Thermal Ablations for Colorectal Liver Metastases

Abstract

Approximately 25% of colorectal cancers patients will develop hepatic metastases in the course of their disease. Surgical resection of hepatic metastases remains the first treatment choice for these patients, when feasible. However, only approximately 30% of metastatic lesions are resectable at the time of diagnosis. Thermal ablations have played an increasing role over the last few decades in the palliative and curative setting of colorectal liver metastases (CRLMs) in nonsurgical candidates with a liver-predominant disease. Several different techniques have been used to perform image-guided thermal ablations in the liver, including radiofrequency ablation, microwave ablation, cryoablation, and laser thermal ablation. We review the current ablation techniques, image-guidance modalities, indications, and debated topics of image-guided thermal ablation in CRLMs. Moreover, recent results from clinical trials are discussed along with future trends in liver thermal ablations.

Keywords

liver - thermal ablation - colorectal metastasis

• References

• 1 Cancer Research UK. Bowel cancer statistics [cited 2018 Nov 20]. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer . Accessed November 21, 2018
• 2 Petre EN, Sofocleous C. Thermal ablation in the management of colorectal cancer patients with oligometastatic liver disease. Visc Med 2017; 33 (01) 62-68
• 3 Solbiati L, Livraghi T, Goldberg SN. , et al. Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. Radiology 2001; 221 (01) 159-166
• 4 Solbiati L, Ahmed M, Cova L, Ierace T, Brioschi M, Goldberg SN. Small liver colorectal metastases treated with percutaneous radiofrequency ablation: local response rate and long-term survival with up to 10-year follow-up. Radiology 2012; 265 (03) 958-968
• 5 Meijerink MR, Puijk RS, van Tilborg AAJM. , et al. 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. Cardiovasc Intervent Radiol 2018; 41 (08) 1189-1204
• 6 Venkat SR, Mohan PP, Gandhi RT. Colorectal liver metastasis: overview of treatment paradigm highlighting the role of ablation. AJR Am J Roentgenol 2018; 210 (04) 883-890
• 7 Shady W, Petre EN, Do KG. , et al. Percutaneous microwave versus radiofrequency ablation of colorectal liver metastases: ablation with clear margins (A0) provides the best local tumor control. J Vasc Interv Radiol 2018; 29 (02) 268-275.e1
• 8 He N, Jin Q-N, Wang D. , et al. Radiofrequency ablation vs. hepatic resection for resectable colorectal liver metastases. J Huazhong Univ Sci Technolog Med Sci 2016; 36 (04) 514-518
• 9 Correa-Gallego C, Fong Y, Gonen M. , et al. A retrospective comparison of microwave ablation vs. radiofrequency ablation for colorectal cancer hepatic metastases. Ann Surg Oncol 2014; 21 (13) 4278-4283
• 10 Babawale SN, Jensen TM, Frøkjær JB. Long-term survival following radiofrequency ablation of colorectal liver metastases: a retrospective study. World J Gastrointest Surg 2015; 7 (03) 33-38
• 11 Ruers T, Punt CJA, Coevorden FV. , et al. Radiofrequency ablation (RFA) combined with chemotherapy for unresectable colorectal liver metastases (CRC LM): long-term survival results of a randomized phase II study of the EORTC-NCRI CCSG-ALM Intergroup 40004 (CLOCC). J Clin Oncol 2015; 33 (15) 3501
• 12 Sgouros J, Cast J, Garadi KK. , et al. Chemotherapy plus percutaneous radiofrequency ablation in patients with inoperable colorectal liver metastases. World J Gastrointest Oncol 2011; 3 (04) 60-66
• 13 Tanaka K, Shimada H, Nagano Y, Endo I, Sekido H, Togo S. Outcome after hepatic resection versus combined resection and microwave ablation for multiple bilobar colorectal metastases to the liver. Surgery 2006; 139 (02) 263-273
• 14 Abdalla EK, Vauthey J-N, Ellis LM. , et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004; 239 (06) 818-825 , discussion 825–827
