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Lin YM, Paolucci I, O’Connor CS, Anderson BM, Rigaud B, Fellman BM, Jones KA, Brock KK, Odisio BC. Ablative Margins of Colorectal Liver Metastases Using Deformable CT Image Registration and Autosegmentation. Radiology 2023; 307:e221373. [PMID: 36719291 PMCID: PMC10102669 DOI: 10.1148/radiol.221373] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/10/2022] [Accepted: 11/18/2022] [Indexed: 02/01/2023]
Abstract
Background Confirming ablation completeness with sufficient ablative margin is critical for local tumor control following colorectal liver metastasis (CLM) ablation. An image-based confirmation method considering patient- and ablation-related biomechanical deformation is an unmet need. Purpose To evaluate a biomechanical deformable image registration (DIR) method for three-dimensional (3D) minimal ablative margin (MAM) quantification and the association with local disease progression following CT-guided CLM ablation. Materials and Methods This single-institution retrospective study included patients with CLM treated with CT-guided microwave or radiofrequency ablation from October 2015 to March 2020. A biomechanical DIR method with AI-based autosegmentation of liver, tumors, and ablation zones on CT images was applied for MAM quantification retrospectively. The per-tumor incidence of local disease progression was defined as residual tumor or local tumor progression. Factors associated with local disease progression were evaluated using the multivariable Fine-Gray subdistribution hazard model. Local disease progression sites were spatially localized with the tissue at risk for tumor progression (<5 mm) using a 3D ray-tracing method. Results Overall, 213 ablated CLMs (mean diameter, 1.4 cm) in 124 consecutive patients (mean age, 57 years ± 12 [SD]; 69 women) were evaluated, with a median follow-up interval of 25.8 months. In ablated CLMs, an MAM of 0 mm was depicted in 14.6% (31 of 213), from greater than 0 to less than 5 mm in 40.4% (86 of 213), and greater than or equal to 5 mm in 45.1% (96 of 213). The 2-year cumulative incidence of local disease progression was 72% for 0 mm and 12% for greater than 0 to less than 5 mm. No local disease progression was observed for an MAM greater than or equal to 5 mm. Among 117 tumors with an MAM less than 5 mm, 36 had local disease progression and 30 were spatially localized within the tissue at risk for tumor progression. On multivariable analysis, an MAM of 0 mm (subdistribution hazard ratio, 23.3; 95% CI: 10.8, 50.5; P < .001) was independently associated with local disease progression. Conclusion Biomechanical deformable image registration and autosegmentation on CT images enabled identification and spatial localization of colorectal liver metastases at risk for local disease progression following ablation, with a minimal ablative margin greater than or equal to 5 mm as the optimal end point. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Sofocleous in this issue.
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Affiliation(s)
- Yuan-Mao Lin
- From the Departments of Interventional Radiology (Y.M.L., I.P.,
B.C.O.), Imaging Physics (C.S.O., B.M.A., B.R., K.A.J., K.K.B.), and
Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, 1515
Holcombe Blvd, Houston, TX 77030
| | - Iwan Paolucci
- From the Departments of Interventional Radiology (Y.M.L., I.P.,
B.C.O.), Imaging Physics (C.S.O., B.M.A., B.R., K.A.J., K.K.B.), and
Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, 1515
Holcombe Blvd, Houston, TX 77030
| | - Caleb S. O’Connor
- From the Departments of Interventional Radiology (Y.M.L., I.P.,
B.C.O.), Imaging Physics (C.S.O., B.M.A., B.R., K.A.J., K.K.B.), and
Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, 1515
Holcombe Blvd, Houston, TX 77030
| | - Brian M. Anderson
- From the Departments of Interventional Radiology (Y.M.L., I.P.,
B.C.O.), Imaging Physics (C.S.O., B.M.A., B.R., K.A.J., K.K.B.), and
Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, 1515
Holcombe Blvd, Houston, TX 77030
| | - Bastien Rigaud
- From the Departments of Interventional Radiology (Y.M.L., I.P.,
B.C.O.), Imaging Physics (C.S.O., B.M.A., B.R., K.A.J., K.K.B.), and
Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, 1515
Holcombe Blvd, Houston, TX 77030
| | - Bryan M. Fellman
- From the Departments of Interventional Radiology (Y.M.L., I.P.,
B.C.O.), Imaging Physics (C.S.O., B.M.A., B.R., K.A.J., K.K.B.), and
Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, 1515
Holcombe Blvd, Houston, TX 77030
| | - Kyle A. Jones
- From the Departments of Interventional Radiology (Y.M.L., I.P.,
B.C.O.), Imaging Physics (C.S.O., B.M.A., B.R., K.A.J., K.K.B.), and
Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, 1515
Holcombe Blvd, Houston, TX 77030
