Thermal Ablation of Metastatic Colon Cancer to the Liver

Abstract

Colorectal cancer (CRC) is responsible for approximately 10% of cancer-related deaths in the Western world. Liver metastases are frequently seen at the time of diagnosis and throughout the course of the disease. Surgical resection is often considered as it provides long-term survival; however, few patients are candidates for resection. Percutaneous ablative therapies are also used in the management of this patient population. Different thermal ablation (TA) technologies are available including radiofrequency ablation, microwave ablation (MWA), laser, and cryoablation. There is growing evidence about the role of interventional oncology and image-guided percutaneous ablation in the management of metastatic colorectal liver disease. This article aims to outline the technical considerations, outcomes, and rational of TA in the management of patients with CRC liver metastases, focusing on the emerging role of MWA.

The Role of Percutaneous Ablation in the Management of Colorectal Cancer Liver Metastatic Disease

“…Molecular and proliferation markers (Ki67, thymidylate synthase, p53, KRAS, and BRAF) may contribute to the prediction of outcomes post-ablation, offering a valuable stratification tool for tumor-tailored therapeutic approach [ 11 ]. The identification of tumor Ki67 at the end of ablation is a strong independent predictor of local tumor progression and overall patient survival, with high Ki67 ratios, suggesting that these tumors may possess an ablation resistance mechanism [ 11 , 41 ].…”

“…Molecular and proliferation markers (Ki67, thymidylate synthase, p53, KRAS, and BRAF) may contribute to the prediction of outcomes post-ablation, offering a valuable stratification tool for tumor-tailored therapeutic approach [ 11 ]. The identification of tumor Ki67 at the end of ablation is a strong independent predictor of local tumor progression and overall patient survival, with high Ki67 ratios, suggesting that these tumors may possess an ablation resistance mechanism [ 11 , 41 ]. Margins over 10 mm were associated with no local progression, especially in patients with KRAS wild-type disease, whereas in RAS mutant tumors, ablation margins larger than 10 mm are mandatory to achieve local cure and sustained local tumor control [ 42 , 43 , 44 , 45 , 46 , 47 ].…”

“…This requires proper lesion and patient selection along with high-standards application of the technique, including real-time imaging confirmation of margins. Several studies support the use of TA in the management of colorectal liver metastatic disease [ 3 , 7 , 8 , 9 , 10 , 11 , 12 ]. These techniques apply different forms of electromagnetic energy, aiming to cause irreversible cellular injury, which will lead to cellular death and tumor eradication.…”

HMGB1, the Next Predictor of Transcatheter Arterial Chemoembolization for Liver Metastasis of Colorectal Cancer?

“…When patients have distant metastasis outside the primary site, it is difficult to obtain satisfactory results only by surgical resection (4)(5)(6). For unresectable metastatic liver cancer, cryoablation, local thermal ablation of liver, transcatheter arterial infusion (TAI), proton therapy, liver radioactive particle implantation, and transcatheter arterial chemoembolization (TACE) are some good non-surgical treatment methods (7)(8)(9)(10).…”

The Application of Laparoscopic B-Ultrasound Microwave Ablation Technology in Liver Metastasis of Colorectal Cancer

“…It is very important to choose the local treatment for CRLM. Thermal ablation is divided into radiofrequency ablation, microwave ablation, laser ablation, high intensity focused ultrasound ablation and cryoablation [1]. Microwave ablation has been proved to be a safe and effective alternative for patients with liver cancer who are not suitable for surgical resection [2].…”