Thermoablation of colorectal liver metastasis

Kulaylat, Mahmoud N.; Gibbs, John F.

doi:10.1002/jso.21504

Cited by 15 publications

(13 citation statements)

References 70 publications

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“…RFA has been used increasingly as an alternative locoregional treatment for primary and secondary hepatic malignancies and has been frequently used in patients who are poor candidates for surgery or deemed unresectable [1–4, 24]. Local tumor control of ablation for CLM varies significantly between published series, with local tumor recurrence rates of 2–60 % [4, 25–34].…”

Section: Discussionmentioning

confidence: 99%

Margin Size is an Independent Predictor of Local Tumor Progression After Ablation of Colon Cancer Liver Metastases

Wang

Sofocleous

Erinjeri

et al. 2012

Cardiovasc Intervent Radiol

289

249

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Purpose This study was designed to evaluate the relationship between the minimal margin size and local tumor progression (LTP) following CT-guided radiofrequency ablation (RFA) of colorectal cancer liver metastases (CLM). Methods An institutional review board-approved, HIP-PA-compliant review identified 73 patients with 94 previously untreated CLM that underwent RFA between March 2003 and May 2010, resulting in an ablation zone completely covering the tumor 4–8 weeks after RFA dynamic CT. Comparing the pre- with the post-RFA CT, the minimal margin size was categorized to 0, 1–5, 6–10, and 11–15 mm. Follow-up included CT every 2–4 months. Kaplan–Meier methodology and Cox regression analysis were used to evaluate the effect of the minimal margin size, tumor location, size, and proximity to a vessel on LTP. Results Forty-five of 94 (47.9 %) CLM progressed locally. Median LTP-free survival (LPFS) was 16 months. Two-year LPFS rates for ablated CLM with minimal margin of 0, 1–5 mm, 6–10 mm, 11–15 mm were 26, 46, 74, and 80 % (p < 0.011). Minimal margin (p = 0.002) and tumor size (p = 0.028) were independent risk factors for LTP. The risk for LTP decreased by 46 % for each 5-mm increase in minimal margin size, whereas each additional 5-mm increase in tumor size increased the risk of LTP by 22 %. Conclusions An ablation zone with a minimal margin uniformly larger than 5 mm 4–8 weeks postablation CT is associated with the best local tumor control.

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Section: Discussionmentioning

confidence: 99%

Margin Size is an Independent Predictor of Local Tumor Progression After Ablation of Colon Cancer Liver Metastases

Wang

Sofocleous

Erinjeri

et al. 2012

Cardiovasc Intervent Radiol

289

249

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“…Finally, the method of guidance of each modality and the approach (percutaneous, laparoscopic or intraoperative) can lead to differences in complications rates, primary technical success and long term success; MWA and CA have been shown to adequately ablate larger volumes of tissues while RFA has a more limited size range. 3,56 It is also hypothesized that larger tumors may be associated with worse overall patient outcomes. 7,56 The forest plots demonstrated the significant heterogeneity of the outcomes of each modality between the studies.…”

Section: Discussionmentioning

confidence: 99%

“…3,56 It is also hypothesized that larger tumors may be associated with worse overall patient outcomes. 7,56 The forest plots demonstrated the significant heterogeneity of the outcomes of each modality between the studies. However, the RFA group showed less heterogeneity in the major complication rates (Fig.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of 12 years of thermal ablative therapies of non-resectable colorectal cancer liver metastases

Saif

Ania

McInnes

2016

Int J Gastrointest Interv

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A B S T R A C TTo compare the effectiveness and complications of various thermal ablative therapies through reviewing the available literature. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement was used to report this systematic review. Our PICO (patient group-intervention-comparator-outcomes) question: In patients with unresectable colorectal cancer liver metastasis (CRCLM), what are the comparative effectiveness and complication rates of the various thermal ablative therapies? All study designs published between 2000 and 2012 considered. Search results were screened in duplicate to determine eligible studies. A customized "risk of bias" assessment tool was utilized. Asymmetry of the funnel plot and heterogeneity were quantified. Representative forest plots of the 1, 3, and 5 years survival rates, major complication rates and local recurrence rates were performed. Data not amenable to pooling is presented in a qualitative and tabular manner. Thirty radiofrequency ablation (RFA), 11 cryoablation (CA), and 5 microwave ablation (MWA) studies were finally included in the qualitative synthesis. The number of patients included from all the studies was 3,107 patients; 2,021 in the RFA group, 988 in the CA, and 98 in the MWA. The forest plots confirm the significant heterogeneity of the included studies. Visual assessment of forest plots, as well as qualitative analysis of included papers suggested that between-studies heterogeneity was too great and thus, pooling through meta-analysis was not appropriate. RFA is the most commonly used ablative modality to treat unresectable CRCLM. Significant heterogeneity of the included studies was encountered precluding a meaningful meta-analysis. Future comparisons of local ablative therapies outcome necessitate prospective, randomized controlled studies.

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“…Other criteria for the use of ablation include fewer than 3 CRLM and hepatic tumor size less than 3 cm [52,53]. Although the use of ablative techniques is popular and safer in some patients when compared with surgical resection, ablation results in higher local recurrence rates [8,[52][53][54]. Radiofrequency ablation (RFA) is the most commonly-used ablation technique used currently and can be used to ablate residual unresectable disease as well as to treat small hepatic recurrences [8,52,53,55].…”

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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Thermoablation of colorectal liver metastasis

Cited by 15 publications

References 70 publications

Margin Size is an Independent Predictor of Local Tumor Progression After Ablation of Colon Cancer Liver Metastases

Margin Size is an Independent Predictor of Local Tumor Progression After Ablation of Colon Cancer Liver Metastases

Systematic review of 12 years of thermal ablative therapies of non-resectable colorectal cancer liver metastases

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

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