A systematic review on the clinical benefit and role of radiofrequency ablation as treatment of colorectal liver metastases

Stang, Axel; Fischbach, Roman; Teichmann, W.; Bokemeyer, Carsten; Braumann, D.

doi:10.1016/j.ejca.2009.03.012

Cited by 133 publications

(90 citation statements)

References 40 publications

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“…2 Retrospective RFA series for colorectal liver metastases have shown site recurrence rates of 9-42% for percutaneous RFA and 5-14% for open RFA with median survival of 36 months. 3,4 For patients not eligible for RFA, stereotactic body radiation therapy (SBRT) offers the possibility to deliver potent biological doses to limited volumes of the liver in a few fractions. High local control rates at 2 years of 74-91% and median survival of 34 months have been reported after SBRT for colorectal liver metastases.…”

Section: Introductionmentioning

confidence: 99%

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Romero

Keskin-Cambay

et al. 2017

Reports of Practical Oncology & Radiotherapy

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Metastases LiverStereotactic body radiation therapy a b s t r a c t Aim: To investigate whether the impact of dose escalation in our patient population represented an improvement in local control without increasing treatment related toxicity. Materials and methods:A cohort of consecutive patients with colorectal liver metastases treated with stereotactic body radiation therapy (SBRT) between December 2002 and December 2013 were eligible for this study. Inclusion criteria were a Karnofsky performance status ≥80% and, according to the multidisciplinary tumor board, ineligibility for surgery or radiofrequency ablation. Exclusion criteria were a lesion size >6 cm, more than 3 metastases, and treatment delivered with other fractionation scheme than 3 times 12.5 Gy or 16.75 Gy prescribed at the 65-67% isodose. To analyze local control, CT or MRI scans were acquired during follow-up. Toxicity was scored using the Common Toxicity Criteria Adverse Events v4.0.Results: A total of 40 patients with 55 colorectal liver metastases were included in this study.We delivered 37.5 Gy to 32 lesions, and 50.25 Gy to 23 lesions. Median follow-up was 26 and 25 months for these two groups. Local control at 2 and 3 years was 74 and 66% in the low dose group while 90 and 81% was reached in the high dose group. No significant difference in local control between the two dose fractionation schemes could be found. Grade 3 toxicity was limited and was not increased in the high dose group.Conclusions: SBRT for colorectal liver metastases offers a high chance of local control at long term. High irradiation doses may contribute to enhance this effect without increasing toxicity.

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Section: Introductionmentioning

confidence: 99%

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Romero

Keskin-Cambay

et al. 2017

Reports of Practical Oncology & Radiotherapy

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“…• Radiofrequency ablation has been used for unresectable metastasis, sometimes in conjunction with the surgical removal of resectable metastases, and may have a role in the treatment of other selected patients [26][27][28][29] .…”

Section: 12mentioning

confidence: 99%

Liver Resection for Colorectal Cancer Metastases

et al. 2013

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These recommendations apply to patients with liver metastases from crc who have had or will have a complete (R0) resection of the primary cancer and who are being considered for resection of the liver, or liver plus specific and limited ehms, with curative intent. 1(a). Patients with liver and lung metastases should be seen in consultation with a thoracic surgeon. Combined or staged metastasectomy is recommended when, taking into account anatomic and physiologic considerations, the assessment is that all pulmonary metastases can also be completely removed. Furthermore, liver resection may be indicated in patients who have had a prior lung resection, and vice versa. 1(b). Routine liver resection is not recommended in patients with portal nodal disease. This group includes patients with radiologically suspicious portal nodes or malignant portal nodes found preoperatively or intraoperatively. Liver plus nodal resection, together with perioperative systemic therapy, may be an option-after a full discussion with the patient-in cases with limited nodal involvement and with metastases that can be completely resected. 1(c). Routine liver resection is not recommended in patients with nonpulmonary ehms. Liver plus extrahepatic resection, together with perioperative systemic therapy, may be an option-after a full discussion with the patient-for metastases that can be completely resected. 2(a). Perioperative chemotherapy, either before and after resection, or after resection, is recommended in patients with resectable ABSTRACT Questions1. Should surgery be considered for colorectal cancer (crc) patients who have liver metastases plus (a) pulmonary metastases, (b) portal nodal disease, or (c) other extrahepatic metastases (ehms)? 2. What is the role of chemotherapy in the surgical management of crc with liver metastases in (a) patients with resectable disease in the liver, or (b) patients with initially unresectable disease in the liver that is downsized with chemotherapy ("conversion")? 3. What is the role of liver resection when one or more crc liver metastases have radiographic complete response (rcr) after chemotherapy? PerspectivesAdvances in chemotherapy have improved survival in crc patients with liver metastases. The 5-year survival with chemotherapy alone is typically less than 1%, although two recent studies with folfox or folfoxiri (or both) reported rates of 5%-10%. However, liver resection is the treatment that is most effective in achieving long-term survival and offering the possibility of a cure in stage iv crc patients with liver metastases. This guideline deals with the role of chemotherapy with surgery, and the role of surgery when there are liver metastases plus ehms. Because only a proportion of patients with crc metastatic disease are considered for liver resection, and because management of this patient population is complex, multidisciplinary management is required. MethodologyRecommendations in the present guideline were formulated based on a prepublication version of a recent systematic review on th...

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“…Ablation is an effective option for patients who are not candidates for hepatic resection due to inadequate FLR or patient co-morbidities [51]. Other criteria for the use of ablation include fewer than 3 CRLM and hepatic tumor size less than 3 cm [52,53].…”

Section: Surgical Techniquesmentioning

confidence: 99%

Designing Liver Resections and Pushing the Envelope with Resections for Hepatic Colorectal Metastases

Guye

Schoellhammer

Chiu

et al. 2013

Indian J Surg Oncol

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Current concepts in the management of hepatic metastases have changed dramatically over the past two decades. Multidisciplinary therapies including chemotherapy, surgery, and regional therapy have alone and in combination significantly improved the survival of patients with metastatic colorectal cancer. Conditions that were previously considered hopeless and treated merely for palliation can now be approached with curative intent. In this paper, we review the surgical treatment for colorectal cancer liver metastasis (CRLM) and describe a paradigm-shift in the management of complex heretofore-considered unresectable CRLM. Utilizing advanced multidisciplinary treatment strategies has improved the prognosis of patients with stage IV colorectal cancer to the point where we may question whether CRLM are now a chronic disease.

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A systematic review on the clinical benefit and role of radiofrequency ablation as treatment of colorectal liver metastases

Cited by 133 publications

References 40 publications

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Liver Resection for Colorectal Cancer Metastases

Designing Liver Resections and Pushing the Envelope with Resections for Hepatic Colorectal Metastases

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