The clinical effectiveness and cost-effectiveness of ablative therapies in the management of liver metastases: systematic review and economic evaluation

Loveman, Emma; Jones, Jeremy; Clegg, Andrew; Picot, Joanna; Colquitt, Jill L; Mendes, Diana; Breen, David J.; Moore, Eric G.; George, Steve; Poston, G.; Cunningham, David; Ruers, Theo J.M.; Primrose, John

doi:10.3310/hta18070

Cited by 47 publications

(32 citation statements)

References 37 publications

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“…As the first capillary bed to be encountered by circulating malignant cells, the liver commonly contains metastases from primary tumours in other organs. Therefore, we also simulated liver metastasis from breast cancer, which is the second most common hepatic metastasis in clinical practice 31 32 33 , by transplanting human breast cancer cells (MDA-MB-231-fLuc) into mouse livers (n = 4). After the administration of ICG/MSNs-RGD, the intraoperative NIR-FMI successfully detected the transplanted tumour lesions in all mice ( Fig.…”

Section: Resultsmentioning

confidence: 99%

Intraoperative Identification of Liver Cancer Microfoci Using a Targeted Near-Infrared Fluorescent Probe for Imaging-Guided Surgery

Zeng

Shang

Wang

et al. 2016

Sci Rep

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Difficulties in the highly sensitive detection of tumour microfoci represent a critical obstacle toward improved surgical intervention in liver cancer. Conventional preoperative imaging methods and surgeons’ subjective experience are limited by their inability to effectively detect tumour lesions measuring less than 2 mm; however, intraoperative fluorescence molecular imaging may overcome this limitation. Here, we synthesised an arginine-glycine-aspartic acid (RGD)-conjugated mesoporous silica nanoparticle (MSN) highly loaded with indocyanine green (ICG) dye that could accurately delineate liver cancer margins and provide excellent tumour-to-normal tissue contrast intraoperatively. The increased ICG loading capacity and tumour specificity enabled the identification of residual microtumours and satellite lesions measuring less than 1 mm in living mice. Histological analysis validated the sensitivity and accuracy of this approach. We believe this technique utilising a new fluorescent nanoprobe with intraoperative optical imaging may offer a more sensitive and accurate method for liver cancer resection guidance, resulting in better surgical outcomes.

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Section: Resultsmentioning

confidence: 99%

Intraoperative Identification of Liver Cancer Microfoci Using a Targeted Near-Infrared Fluorescent Probe for Imaging-Guided Surgery

Zeng

Shang

Wang

et al. 2016

Sci Rep

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“…Although treatment is highly successful, especially in early-stage BC (100% 5-year survival for stage I and 60% for stage II), treatment of more advanced forms of the disease that also include BCLM in the long-term remains associated with relatively early disease recurrence and high mortality, in contrast to the treatment e.g. of colorectal cancer liver metastases (5,6). In 2015, 1,609 women died of BC in the CR, which represents ~31 deaths/100,000 women.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Tumour Marker Levels as Prognostic Factors for Surgical Treatment of Breast Cancer Liver Metastases

Třeška¹,

Topolčan²,

Zoubkova³

et al. 2018

Anticancer Res

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Abstract. Background RFS (p<0.04; p<0.01; p<0.02), while CA19-9 postoperative levels were significant for OS and RFS (p<0.03; p<0.01 Breast cancer (BC) represents the most frequent cancer worldwide among women and is one of the most frequent causes of death in this population. BC metastases either develop concomitantly with the primary BC or at different time intervals in more than 50% of women with BC. Breast cancer liver metastases (BCLM) in most women are associated with concurrent BC dissemination to the lungs and bones and these represent the only site of metastatic BC in 12-15% women. Although great progress has been made in the diagnosis and effective treatment of BC, metastases develop in 30% of women despite timely diagnosis and radical treatment (1, 2).Surgical treatment of BCLM is an important component of multimodal therapeutic approaches. However, its results remain suboptimal compared, for example, to patients with colorectal cancer liver metastases. In our view, one strategy that might improve the results of surgical management of BCLM is the search for early indicators of tumour dissemination or for prognostically high-risk patients.Tumour markers are general indicators used in monitoring and follow-up of patients. The most frequently used markers to monitor treatment efficacy and diagnose BCLM recurrence include mucins, such as carbohydrate antigen CA 19-9, cytokeratins such as tissue polypeptide antigen (TPA) and tissue-specific polypeptide antigen (TPS), proliferation markers such as thymidine kinase (TK) and carcinoembryonic antigen (CEA). However, no study regarding the prognostic significance of preoperative serum tumour marker levels in patients undergoing surgery for BCLM has been published to date, as far as we are aware.The aim of our retrospective study was to determine whether perioperative levels of clinically routinely used tumour markers influence overall survival (OS) and recurrence-free survival (RFS) of patients undergoing resection or thermoablative therapy for BCLM as part of a multimodal approach. Patients and MethodsFrom January 1, 2000 until January 1, 2018, a total of 32 women underwent surgery for BCLM at the Department of Surgery, University Hospital in Pilsen, Czech Republic. Surgery was indicated in women in a general good state of health from the aspect of surgery and those who had consented to undergo the proposed surgical procedure. Surgery was indicated only if the metastases were located solely within the liver parenchyma. Every patient underwent hybrid imaging using positron-emission tomography (PET) and computed tomography (CT) or PET and magnetic resonance imaging (MRI) before surgery. Another requirement was that the future liver remnant volume exceed 30% of the total liver volume. The average age of these women was 49.5±10.7 years. The primary BC types were: ductal in 20 cases, lobular in seven, erysipeloid in four, and sarcomatoid (spindle cell) carcinoma in one. The average interval between initial breast surgery and BCLM surgery was 4.7±3.7 years.

