The Role of Percutaneous Ablation in the Management of Colorectal Cancer Liver Metastatic Disease

Abstract

Approximately 50% of colorectal cancer patients will develop metastases during the course of the disease. Local or locoregional therapies for the treatment of liver metastases are used in the management of oligometastatic colorectal liver disease, especially in nonsurgical candidates. Thermal ablation (TA) is recommended in the treatment of limited liver metastases as free-standing therapy or in combination with surgery as long as all visible disease can be eradicated. Percutaneous TA has been proven as a safe and efficacious therapy offering sustained local tumor control and improved patient survival. Continuous technological advances in diagnostic imaging and guidance tools, the evolution of devices allowing for optimization of ablation parameters, as well as the ability to perform margin assessment have improved the efficacy of ablation. This allows resectable small volume diseases to be cured with percutaneous ablation. The ongoing detailed information and increasing understanding of tumor biology, genetics, and tissue biomarkers that impact oncologic outcomes as well as their implications on the results of ablation have further allowed for treatment customization and improved oncologic outcomes even in those with more aggressive tumor biology. The purpose of this review is to present the most common indications for image-guided percutaneous ablation in colorectal cancer liver metastases, to describe technical considerations, and to discuss relevant peer-reviewed evidence on this topic. The growing role of imaging and image-guidance as well as controversies regarding several devices are addressed.

Health-Related Quality of Life in Metastatic Colorectal Cancer Patients Treated with Curative Resection and/or Local Ablative Therapy or Systemic Therapy in the Finnish RAXO-Study

“…It is frequently combined with perioperative chemotherapy since this reduces recurrence rates [ 41 ]. Local ablative treatment (LAT) is an acceptable alternative therapy, sometimes the only possible treatment, for patients who are poor candidates for surgery and for patients with post-metastasectomy recurrence [ 3 , 42 , 43 , 44 , 45 , 46 ], the main inclusion criteria for LAT only strategy in the RAXO study. It is also often combined with metastasectomy to obtain a radical procedure when surgery cannot leave a sufficient amount of normal liver behind [ 42 ], constituting the majority of patients with LAT in this study.…”

“…The CLOCC trial compared systemic therapy with or without radiofrequency ablation and demonstrated that adding a local treatment might prolong OS in patients with non-resectable CRC liver metastases [ 48 ]; contrary to the aim of cure with LAT in this study. Currently, there is no clear evidence supporting the superiority of one LAT technique over the other [ 43 ]. In oligometastatic mCRC, LAT of lung or liver metastases offers both disease-free and chemotherapy-free intervals [ 3 ] with a favourable safety profile [ 43 , 44 , 45 , 46 ], which may contribute to better QoL compared with systemic therapy only [ 49 ].…”

“…Currently, there is no clear evidence supporting the superiority of one LAT technique over the other [ 43 ]. In oligometastatic mCRC, LAT of lung or liver metastases offers both disease-free and chemotherapy-free intervals [ 3 ] with a favourable safety profile [ 43 , 44 , 45 , 46 ], which may contribute to better QoL compared with systemic therapy only [ 49 ]. In our study, being the tradition among Finnish liver surgeons, LAT was mainly used in combination with metastasectomy to obtain macroscopic removal of all visible tumour if this was not possible with surgery only, and only seven out of 31 patients had LAT only.…”

The Increasing Role of CT-Guided Cryoablation for the Treatment of Liver Cancer: A Single-Center Report

“…Radiofrequency ablation (RFA) is the most clinically verified and used ablation modality, although it has specific limitations. Alternate energy-based technologies using thermal (hot or cold) effect for focal tumor ablation have been recently introduced in clinical use, namely microwave ablation (MWA), cryoablation (CrA), high-intensity focused ultrasound (HIFU), laser therapy, and irreversible electroporation (IRE) [ 4 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ].…”

Percutaneous Navigation under Local Anesthesia for Computed Tomography-Guided Microwave Ablation of Malignant Liver Lesions Located in the Hepatic Dome

“…Percutaneous ablation of primary and secondary liver lesions constitutes a well-established therapeutic technique for the management of hepatocellular carcinoma or hepatic metastases of various neoplasmatic origin [ 1 , 2 , 3 ]. Almost all diagnostic methods have been used either solely or in combination (with or without fusion imaging) for ablation guidance [ 4 ]. In the vast majority of ablation sessions, a conventional manual free-hand approach is performed; more recently, however, a stereotactic computer-assisted navigation has been applied, aiming to improve the precision of the needle placement [ 5 , 6 , 7 , 8 , 9 , 10 ].…”