Combination of ablation and embolization for intermediate-sized liver metastases from colorectal cancer: what can we learn from treating primary liver cancer?

Colorectal cancer liver metastases (CRLMs) are common. Treating CRLMs with thermal ablation can prolong survival, but compared to lesions smaller than 3 cm, local control rates and overall survival are relatively worse with larger, intermediate (3-5 cm) lesions. Local recurrence rates range between...

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Bibliographic Details
Published in:Diagnostic and interventional radiology (Ankara, Turkey) Turkey), 2021-09, Vol.27 (5), p.677-683
Main Authors: Seager, Matthew J, Jakobs, Tobias F, Sharma, Ricky A, Bandula, Steve
Format: Article
Language:English
Subjects:
Ablation (Surgery)
Cancer
Carcinoma, Hepatocellular - therapy
Care and treatment
Catheter Ablation
Chemoembolization, Therapeutic
Colorectal cancer
Colorectal Neoplasms
Combined modality therapy
Humans
Interventional Radiology
Liver cancer
Liver Neoplasms - surgery
Metastasis
Methods
Neoplasm Recurrence, Local
Oncology, Experimental
Patient outcomes
Retrospective Studies
Therapeutic embolization
Treatment Outcome
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Summary:Colorectal cancer liver metastases (CRLMs) are common. Treating CRLMs with thermal ablation can prolong survival, but compared to lesions smaller than 3 cm, local control rates and overall survival are relatively worse with larger, intermediate (3-5 cm) lesions. Local recurrence rates range between 1.7%-20.2% and 6.7%-68.9% for CRLMs less than 3 cm and greater than 3 cm, respectively. Worse outcomes are also present when ablating intermediate size hepatocellular carcinoma (HCC) and there are some pathological similarities with CRLMs, namely the presence of micrometastatic disease. Combining ablation with transarterial chemoembolization is more effective in treating intermediate-size HCC than ablation alone. A meta-analysis of robust randomized controlled trials demonstrated long-term improved survival with combination therapy compared to ablation alone (odds ratio at 1, 3 and 5 years of 2.74, 2.77 and 5.23, respectively). There is, however, minimal evidence for combination therapy in CRLMs, limited to a handful of studies that are predominantly retrospective and have heterogeneous inclusion criteria. Given the difficulty in successfully treating intermediate CRLMs, the strong evidence for combination therapy in intermediate HCC and potential pathological similarities, formal evaluation of combination treatment in CRLM is merited. This review highlights existing evidence for treatment of intermediate-size liver lesions and highlights where trials in CRLMs should focus.
ISSN:1305-3825
1305-3612
DOI:10.5152/dir.2021.20520