Ablative Therapies for Colorectal Liver Metastases
Section snippets
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.
References (80)
- et al.
Radiofrequency ablation of hepatic metastases
Semin Oncol
(2002) - et al.
A pilot study of cryochemotherapy for hepatic metastases from colorectal cancer
Cryobiology
(1996) - et al.
A morphological study of cooling rate response in normal and neoplastic human liver tissue: cryosurgical implications
Cryobiology
(1993) - et al.
Mechanisms of focal heat destruction of liver tumors
J Surg Res
(2005) - et al.
Transdiaphragmatic radiofrequency ablation of liver tumors
J Am Coll Surg
(2004) - et al.
Radiofrequency ablation for unresectable hepatic tumors
Am J Surg
(2001) - et al.
Local, intrahepatic, and systemic recurrence patterns after radiofrequency ablation of hepatic malignancies
J Gastrointest Surg
(2002) - et al.
Complication, local recurrence, and survival rates after radiofrequency ablation for hepatic malignancies
Surg Oncol Clin N Am
(2003) Radiofrequency tumor ablation: principles and techniques
Eur J Ultrasound
(2001)- et al.
Ultrasound-guided radiofrequency thermal ablation of liver tumors: percutaneous, laparoscopic, and open surgical approaches
J Gastrointest Surg
(2001)
Outcome after hepatic resection versus combined resection and microwave ablation for multiple bilobar colorectal metastases to the liver
Surgery
Hepatic inflow occlusion increases the efficacy of interstitial laser-induced thermotherapy in rat
J Surg Res
MR-guided laser thermal ablation of primary and secondary liver tumours
Clin Radiol
Cancer statistics, 2009
CA Cancer J Clin
Resection of hepatic metastases from colorectal cancer. Biologic perspective
Ann Surg
Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history
Br J Surg
The treatment of hepatic metastases in colorectal carcinoma
Am Surg
Actual 10-year survival after resection of colorectal liver metastases defines cure
J Clin Oncol
Local surgical, ablative, and radiation treatment of metastases
CA Cancer J Clin
Oligometastases
J Clin Oncol
The Norton-Simon hypothesis revisited
Cancer Treat Rep
The Norton-Simon hypothesis: designing more effective and less toxic chemotherapeutic regimens
Nat Clin Pract Oncol
Application of cryogenic surgery to resection of parenchymal organs
N Engl J Med
Local ablation for unresectable liver tumors: is thermal best?
J Hepatobiliary Pancreat Surg
Ultrasound-guided hepatic cryosurgery in the treatment of metastatic colon carcinoma. Preliminary results
Cancer
Anaesthetic experience with cryotherapy for treatment of hepatic malignancy
Anaesth Intensive Care
World survey on the complications of hepatic and prostate cryotherapy
World J Surg
Thermal ablative therapies for secondary hepatic malignancies
Cancer J
Place of cryosurgery in the treatment of malignant liver tumors
Ann Surg
A comparison of percutaneous cryosurgery and percutaneous radiofrequency for unresectable hepatic malignancies
Arch Surg
Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies
Am J Surg
Radiofrequency ablation of malignant liver tumors
Ann Surg Oncol
Hyperthermia in cancer therapy: where are we today and where are we going?
Bull N Y Acad Med
Laser hyperthermia and radiofrequency ablation of hepatic lesions
Semin Interv Radiol
Temperature range and selective sensitivity of tumors to hyperthermia: a critical review
Ann N Y Acad Sci
Hepatic ablation using radiofrequency electrocautery
Invest Radiol
Thermal lesions induced by 480 KHz localized current field in guinea pig and pig liver
Tumori
Accuracy of preoperative imaging of hepatic tumors with helical computed tomography
Ann Surg Oncol
Minimizing diaphragmatic injury during radio-frequency ablation: efficacy of subphrenic peritoneal saline injection in a porcine model
Radiology
Use of dextrose 5% in water instead of saline to protect against inadvertent radiofrequency injuries
AJR Am J Roentgenol
Cited by (4)
Longterm survival outcomes of patients undergoing treatment with radiofrequency ablation for hepatocellular carcinoma and metastatic colorectal cancer liver tumors
2016, HPBCitation 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, HPBCitation 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 TherapyImpact of treatment modality and number of lesions on recurrence and survival outcomes after treatment of colorectal cancer liver metastases
2014, Journal of Gastrointestinal Oncology