA for CRLM.…”