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

Abstract

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.

18F-FDG PET as novel imaging biomarker for disease progression after ablation therapy in colorectal liver metastases

“…Despite the differences in the LTP rate, percutaneous ablation is considered the least invasive method and is recommended over the open approach due to the increased mortality and morbidity of the latter [3]. Obviously, this does not count for an ablation procedure that is combined with surgical liver resection [3] Moreover, it would be of interest whether and EHR-FS extrahepatic recurrence free survival; LTP-FS local tumour progression free survival; NHR-FS new hepatic recurrence free survival.…”

“…Obviously, this does not count for an ablation procedure that is combined with surgical liver resection [3] Moreover, it would be of interest whether and EHR-FS extrahepatic recurrence free survival; LTP-FS local tumour progression free survival; NHR-FS new hepatic recurrence free survival. *Relevant metabolic parameters used in the multivariable models are marked F-FDG uptake in the tumour lesion with the median SUL peak value as cutoff point (median SUL peak of 4.8) how the OS or the progression free survival is affected by the approach of the procedure.…”

“…To maintain good survival rates, similar as after surgical resection of liver metastases, adjuvant systemic therapy should be acknowledged after curative thermal ablation [3]. However, it is not clear which patients benefit most from adjuvant systemic treatment.…”

“…techniques with the ability to accomplish local disease control as shown in large cohort studies and meta-analyses [2,3]. Furthermore, thermal ablation is frequently performed combined with concomitant liver resection [4].…”

Fusion imaging of contrast-enhanced ultrasound and contrast-enhanced CT or MRI before radiofrequency ablation for liver cancers

“…[1][2][3] Percutaneous radiofrequency ablation (RFA) and microwave ablation are the most widely used minimal invasive modalities for the treatment of liver cancer, especially for small tumours. [4][5][6][7][8] RFA is usually guided by conventional ultrasound or CT. 9 Ultrasoundguided RFA is more extensively used because of the virtues of conventional ultrasound such as real-time scanning, convenience, wide availability and no radiation. However, because of the relatively low spatial resolution and penetration, coarse background of associated liver cirrhosis, interference of bowel gas and limited acoustic window, some lesions show poor conspicuity on conventional ultrasound.…”