Radiofrequency ablation in the treatment of liver metastases from colorectal cancer

Cirocchi, Roberto; Trastulli, Stefano; Boselli, Carlo; Montedori, Alessandro; Cavaliere, Davide; Parisi, Amilcare; Noya, Giuseppe; Abraha, Iosief

doi:10.1002/14651858.cd006317.pub3

Cited by 89 publications

(72 citation statements)

References 71 publications

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“…The question of where ablation fits in the overall management of patients with metastatic colorectal cancer is still being debated. In the last few years there have been numerous reviews of the ablation literature [13][14][15][16][17][18][19][20][21][22][23][24][25][26]. All of these have concluded that there is insufficient data, in particular randomised controlled trial (RCT) data, and as a result have had difficulty providing recommendations on the role of ablation.…”

Section: Introductionmentioning

confidence: 99%

Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, the interventional oncology sans frontières meeting 2013

et al. 2015

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Objectives Previous attempts at meta-analysis and systematic review have not provided clear recommendations for the clinical application of thermal ablation in metastatic colorectal cancer. Many authors believe that the probability of gathering randomised controlled trial (RCT) data is low. Our aim is to provide a consensus document making recommendations on the appropriate application of thermal ablation in patients with colorectal liver metastases. Methods This consensus paper was discussed by an expert panel at The Interventional Oncology Sans Frontières 2013. A literature review was presented. Tumour characteristics, ablation technique and different clinical applications were considered and the level of consensus was documented.Eur Radiol (2015) Results Specific recommendations are made with regard to metastasis size, number, and location and ablation technique. Mean 31 % 5-year survival post-ablation in selected patients has resulted in acceptance of this therapy for those with technically inoperable but limited liver disease and those with limited liver reserve or co-morbidities that render them inoperable.Conclusions In the absence of RCT data, it is our aim that this consensus document will facilitate judicious selection of the patients most likely to benefit from thermal ablation and provide a unified interventional oncological perspective for the use of this technology. Key Points• Best results require due consideration of tumour size, number, volume and location.• Ablation technology, imaging guidance and intraprocedural imaging assessment must be optimised.• Accepted applications include inoperable disease due to tumour distribution or inadequate liver reserve.• Other current indications include concurrent co-morbidity, patient choice and the test-of-time approach.• Future applications may include resectable disease, e.g. for small solitary tumours.

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Section: Introductionmentioning

confidence: 99%

Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, the interventional oncology sans frontières meeting 2013

et al. 2015

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“…The prolonged survival times of patients have highlighted the importance of local therapy for CRC and limited metastatic disease. In patients who are unfit for surgery, alternative local therapeutic approaches, including radiofrequency ablation (RFA), are available to treat liver metastases; these approaches are minimally invasive and can achieve good local control (8,9). However, their indication is currently limited to relatively small tumors that are located far away from critical structures (8,9).…”

Section: Introductionmentioning

confidence: 99%

Effect of primary tumor location and tumor size on the response to radiotherapy for liver metastases from colorectal cancer

et al. 2017

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Abstract. Metastatic liver tumors (MLTs) from colorectal cancer (CRC) are often treated with stereotactic body radiation therapy (SBRT). The present study aimed to examine the predictive factors for response of MLTs to SBRT. A total of 39 MLTs from 24 patients with CRC were retrospectively analyzed. Radiotherapy for MLT was typically performed with a prescribed dose equivalent to a biologically effective dose (BED) 10 of 100 Gy. The median follow-up period was 16 months (range, 5-64 months). The median prescribed dose and total BED 10 were 56 Gy (range, 45-72 Gy) and 97.5 Gy (range, 71.7-115.5 Gy), respectively, in a median of 8 fractions (range, 4-33 fractions). The 1-and 2-year local control rates were 67.2 and 35.9%, respectively. For patients with MLT treated with ablative SBRT (BED 10 ≥100 Gy in ≤5 fractions), the 1-and 2-year local control rates were 83.3 and 62.5%, respectively. Univariate analysis showed that primary tumor location (left-sided colon), maximum tumor diameter (≤30 mm) and ablative SBRT (BED 10 ≥100 Gy in ≤5 fractions) were significantly associated with improved local control (P=0.0058, P=0.0059 and P=0.0268, respectively). Multivariate analysis showed that tumor diameter was significantly associated with improved local control (P=0.0314). In addition, patients who received ablative SBRT had significantly prolonged overall survival times compared with those treated with non-ablative SBRT (P= 0.0261). To conclude, tumors ≤30 mm that can be treated with ablative SBRT are associated with good local control rates. The primary tumor location may affect the radiosensitivity of MLTs. IntroductionPatients with colorectal cancer (CRC) often have metastases at initial presentation or during follow-up (1,2). The liver is one of the most frequent sites of metastasis (1,2). Newly developed chemotherapeutic agents, including targeted therapies, have improved the progression-free and overall survival times of patients with metastatic CRC (3,4). There is also evidence supporting the benefit of surgery to treat metastases from CRCs, with surgery improving overall survival time (5-7). The prolonged survival times of patients have highlighted the importance of local therapy for CRC and limited metastatic disease. In patients who are unfit for surgery, alternative local therapeutic approaches, including radiofrequency ablation (RFA), are available to treat liver metastases; these approaches are minimally invasive and can achieve good local control (8,9). However, their indication is currently limited to relatively small tumors that are located far away from critical structures (8,9).Modern radiotherapeutic techniques, including intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT), have recently become more frequently utilized to curatively treat limited metastatic tumors (10-14). SBRT, also termed stereotactic ablative radiation therapy, is a proven curative treatment for medically inoperable small tumors in the lung and liver; it delivers highly conformal radiation in a ...

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“…Tumor eradication is the main contributor to this improvement, and therefore surgical resection is generally considered the gold standard for local treatment of patients with CRLM, although only a minority of these patients are primarily eligible for surgery [31]. Neo-adjuvant chemotherapeutics are able to downstage metastases and increase the number of patients in which surgical resection is possible [32].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Ablative Radiotherapy to Treat Colorectal Liver Metastases: Ready for Prime-Time?

Nielsen¹

2016

J Liver

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Radiofrequency ablation in the treatment of liver metastases from colorectal cancer

Cited by 89 publications

References 71 publications

Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, the interventional oncology sans frontières meeting 2013

Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, the interventional oncology sans frontières meeting 2013

Effect of primary tumor location and tumor size on the response to radiotherapy for liver metastases from colorectal cancer

Stereotactic Ablative Radiotherapy to Treat Colorectal Liver Metastases: Ready for Prime-Time?

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