Ablative Therapies for Colorectal Liver Metastases

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Cryoablation

Cryoablation was described early in the evolution of liver ablative technologies11 and involves placement of a cryoprobe into liver metastases by open surgical, laparoscopic, or percutaneous approaches. The cryoprobe tip is then rapidly cooled using liquefied gases and, over sequential freeze-thaw cycles, forms an ice ball encompassing the CLM and a rim of normal liver. The progression of the ice ball can be easily monitored by ultrasound. Tissue destruction follows via multiple mechanisms,

Hyperthermic ablative technologies

The use of hyperthermia to treat tumors dates to ancient times, with the use of cautery to treat superficial tumors.21 Modern hyperthermic ablative technologies rely on exposure of tumors to supranormal temperatures to ablate intrahepatic tumors. In contrast to cryotherapy, where tumors are more resistant to freezing than normal cells, malignant cells are more sensitive to hyperthermic damage than normal cells.22, 23 Tumors lack the ability to dissipate heat by augmenting blood flow that is

Irreversible electroporation

Irreversible electroporation (IRE) is an emerging intraparenchymal ablative technology that is based on the application of short-duration (micro- to millisecond) high-voltage (1000–3000 V) pulses to target tissues, with the formation of nanoscale defects in the lipid bilayer and resultant cell necrosis.77, 78 IRE probes can be placed using open surgical, laparoscopic, or percutaneous approaches, and multiprobe arrays can be used to achieve increased ablation volumes.

IRE is unique in two

Summary

Although hepatic resection remains the gold standard therapy for CLM, many patients will continue to benefit from ablative therapies. Further refinements in techniques and technologies will continue to expand the ablative options available to patients with CLM. Continued analysis is required to delineate the biology of CLM and define the optimal role of ablation in the multidisciplinary treatment of CLM. The optimal technique for ablation of CLM should be based on patient and operator factors.

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References (80)

  • K. Tanaka et al.

    Outcome after hepatic resection versus combined resection and microwave ablation for multiple bilobar colorectal metastases to the liver

    Surgery

    (2006)
  • C. Sturesson et al.

    Hepatic inflow occlusion increases the efficacy of interstitial laser-induced thermotherapy in rat

    J Surg Res

    (1997)
  • E.A. Dick et al.

    MR-guided laser thermal ablation of primary and secondary liver tumours

    Clin Radiol

    (2003)
  • A. Jemal et al.

    Cancer statistics, 2009

    CA Cancer J Clin

    (2009)
  • G. Steele et al.

    Resection of hepatic metastases from colorectal cancer. Biologic perspective

    Ann Surg

    (1989)
  • J. Scheele et al.

    Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history

    Br J Surg

    (1990)
  • A.M. Lewis et al.

    The treatment of hepatic metastases in colorectal carcinoma

    Am Surg

    (2006)
  • J.S. Tomlinson et al.

    Actual 10-year survival after resection of colorectal liver metastases defines cure

    J Clin Oncol

    (2007)
  • R.D. Timmerman et al.

    Local surgical, ablative, and radiation treatment of metastases

    CA Cancer J Clin

    (2009)
  • S. Hellman et al.

    Oligometastases

    J Clin Oncol

    (1995)
  • L. Norton et al.

    The Norton-Simon hypothesis revisited

    Cancer Treat Rep

    (1986)
  • R. Simon et al.

    The Norton-Simon hypothesis: designing more effective and less toxic chemotherapeutic regimens

    Nat Clin Pract Oncol

    (2006)
  • I.S. Cooper et al.

    Application of cryogenic surgery to resection of parenchymal organs

    N Engl J Med

    (1966)
  • S.A. Wemyss-Holden et al.

    Local ablation for unresectable liver tumors: is thermal best?

    J Hepatobiliary Pancreat Surg

    (2004)
  • G. Onik et al.

    Ultrasound-guided hepatic cryosurgery in the treatment of metastatic colon carcinoma. Preliminary results

    Cancer

    (1991)
  • D.B. Goodie et al.

    Anaesthetic experience with cryotherapy for treatment of hepatic malignancy

    Anaesth Intensive Care

    (1992)
  • J.K. Seifert et al.

    World survey on the complications of hepatic and prostate cryotherapy

    World J Surg

    (1999)
  • S.C. Mayo et al.

    Thermal ablative therapies for secondary hepatic malignancies

    Cancer J

    (2010)
  • R. Adam et al.

    Place of cryosurgery in the treatment of malignant liver tumors

    Ann Surg

    (1997)
  • R. Adam et al.

    A comparison of percutaneous cryosurgery and percutaneous radiofrequency for unresectable hepatic malignancies

    Arch Surg

    (2002)
  • A.S. Pearson et al.

    Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies

    Am J Surg

    (1999)
  • S.A. Curley

    Radiofrequency ablation of malignant liver tumors

    Ann Surg Oncol

    (2003)
  • R.A. Steeves

    Hyperthermia in cancer therapy: where are we today and where are we going?

    Bull N Y Acad Med

    (1992)
  • R.F. Leveen

    Laser hyperthermia and radiofrequency ablation of hepatic lesions

    Semin Interv Radiol

    (1997)
  • J.A. Dickson et al.

    Temperature range and selective sensitivity of tumors to hyperthermia: a critical review

    Ann N Y Acad Sci

    (1980)
  • J.P. McGahan et al.

    Hepatic ablation using radiofrequency electrocautery

    Invest Radiol

    (1990)
  • S. Rossi et al.

    Thermal lesions induced by 480 KHz localized current field in guinea pig and pig liver

    Tumori

    (1990)
  • C.L. Scaife et al.

    Accuracy of preoperative imaging of hepatic tumors with helical computed tomography

    Ann Surg Oncol

    (2006)
  • S.S. Raman et al.

    Minimizing diaphragmatic injury during radio-frequency ablation: efficacy of subphrenic peritoneal saline injection in a porcine model

    Radiology

    (2002)
  • P.F. Laeseke et al.

    Use of dextrose 5% in water instead of saline to protect against inadvertent radiofrequency injuries

    AJR Am J Roentgenol

    (2005)
  • Cited by (4)

    • Longterm survival outcomes of patients undergoing treatment with radiofrequency ablation for hepatocellular carcinoma and metastatic colorectal cancer liver tumors

      2016, HPB
      Citation Excerpt :

      Several local ablative treatments which include transarterial chemoembolization, percutaneous ethanol injection, and RFA were then developed. RFA particularly have emerged as a promising adjunct in the treatment of CLM and HCC in the past decade due to its safety, efficacy, and ability to provide more consistent results in local tumor control, especially in patients with limited hepatic reserve.10,11 While there have been several studies evaluating 5-year survival in small cohorts of patients undergoing RFA as part of their treatment strategy for HCC or CLM, there are only limited data on 10-year survival, which is a time interval that we believe is equivocal with cure.3,12–15

    • Radiofrequency ablation compared to resection in early-stage hepatocellular carcinoma

      2013, HPB
      Citation Excerpt :

      These include transarterial chemoembolization, percutaneous ethanol injection and radiofrequency ablation (RFA). The last of these has been increasingly used as a second‐line alternative to surgery for primary and metastatic hepatic malignancies because it is superior to other locally ablative modalities, safer and provides more consistent results in local tumour control.6-8 Its major usage has been in patients with early‐stage HCC and limited liver reserve, who are unsuitable for surgical resection.

    • Liver-directed therapy in metastatic colorectal cancer

      2017, Expert Review of Anticancer Therapy
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