Abstract
Simple SummaryColorectal cancer is the fourth most common type of cancer globally. Approximately 20% of patients with colorectal cancer present with synchronous liver metastases, and up to 60% will develop metachronous metastases during the course of the disease. Although liver resection is currently considered the local treatment of choice for colorectal liver metastasis (CLM), less than one-third of patients are eligible for surgery at the time of diagnosis of CLM. Ablation is a well-established, less invasive, locoregional therapy for patients with small CLMs, which has shown favorable oncological outcomes in patients with unresectable CLMs, comparable to those in patients eligible for surgery. The increasing knowledge of factors affecting oncological outcomes has allowed selected patients with resectable small volume CLMs to be treated with thermal ablation with curative intent. The continuous technological evolutions in imaging and image guidance have contributed to this paradigm shift in CLM treatment. The importance of patient selection, patient factors, tumor factors, ablation techniques, and clinical applications is discussed in this article.Image-guided ablation can provide effective local tumor control in selected patients with CLM. A randomized controlled trial suggested that radiofrequency ablation combined with systemic chemotherapy resulted in a survival benefit for patients with unresectable CLM, compared to systemic chemotherapy alone. For small tumors, ablation with adequate margins can be considered as an alternative to resection. The improvement of ablation technologies can allow the treatment of tumors close to major vascular structures or bile ducts, on which the applicability of thermal ablation modalities is challenging. Several factors affect the outcomes of ablation, including but not limited to tumor size, number, location, minimal ablation margin, RAS mutation status, prior hepatectomy, and extrahepatic disease. Further understanding of the impact of tumor biology and advanced imaging guidance on overall patient outcomes might help to tailor its application, and improve outcomes of image-guided ablation.
Highlights
Colorectal cancer is the fourth most common malignancy and the third leading cause of cancer-related death in the world [1]
The results showed that Radiofrequency ablation (RFA) in addition to hepatectomy for unresectable colorectal liver metastasis (CLM) resulted in comparable overall survival to hepatectomy alone
In a case-matched study comparing patients treated with hepatectomy combined with RFA and those treated with hepatectomy alone, there were no significant differences in 5-year overall survival (57% vs. 61%, p = 0.573) or disease-free survival (19% vs. 17%, p = 0.865) [39]
Summary
Colorectal cancer is the fourth most common malignancy and the third leading cause of cancer-related death in the world [1]. 20% of patients with colorectal cancer present with synchronous liver metastases, and up to 60% will develop metachronous metastases during the course of the disease [2]. The liver is the most common site of metastases, and liver metastases are negatively associated with overall survival [2]. Liver resection is currently considered the local treatment of choice for colorectal liver metastasis (CLM), with reported 5-year overall survival rates of up to 58% in selected patients [3]. The role of ablation is increasing, and the treatment paradigm of CLM patients is evolving. This article aims to review the role of ablation, as well as to discuss the future directions of this treatment modality on the management of patients with CLM
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