• 15 Tropea A, Biondi A, Corsaro A, Donati M, Basile F, Gruttadauria S. Combined microwave thermal ablation and liver resection for single step treatment of otherwise unresectable colorectal liver metastases; a monoistitutional experiences. Eur Rev Med Pharmacol Sci 2014; 18 (2, Suppl): 6-10
• 16 Cirocchi R, Trastulli S, Boselli C. , et al. Radiofrequency ablation in the treatment of liver metastases from colorectal cancer. Cochrane Database Syst Rev 2012; (06) CD006317
• 17 Shady W, Petre EN, Gonen M. , et al. Percutaneous radiofrequency ablation of colorectal cancer liver metastases: factors affecting outcomes--a 10-year experience at a single center. Radiology 2016; 278 (02) 601-611
• 18 van Tilborg AAJM, Scheffer HJ, de Jong MC. , et al. MWA versus RFA for perivascular and peribiliary CRLM: a retrospective patient- and lesion-based analysis of two historical cohorts. Cardiovasc Intervent Radiol 2016; 39 (10) 1438-1446
• 19 Lubner MG, Brace CL, Hinshaw JL, Lee Jr FT. Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Interv Radiol 2010; 21 (8, Suppl): S192-S203
• 20 Shyn PB, Mauri G, Alencar RO. , et al. Percutaneous imaging-guided cryoablation of liver tumors: predicting local progression on 24-hour MRI. AJR Am J Roentgenol 2014; 203 (02) W181-91
• 21 Zampino MG, Magni E, Ravenda PS. , et al. Treatments for colorectal liver metastases: A new focus on a familiar concept. Crit Rev Oncol Hematol 2016; 108: 154-163
• 22 Gillams A, Goldberg N, Ahmed M. , et al. Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, The Interventional Oncology Sans Frontières meeting 2013. Eur Radiol 2015; 25 (12) 3438-3454
• 23 Van Cutsem E, Cervantes A, Adam R. , et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 2016; 27 (08) 1386-1422
• 24 Wang X, Sofocleous CT, Erinjeri JP. , et al. Margin size is an independent predictor of local tumor progression after ablation of colon cancer liver metastases. Cardiovasc Intervent Radiol 2013; 36 (01) 166-175
• 25 Sofocleous CT, Petre EN, Gonen M. , et al. CT-guided radiofrequency ablation as a salvage treatment of colorectal cancer hepatic metastases developing after hepatectomy. J Vasc Interv Radiol 2011; 22 (06) 755-761
• 26 Mauri G, Cova L, De Beni S. , et al. Real-time US-CT/MRI image fusion for guidance of thermal ablation of liver tumors undetectable with US: results in 295 cases. Cardiovasc Intervent Radiol 2015; 38 (01) 143-151
• 27 Mauri G, Gennaro N, De Beni S. , et al. Real-Time US-¹⁸FDG-PET/CT image fusion for guidance of thermal ablation of ¹⁸FDG-PET-positive liver metastases: the added value of contrast enhancement. Cardiovasc Intervent Radiol 2019; 42 (01) 60-68
• 28 Livraghi T, Solbiati L, Meloni F, Ierace T, Goldberg SN, Gazelle GS. Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection: the “test-of-time approach.”. Cancer 2003; 97 (12) 3027-3035
• 29 Rizzo SMR, Kalra MK, Schmidt B. , et al. CT images of abdomen and pelvis: effect of nonlinear three-dimensional optimized reconstruction algorithm on image quality and lesion characteristics. Radiology 2005; 237 (01) 309-315
• 30 Bellomi M, Rizzo S, Travaini LL. , et al. Role of multidetector CT and FDG-PET/CT in the diagnosis of local and distant recurrence of resected rectal cancer. Radiol Med (Torino) 2007; 112 (05) 681-690
• 31 Monfardini L, Orsi F, Caserta R. , et al. Ultrasound and cone beam CT fusion for liver ablation: technical note. Int J Hyperthermia 2018; 35 (01) 500-504
• 32 Hakime A, Yevich S, Tselikas L, Deschamps F, Petrover D, De Baere T. Percutaneous thermal ablation with ultrasound guidance. fusion imaging guidance to improve conspicuity of liver metastasis. Cardiovasc Intervent Radiol 2017; 40 (05) 721-727
• 33 Di Mauro E, Solbiati M, De Beni S, Forzoni L, D'Onofrio S, Solbiati L. Virtual navigator real-time ultrasound fusion imaging with positron emission tomography for liver interventions. Conf Proc IEEE Eng Med Biol Soc 2013; 2013: 1406-1409
