Resection or radiofrequency ablation of colorectal liver metastasis

PurposeTo assess safety and outcome of radiofrequency ablation (RFA) and microwave ablation (MWA) as compared to systemic chemotherapy and partial hepatectomy (PH) in the treatment of colorectal liver metastases (CRLM).MethodsMEDLINE, Embase and the Cochrane Library were searched. Randomized trials and comparative observational studies with multivariate analysis and/or matching were included. Guidelines from National Guideline Clearinghouse and Guidelines International Network were assessed using the AGREE II instrument.ResultsThe search revealed 3530 records; 328 were selected for full-text review; 48 were included: 8 systematic reviews, 2 randomized studies, 26 comparative observational studies, 2 guideline-articles and 10 case series; in addition 13 guidelines were evaluated. Literature to assess the effectiveness of ablation was limited. RFA + systemic chemotherapy was superior to chemotherapy alone. PH was superior to RFA alone but not to RFA + PH or to MWA. Compared to PH, RFA showed fewer complications, MWA did not. Outcomes were subject to residual confounding since ablation was only employed for unresectable disease.ConclusionThe results from the EORTC-CLOCC trial, the comparable survival for ablation + PH versus PH alone, the potential to induce long-term disease control and the low complication rate argue in favour of ablation over chemotherapy alone. Further randomized comparisons of ablation to current-day chemotherapy alone should therefore be considered unethical. Hence, the highest achievable level of evidence for unresectable CRLM seems reached. The apparent selection bias from previous studies and the superior safety profile mandate the setup of randomized controlled trials comparing ablation to surgery.Electronic supplementary materialThe online version of this article (10.1007/s00270-018-1959-3) contains supplementary material, which is available to authorized users.

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“…5) [13, 30, 31, 33–35, 37, 39, 45, 46]. Pooling of the results showed that RFA was associated with an inferior OS (HR = 1.78; 95%CI 1.35–2.33)).…”

Section: Resultsmentioning

confidence: 99%

“…Five articles allowed for pooling of OS results for solitary metastases. Again, RFA was associated with a less favourable outcome (HR = 1.77; 95%CI 1.18–2.65) [ 31 , 33 – 35 , 39 ]. The corrected odds ratio as reported by Aloia et al also showed better results for PH alone (odds ratio 3.22; 95%CI 1.74–5.96) [ 32 ].…”

Section: Resultsmentioning

confidence: 99%

Radiofrequency and Microwave Ablation Compared to Systemic Chemotherapy and to Partial Hepatectomy in the Treatment of Colorectal Liver Metastases: A Systematic Review and Meta-Analysis

Meijerink

Puijk

Tilborg

et al. 2018

Cardiovasc Intervent Radiol

165

131

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“…A total of 1060 patients were treated for CRLM with the use of RFA and 1817 patients with hepatic resection. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] Quality assessment Quality assessment is shown in eTable 2 with 16 of the 20 studies having a score of at least 6/9 as per the NOS grading. [23][24][25][26][27]29,30,[32][33][34][35][37][38][39]41,42 Studies were downgraded because patients who received resection were not selected from the exact same population as patients who received RFA.…”

Section: Study Selectionmentioning

confidence: 99%

“…Three studies were additionally downgraded because they did not provide a description of how different outcomes were assessed, leaving a grade of 5 in the scale. 31,36,40 One study only had a grade of 3, because it was a seminar which only showed results without mentioning in detail the methods. 28…”

Section: Study Selectionmentioning

confidence: 99%

Radiofrequency ablation compared to surgical resection for curative treatment of patients with colorectal liver metastases – a meta-analysis

Amerongen

Jenniskens

Boezem

et al. 2017

HPB

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“…Several studies revealed that complications were significantly more common after surgery compared to RFA (relative risk [RR] = 0.47; 95%CI 0.28–0.78) [ 22 – 29 , 59 , 64 – 66 ]. Two studies reported serious adverse events in 21–28% after surgery vs 13–37% in the surgery + ablation group [ 18 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Colorectal liver metastases: surgery versus thermal ablation (COLLISION) – a phase III single-blind prospective randomized controlled trial

et al. 2018

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BackgroundRadiofrequency ablation (RFA) and microwave ablation (MWA) are widely accepted techniques to eliminate small unresectable colorectal liver metastases (CRLM). Although previous studies labelled thermal ablation inferior to surgical resection, the apparent selection bias when comparing patients with unresectable disease to surgical candidates, the superior safety profile, and the competitive overall survival results for the more recent reports mandate the setup of a randomized controlled trial. The objective of the COLLISION trial is to prove non-inferiority of thermal ablation compared to hepatic resection in patients with at least one resectable and ablatable CRLM and no extrahepatic disease.MethodsIn this two-arm, single-blind multi-center phase-III clinical trial, six hundred and eighteen patients with at least one CRLM (≤3 cm) will be included to undergo either surgical resection or thermal ablation of appointed target lesion(s) (≤3 cm). Primary endpoint is OS (overall survival, intention-to-treat analysis). Main secondary endpoints are overall disease-free survival (DFS), time to progression (TTP), time to local progression (TTLP), primary and assisted technique efficacy (PTE, ATE), procedural morbidity and mortality, length of hospital stay, assessment of pain and quality of life (QoL), cost-effectiveness ratio (ICER) and quality-adjusted life years (QALY).DiscussionIf thermal ablation proves to be non-inferior in treating lesions ≤3 cm, a switch in treatment-method may lead to a reduction of the post-procedural morbidity and mortality, length of hospital stay and incremental costs without compromising oncological outcome for patients with CRLM.Trial registrationNCT03088150, January 11th 2017.

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Resection or radiofrequency ablation of colorectal liver metastasis

Abstract: This study shows that the patients with solitary hepatic colorectal cancer metastases should be considered for hepatic resection whenever it is feasible, because this procedure provides superior long-term survival as compared to radiofrequency ablation.

Cited by 4 publications

References 11 publications

Radiofrequency and Microwave Ablation Compared to Systemic Chemotherapy and to Partial Hepatectomy in the Treatment of Colorectal Liver Metastases: A Systematic Review and Meta-Analysis

Radiofrequency and Microwave Ablation Compared to Systemic Chemotherapy and to Partial Hepatectomy in the Treatment of Colorectal Liver Metastases: A Systematic Review and Meta-Analysis

Radiofrequency ablation compared to surgical resection for curative treatment of patients with colorectal liver metastases – a meta-analysis

Colorectal liver metastases: surgery versus thermal ablation (COLLISION) – a phase III single-blind prospective randomized controlled trial

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