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16 - Colorectal masses: Ablation

from Section IV - Organ-specific cancers – liver metastases

Published online by Cambridge University Press:  05 September 2016

Elena N. Petre
Affiliation:
Department of Radiology
Stephen B. Solomon
Affiliation:
Department of Radiology
Constantinos T. Sofocleous
Affiliation:
Department of Radiology
Jean-Francois H. Geschwind
Affiliation:
Yale University School of Medicine, Connecticut
Michael C. Soulen
Affiliation:
Department of Radiology, University of Pennsylvania Hospital, Philadelphia
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Summary

Introduction

Colorectal cancer (CRC) is the third most frequently diagnosed cancer and the third leading cause of cancer-related death in the USA. About 10–25% of patients present with synchronous liver metastases at the time of primary diagnosis and another 20–25% develop metachronous liver metastases during the course of the disease. Surgical resection of distant CRC metastases may result in improved long-term survival and even cure in a subset of selected patients. The 5-year survival rates after curative resection of liver metastases range from 35% to 58%. However, only 25% of patients with colorectal liver metastases (CLM) are candidates for liver resection, while the majority remain unresectable. Chemotherapy and newer therapies can extend survival of patients with non-resectable CLM up to 24 months.

In recent years, image-guided percutaneous ablation therapies have flourished as alternative treatment options for selected patients with unresectable CLM. Different ablation technologies include radiofrequency, microwave, laser, and cryoablation, that use heat or freezing as a means of causing cell damage and death of the target tumor. More recently, irreversible electroporation (IRE), a non-thermal technology, has been applied for liver tumor ablation, including CLM.

The goal of local tumor ablation is to efficiently destroy the malignant tumor with surrounding margins while minimizing the destruction of non-affected liver. This is an important parameter for patients with low volume of healthy functioning parenchyma as those with underlying cirrhosis or steatohepatitis from prolonged chemotherapy exposure as well as those who have previously undergone extensive liver resection and present for ablation as a salvage therapy for postsurgical recurrences.

The safety and effectiveness of local tumor ablation in patients with CLM have been demonstrated in several uncontrolled studies. Patient survival after percutaneous ablation seems comparable to that of surgical series (up to 55% at 5 years) in selected patients with small-volume disease that can be treated with sufficient margins. This observation may suggest that image-guided ablation could be an equally effective and less morbid alternative to surgery for a subset of selected patients.

Type
Chapter
Information
Interventional Oncology
Principles and Practice of Image-Guided Cancer Therapy
, pp. 139 - 147
Publisher: Cambridge University Press
Print publication year: 2016

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