• 34 Hakime A, Deschamps F, De Carvalho EGM, Teriitehau C, Auperin A, De Baere T. Clinical evaluation of spatial accuracy of a fusion imaging technique combining previously acquired computed tomography and real-time ultrasound for imaging of liver metastases. Cardiovasc Intervent Radiol 2011; 34 (02) 338-344
• 35 Song KD, Lee MW, Rhim H, Cha DI, Chong Y, Lim HK. Fusion imaging-guided radiofrequency ablation for hepatocellular carcinomas not visible on conventional ultrasound. AJR Am J Roentgenol 2013; 201 (05) 1141-1147
• 36 Mauri G, Porazzi E, Cova L. , et al. Intraprocedural contrast-enhanced ultrasound (CEUS) in liver percutaneous radiofrequency ablation: clinical impact and health technology assessment. Insights Imaging 2014; 5 (02) 209-216
• 37 Solbiati M, Passera KM, Goldberg SN. , et al. A novel CT to cone-beam CT registration method enables immediate real-time intraprocedural three-dimensional assessment of ablative treatments of liver malignancies. Cardiovasc Intervent Radiol 2018; 41 (07) 1049-1057
• 38 Cornelis F, Sotirchos V, Violari E. , et al. 18F-FDG PET/CT is an immediate imaging biomarker of treatment success after liver metastasis ablation. J Nucl Med 2016; 57 (07) 1052-1057
• 39 Samim M, Prevoo W, de Wit-van der Veen BJ. , et al. ¹⁸F-FDG PET as novel imaging biomarker for disease progression after ablation therapy in colorectal liver metastases. Eur J Nucl Med Mol Imaging 2017; 44 (07) 1165-1175
• 40 Raj S, Irani FG, Tay KH, Tan BS. C-arm cone beam computed tomography: a new tool in the interventional suite. Ann Acad Med Singapore 2013; 42 (11) 585-592
• 41 Iwazawa J, Ohue S, Hashimoto N, Mitani T. Ablation margin assessment of liver tumors with intravenous contrast-enhanced C-arm computed tomography. World J Radiol 2012; 4 (03) 109-114
• 42 Kong S, Yue X, Kong S, Ren Y. Application of contrast-enhanced ultrasound and enhanced CT in diagnosis of liver cancer and evaluation of radiofrequency ablation. Oncol Lett 2018; 16 (02) 2434-2438
• 43 Sotirchos VS, Petrovic LM, Gönen M. , et al. Colorectal cancer liver metastases: biopsy of the ablation zone and margins can be used to predict oncologic outcome. Radiology 2016; 280 (03) 949-959
• 44 Gillams AR, Lees WR. Radiofrequency ablation of colorectal liver metastases. Abdom Imaging 2005; 30 (04) 419-426
• 45 Elias D, Baton O, Sideris L, Matsuhisa T, Pocard M, Lasser P. Local recurrences after intraoperative radiofrequency ablation of liver metastases: a comparative study with anatomic and wedge resections. Ann Surg Oncol 2004; 11 (05) 500-505
• 46 Nielsen K, van Tilborg AAJM, Meijerink MR. , et al. Incidence and treatment of local site recurrences following RFA of colorectal liver metastases. World J Surg 2013; 37 (06) 1340-1347
• 47 Zhou F, Yu X, Liang P. , et al. Does primary tumor location impact the prognosis of colorectal liver metastases patients after microwave ablation? - Lessons from 10 years' experience. Oncotarget 2017; 8 (59) 100791-100800
• 48 de Baere T, Tselikas L, Yevich S. , et al. The role of image-guided therapy in the management of colorectal cancer metastatic disease. Eur J Cancer 2017; 75: 231-242
• 49 Chan FK, Cheng KC. Laparoscopic liver resection: western versus eastern experience. Chin J Cancer Res 2014; 26 (03) 243-244
• 50 Langella S, Russolillo N, D'Eletto M, Forchino F, Lo Tesoriere R, Ferrero A. Oncological safety of ultrasound-guided laparoscopic liver resection for colorectal metastases: a case-control study. Updates Surg 2015; 67 (02) 147-155
• 51 Aloia TA, Vauthey J-N, Loyer EM. , et al. Solitary colorectal liver metastasis: resection determines outcome. Arch Surg 2006; 141 (05) 460-466 , discussion 466–467
• 52 COLLISION Trial - Colorectal Liver Metastases. Surgery vs Thermal Ablation [Internet] [cited 2018 Nov 20]. https://clinicaltrials.gov/ct2/show/NCT03088150 . Accessed November 20, 2018
