Thermal Ablation in the Management of Colorectal Cancer Patients with Oligometastatic Liver Disease

Abstract

Background: Surgical resection of limited colorectal liver disease improves long-term survival and can be curative in a subset of selected cases. Image-guided percutaneous ablation therapies have emerged as safe and effective alternative options for selected patients with unresectable colorectal liver metastases (CLM) that can be ablated with margins. Ablation causes focal destruction of tissue and has increasingly been shown to provide durable eradication of tumors. Methods: A selective review of literature was conducted in PubMed, focusing on recent studies reporting on the safety, efficacy, and long-term outcomes of percutaneous ablation modalities in the treatment of CLM. The present work gives an overview of the different ablation techniques, their current clinical indications, and reported outcomes from most recently published studies. The ‘test of time' concept for using ablation as a first local therapy is also described. Results: There are several thermal ablative tools currently available, including radiofrequency ablation (RFA), microwave ablation, and cryoablation. Most data to date originated from the application of RFA. Adjuvant thermal ablation in the treatment of oligometastatic colon cancer liver disease offers improved oncologic outcomes. The ideal CLM amenable to percutaneous ablation is a solitary tumor with the largest diameter up to 3 cm that can be completely ablated with a sufficient margin. 5-year overall survival rates up to 70% after ablation of unresectable CLM have been reported. Pathologic confirmation of complete tumor necrosis with margins over 5 mm provides best long-term local tumor control by thermal ablation. Conclusion: Current evidence suggests that percutaneous ablation as adjuvant to chemotherapy improves oncologic outcomes of patients with CLM. For small tumors that can be ablated completely with clear margins, percutaneous ablation may offer outcomes similar to those of surgery.

Multidisciplinary Tumor Board Recommendations for Oligometastatic Malignancies: A Prospective Single-Center Analysis

“…Data on oligometastases of lung cancer have frequently been reported [21,22,23]. Oligometastatic prostate cancer and oligometastatic liver disease in colorectal cancer are also often discussed [5,24,25,26]. So far, malignant melanoma and malignancies of the cervix and breast are reported less frequently in the context of oligometastasis [27,28,29].…”

Treatment of Primary Liver Tumors and Liver Metastases, Part 2: Non–Nuclear Medicine Techniques

“…Percutaneous ablation techniques can be performed with curative intent for primary and secondary liver tumors. Several ablation methods are known to have tumoricidal effects: chemical injection of alcohol, heating, cooling, and irreversible electroporation or electrochemotherapy (5)(6)(7)(8). Under imaging guidance such as ultrasound, CT, MRI, or PET/CT, percutaneous ablation can be performed effectively ( Fig.…”

Thermal Ablations for Colorectal Liver Metastases

“…1 Thermal ablations has played an increasing role over the last few decades in the palliative and curative setting of colorectal liver metastases (CRLMs) in nonsurgical candidates with liver-predominant disease. 2 Almost 20 years ago, in a landmark paper, Solbiati et al 3 reported survival outcomes after CRLMs comparable with surgery (93, 69, and 46% at 1, 2, and 3 years, respectively). Results improved when small lesions (<4 cm in diameter) could be treated with broad tumor-free margins (5 mm).…”

“…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.…”