Percutaneous Microwave versus Radiofrequency Ablation of Colorectal Liver Metastases: Ablation with Clear Margins (A0) Provides the Best Local Tumor Control

Shady, Waleed; Petre, Elena N.; Gian, Richard Kinh; Gönen, Mithat; Yarmohammadi, Hooman; Brown, Karen T.; Kemeny, Nancy E.; D’Angelica, Michael I.; Kingham, Peter; Solomon, Stephen B.; Sofocleous, Constantinos T.

doi:10.1016/j.jvir.2017.08.021

Cited by 221 publications

(223 citation statements)

References 33 publications

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“…Evidence suggests that metastases > 3 cm are more likely to undergo incomplete ablation. Local tumor progression-free survival after ablation in mutant-RAS was significantly worse than wild type [39][40][41][42]. Blood vessels > 3 mm may cause dispersion in tissue heating.…”

Section: Unfit Patients (Fig 1b)mentioning

confidence: 99%

“…Radiofrequency is the most commonly used thermal ablation therapy since the late 90s and has shown as much as 94% of local control and 31% 5-year OS when treated tumors are ≤ 3 cm, centrally located and with ablation margins greater than 5 mm [39]. MW is a promising technology with some advantages over RF [40]. The indications for RF and MW are well-located tumors less than 5 cm.…”

Section: Unfit Patients (Fig 1b)mentioning

confidence: 99%

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Multidisciplinary management of liver metastases in patients with colorectal cancer: a consensus of SEOM, AEC, SEOR, SERVEI, and SEMNIM

et al. 2019

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Colorectal cancer (CRC) has the second-highest tumor incidence and is a leading cause of death by cancer. Nearly 20% of patients with CRC will have metastases at the time of diagnosis, and more than 50% of patients with CRC develop metastatic disease during the course of their disease. A group of experts from Medicine and Molecular Imaging met to discuss and provide a multidisciplinary consensus on the management of liver metastases in patients with CRC. The group defined the different scenarios in which the disease can present: fit or unfit patients with resectable liver metastases, patients with potential resectable liver metastases, and patients with unresectable liver metastases. Within each scenario, the different strategies and therapeutic approaches are discussed.

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Section: Unfit Patients (Fig 1b)mentioning

confidence: 99%

Section: Unfit Patients (Fig 1b)mentioning

confidence: 99%

Multidisciplinary management of liver metastases in patients with colorectal cancer: a consensus of SEOM, AEC, SEOR, SERVEI, and SEMNIM

et al. 2019

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“…It was previously reported that the biopsy proof of CTA and adequate safety margins (>5 mm) are independent predictors of LTP and yielded the best oncologic outcomes after resection or ablation . These factors were demonstrated to be associated with better local tumor control and a better survival rate after hepatic malignant tumor ablation for the existence of satellite focal or microscopic disease within 5 mm around the index tumor . Evidence showed that margins larger than 5 mm were critical for local tumor control, with no LTP noted for margins over 10 mm, regardless of the thermal ablation modality used, and MWA proved to be resilient to the heat‐sink effect compared to RFA, offering good control for perivascular tumors .…”

Section: Discussionmentioning

confidence: 98%

Percutaneous Laser Ablation of Hepatic Tumors Located in the Portacaval Space: Preliminary Results

2019

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Background and Objectives Limited data have been used to evaluate the feasibility and effectiveness of percutaneous laser ablation (PLA) (a modality that has been proven to be a safe method for tumors in high‐risk locations) for hepatic tumors in the space between the portal vein and inferior vena cava (IVC). The goal of this study was to investigate the characteristics and therapeutic effectiveness of ultrasound‐guided PLA of hepatic tumors in the portacaval space. Study Design/Materials and Methods Ten patients, who had hepatic tumors in the portacaval space (defined as tumors located in the space formed by the hepatic portal vein and IVC less than 5 mm from the margins of both vessels), receiving ultrasound‐guided PLA between January 2016 and June 2017 were analyzed. Tumors in the type I portacaval space were enclosed on three sides of major vessels, and tumors in the type II portacaval space were enclosed on two sides of major vessels. The technical success, treatment response, complete tumor ablation (CTA), local tumor progression (LTP), and distant tumor recurrence (DTR) were assessed and recorded at the follow‐up. Results The mean tumor diameter was 1.8 ± 0.4 cm. Technical success and initial CTA were achieved in all 10 patients without major complications. The 6‐month and 12‐month LTP rates were 0% and 10%, respectively. The DTR rate was 20% at both the 6‐ and 12‐month follow‐ups. Conclusions The preliminary results showed that ultrasound‐guided PLA was feasible and safe for tumors in the portacaval space, and further studies on larger populations with a longer follow‐up are needed to delineate the use of PLA and evaluate its therapeutic efficacy. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

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“…Theoretical benefits of MWA over RFA include larger ablation zone, shorter duration, and no heat‐sink effect . There are some studies reporting the outcomes of MWA for colorectal liver metastases as a safe and effective modality for use in the treatment of CRLM patients . Correa‐Gallego et al.…”

Section: Specific Techniques To Increase Resectabilitymentioning

confidence: 99%

How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective

Imai

Adam

Baba

2019

Annals of Gastroent Surgery

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Although surgical resection is the only treatment of choice that can offer prolonged survival and a chance of cure in patients with colorectal liver metastases (CRLM), nearly 80% of patients are deemed to be unresectable at the time of diagnosis. Considerable efforts have been made to overcome this initial unresectability, including expanding the indication of surgery, the advent of conversion chemotherapy, and development and modification of specific surgical techniques, regulated under multidisciplinary approaches. In terms of specific surgical techniques, portal vein ligation/embolization can increase the volume of future liver remnant and thereby reduce the risk of hepatic insufficiency and death after major hepatectomy. For multiple bilobar CRLM that were traditionally considered unresectable even with preoperative chemotherapy and portal vein embolization, two‐stage hepatectomy was introduced and has been adopted worldwide with acceptable short‐ and long‐term outcomes. Recently, ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) was reported as a novel variant of two‐stage hepatectomy. Although issues regarding safety remain unresolved, rapid future liver remnant hypertrophy and subsequent shorter intervals between the two stages lead to a higher feasibility rate, reaching 98%. In addition, adding radiofrequency ablation and vascular resection and reconstruction techniques can allow expansion of the pool of patients with CRLM who are candidates for liver resection and thus a cure. In this review, we discuss specific techniques that may expand the criteria for resectability in patients with initially unresectable CRLM.

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Percutaneous Microwave versus Radiofrequency Ablation of Colorectal Liver Metastases: Ablation with Clear Margins (A0) Provides the Best Local Tumor Control

Abstract: Regardless of the thermal ablation modality used, margins larger than 5 mm are critical for local tumor control, with no LTP noted for margins over 10 mm. Unlike RF ablation, the efficiency of MW ablation was not affected for perivascular tumors.

Cited by 221 publications

References 33 publications

Multidisciplinary management of liver metastases in patients with colorectal cancer: a consensus of SEOM, AEC, SEOR, SERVEI, and SEMNIM

Multidisciplinary management of liver metastases in patients with colorectal cancer: a consensus of SEOM, AEC, SEOR, SERVEI, and SEMNIM

Percutaneous Laser Ablation of Hepatic Tumors Located in the Portacaval Space: Preliminary Results

How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective

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