• 53 Shibata T, Niinobu T, Ogata N, Takami M. Microwave coagulation therapy for multiple hepatic metastases from colorectal carcinoma. Cancer 2000; 89 (02) 276-284
• 54 Huo YR, Eslick GD. Microwave ablation compared to radiofrequency ablation for hepatic lesions: a meta-analysis. J Vasc Interv Radiol 2015; 26 (08) 1139-1146.e2
• 55 Korpan NN. Hepatic cryosurgery for liver metastases. Long-term follow-up. Ann Surg 1997; 225 (02) 193-201
• 56 Sartori S, Di Vece F, Ermili F, Tombesi P. Laser ablation of liver tumors: an ancillary technique, or an alternative to radiofrequency and microwave?. World J Radiol 2017; 9 (03) 91-96
• 57 Vogl TJ, Dommermuth A, Heinle B. , et al. Colorectal cancer liver metastases: long-term survival and progression-free survival after thermal ablation using magnetic resonance-guided laser-induced interstitial thermotherapy in 594 patients: analysis of prognostic factors. Invest Radiol 2014; 49 (01) 48-56
• 58 Pacella CM, Francica G, Di Costanzo GG. Laser ablation for small hepatocellular carcinoma. Radiol Res Pract 2011; 2011: 595627
• 59 Pacella CM, Valle D, Bizzarri G. , et al. Percutaneous laser ablation in patients with isolated unresectable liver metastases from colorectal cancer: results of a phase II study. Acta Oncol 2006; 45 (01) 77-83
• 60 Shamimi-Noori S, Gonsalves CF, Shaw CM. Metastatic liver disease: indications for locoregional therapy and supporting data. Semin Intervent Radiol 2017; 34 (02) 145-166
• 61 Lahat E, Eshkenazy R, Zendel A. , et al. Complications after percutaneous ablation of liver tumors: a systematic review. Hepatobiliary Surg Nutr 2014; 3 (05) 317-323
• 62 Lubner MG, Stabo N, Lubner SJ. , et al. CT textural analysis of hepatic metastatic colorectal cancer: pre-treatment tumor heterogeneity correlates with pathology and clinical outcomes. Abdom Imaging 2015; 40 (07) 2331-2337
• 63 Simpson AL, Doussot A, Creasy JM. , et al. Computed tomography image texture: a noninvasive prognostic marker of hepatic recurrence after hepatectomy for metastatic colorectal cancer. Ann Surg Oncol 2017; 24 (09) 2482-2490
• 64 ECR Online. 2018 [Internet] [cited 2018 Dec 6] https://ecronline.myesr.org/ecr2018/index.php?p=recording&t=recorded&lecture=a-new-software-for-immediate-volumetric-assessment-of-tumour-ablation-completeness-could-it-allow-to-spare-local-retreatments . Accessed December 6, 2018
• 65 Saini A, Breen I, Pershad Y. , et al. Radiogenomics and radiomics in liver cancers. Diagnostics (Basel) 2018; 9 (01) E4
• 66 Ji G-W, Wang K, Xia Y-X, Li X-C, Wang X-H. Decoding tumor biology of colorectal liver metastases with radiogenomics: A novel insight into surgical approach selection. Ann Surg 2019; 269 (01) e3-e4
• 67 Solbiati M, Muglia R, Goldberg SN. , et al. A novel software platform for volumetric assessment of ablation completeness. Int J Hyperthermia 2019; 36 (01) 337-343
• 68 Ablation-fit imaging software [Internet] [cited 2018 Nov 28] http://www.ablation-fit.com/ . Accessed November 28, 2018
• 69 BMC. ISRCTN Registry. Liver resection surgery versus thermal ablation for colorectal liver metastases [Internet] [cited 2019 Mar 23]. http://www.isrctn.com/ISRCTN52040363?q=&filters=conditionCategory:Cancer&sort=&offset=4&totalResults=1800&page=1&pageSize=10&searchType=basic-search . Accessed March 23, 2019
• 70 ClinicalTrials.gov. A Trial on SBRT Versus MWA for Inoperable Colorectal Liver Metastases (CLM) [Internet] [cited 2018 Dec 4]. https://clinicaltrials.gov/ct2/show/NCT02820194?term=thermal+ablation&cond=colorectal+liver+metastases&rank=4 . Accessed December 24, 2018
• 71 ClinicalTrials.gov. Phase 2 Study of Thermodox as Adjuvant Therapy With Thermal Ablation (RFA) in Treatment of Metastatic Colorectal Cancer(mCRC) [Internet] [cited 2018 Dec 4]. https://clinicaltrials.gov/ct2/show/NCT01464593?term=thermal+ablation&cond=colorectal+liver+metastases&rank=3 . Accessed December 4, 2018