Book contents
- Frontmatter
- Contents
- List of contributors
- Section I Principles of oncology
- Section II Principles of image-guided therapies
- Section III Organ-specific cancers – primary liver cancers
- Section IV Organ-specific cancers – liver metastases
- 16 Colorectal masses: Ablation
- 17 Assessment, triage, and chemoembolization for colorectal liver metastases
- 18 Radioembolization for colorectal liver metastases
- 19 Assessment, triage, and liver-directed therapies for neuroendocrine tumor metastases
- 20 Preoperative portal vein embolization
- Section V Organ-specific cancers – extrahepatic biliary cancer
- Section VI Organ-specific cancers – renal cell carcinoma
- Section VII Organ-specific cancers – chest
- Section VIII Organ-specific cancers – musculoskeletal
- Section IX Organ-specific cancers – prostate
- Section X Specialized interventional techniques in cancer care
- Index
- References
16 - Colorectal masses: Ablation
from Section IV - Organ-specific cancers – liver metastases
Published online by Cambridge University Press: 05 September 2016
- Frontmatter
- Contents
- List of contributors
- Section I Principles of oncology
- Section II Principles of image-guided therapies
- Section III Organ-specific cancers – primary liver cancers
- Section IV Organ-specific cancers – liver metastases
- 16 Colorectal masses: Ablation
- 17 Assessment, triage, and chemoembolization for colorectal liver metastases
- 18 Radioembolization for colorectal liver metastases
- 19 Assessment, triage, and liver-directed therapies for neuroendocrine tumor metastases
- 20 Preoperative portal vein embolization
- Section V Organ-specific cancers – extrahepatic biliary cancer
- Section VI Organ-specific cancers – renal cell carcinoma
- Section VII Organ-specific cancers – chest
- Section VIII Organ-specific cancers – musculoskeletal
- Section IX Organ-specific cancers – prostate
- Section X Specialized interventional techniques in cancer care
- Index
- References
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 OncologyPrinciples and Practice of Image-Guided Cancer Therapy, pp. 139 - 147Publisher: Cambridge University PressPrint publication year: 2016