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“…Thermal ablation may be associated with a lower chance of cure than surgery because of the problem with local recurrence. To determine the evidence for thermal ablation, a National Institute for Health Research (NIHR) Health Technology Assessment (HTA)-funded systematic review of literature was commissioned and subsequently published in February 2014 [ 25 ]. The systematic review identified one non-randomised comparative study in which the survival in patients with RFA was similar to liver resection surgery despite the RFA group having more co-morbidities or more extensive liver metastases [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

“…Non-randomised studies comparing MWA with RFA suggested that MWA is better than RFA in terms of technical feasibility and lower disease recurrence in patients with unresectable CLM [ 25 ]. Of the newer forms of ablative methods, such as HIFU, CyberKnife®, and cryotherapy, there are no publications comparing these newer ablation methods with either RFA or MWA.…”

Section: Introductionmentioning

confidence: 99%

Liver resection surgery versus thermal ablation for colorectal LiVer MetAstases (LAVA): study protocol for a randomised controlled trial

Gurusamy

Corrigan

Croft

et al. 2018

Trials

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BackgroundAlthough surgical resection has been considered the only curative option for colorectal liver metastases (CLM), thermal ablation has recently been suggested as an alternative curative treatment. A prospective randomised trial is required to define the efficacy of resection vs ablation for the treatment of colorectal liver metastases.MethodsDesign and setting: This is a multicentre, open, randomised controlled non-inferiority trial design with internal pilot and will be performed in tertiary liver centres in UK and The Netherlands.Participants: Eligible patients will be those with colorectal liver metastases at high surgical risk because of their age, co-morbidities or tumour burden and who would be suitable for liver resection or thermal ablation.Intervention: Thermal ablation as per local policy.Control: Surgical liver resection performed as per centre protocol.Co-interventions: Further chemotherapy will be offered to patients as per current practice. Outcomes Pilot study: Same as main study and in addition patients and clinicians’ acceptability of the trial to assist in optimisation of recruitment.Primary outcome: Disease-free survival (DFS) at two years post randomisation.Secondary outcomes: Overall survival, timing and site of recurrence, additional therapy after treatment failure, quality of life, complications, length of hospital stay, costs, trial acceptability, DFS measured from end of intervention.Follow-up: 24 months from randomisation; five-year follow-up for overall survival.Sample size: 330 patients to demonstrate non-inferiority of thermal ablation.DiscussionThis trial will determine the effectiveness and cost-effectiveness of thermal ablation vs surgical resection for high-risk people with colorectal liver metastases, and guide the optimal treatment for these patients.Trial registrationISRCTN Registry, ISRCTN52040363. Registered on 9 March 2016.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2499-5) contains supplementary material, which is available to authorized users.

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The clinical effectiveness and cost-effectiveness of ablative therapies in the management of liver metastases: systematic review and economic evaluation

Cited by 47 publications

References 37 publications

Intraoperative Identification of Liver Cancer Microfoci Using a Targeted Near-Infrared Fluorescent Probe for Imaging-Guided Surgery

Intraoperative Identification of Liver Cancer Microfoci Using a Targeted Near-Infrared Fluorescent Probe for Imaging-Guided Surgery

Perioperative Tumour Marker Levels as Prognostic Factors for Surgical Treatment of Breast Cancer Liver Metastases

Liver resection surgery versus thermal ablation for colorectal LiVer MetAstases (LAVA): study protocol for a randomised controlled trial

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