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Lin YM, Paolucci I, Anderson BM, O'Connor CS, Rigaud B, Briones-Dimayuga M, Jones KA, Brock KK, Fellman BM, Odisio BC. Study Protocol COVER-ALL: Clinical Impact of a Volumetric Image Method for Confirming Tumour Coverage with Ablation on Patients with Malignant Liver Lesions. Cardiovasc Intervent Radiol 2022; 45:1860-1867. [PMID: 36058995 PMCID: PMC9712233 DOI: 10.1007/s00270-022-03255-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE This study aims to evaluate the intra-procedural use of a novel ablation confirmation (AC) method, consisting of biomechanical deformable image registration incorporating AI-based auto-segmentation, and its impact on tumor coverage by quantitative three-dimensional minimal ablative margin (MAM) CT-generated assessment. MATERIALS AND METHODS This single-center, randomized, phase II, intent-to-treat trial is enrolling 100 subjects with primary and secondary liver tumors (≤ 3 tumors, 1-5 cm in diameter) undergoing microwave or radiofrequency ablation with a goal of achieving ≥ 5 mm MAM. For the experimental arm, the proposed novel AC method is utilized for ablation applicator(s) placement verification and MAM assessment. For the control arm, the same variables are assessed by visual inspection and anatomical landmarks-based quantitative measurements aided by co-registration of pre- and post-ablation contrast-enhanced CT images. The primary objective is to evaluate the impact of the proposed AC method on the MAM. Secondary objectives are 2-year LTP-free survival, complication rates, quality of life, liver function, other oncological outcomes, and impact of AC method on procedure workflow. DISCUSSION The COVER-ALL trial will provide information on the role of a biomechanical deformable image registration-based ablation confirmation method incorporating AI-based auto-segmentation for improving MAM, which might translate in improvements of liver ablation efficacy. CONCLUSION The COVER-ALL trial aims to provide information on the role of a novel intra-procedural AC method for improving MAM, which might translate in improvements of liver ablation efficacy. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04083378.
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Affiliation(s)
- Yuan-Mao Lin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Iwan Paolucci
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Brian M Anderson
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, TX, 77030, Houston, USA
| | - Caleb S O'Connor
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, TX, 77030, Houston, USA
| | - Bastien Rigaud
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, TX, 77030, Houston, USA
| | - Maria Briones-Dimayuga
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Kyle A Jones
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, TX, 77030, Houston, USA
| | - Kristy K Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, TX, 77030, Houston, USA
| | - Bryan M Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Bruno C Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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Du H, Tan X, Cheng L, Zhang B, Wang D. Application and Evaluation of a 64-Slice CT Three-Dimensional Fusion Technique in the Determination of the Effective Ablation Margin after Radiofrequency Ablation of Hepatocellular Carcinoma. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6898233. [PMID: 35126633 PMCID: PMC8813220 DOI: 10.1155/2022/6898233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/02/2021] [Accepted: 12/01/2021] [Indexed: 11/24/2022]
Abstract
Due to the low accuracy of traditional three-dimensional fusion technology in radiofrequency ablation of hepatocellular carcinoma, this paper studies the advantages of three-dimensional CT fusion technology over traditional two-dimensional imaging technology in preoperative visualization and radiofrequency ablation path selection of hepatocellular carcinoma. To study the prognostic differences of hepatocellular carcinoma patients with different ablation margins (AM) in the three groups, so as to explore the best AM value, so as to minimize the liver injury caused by radiofrequency ablation. The selected patients underwent CT plain scan and three-phase enhancement at 1, 3, 6, and 12 months after operation and were rechecked every 6 months. For recurrent patients, CT was rechecked every three months. The images were obtained by GE 64-slice spiral CT. The thickness of the reconstruction layer is 1 mm, and the interval is 1 mm. The reconstructed image is imported into 3D fusion software. The three-dimensional images of tumor focus, hepatic artery, portal vein, and hepatic vein were reconstructed by two experienced doctors by superimposing the saved tumor images, merging the vascular images into the display, and measuring the ablation boundary (AM value). The results showed that the recurrence rate in group A was higher than that in group B (P = 0.041), and there was no significant difference between group B and group C (P = 1.000). Compared with traditional two-dimensional imaging, three-dimensional CT fusion technology can display the anatomical structure and three-dimensional spatial relationship of tumors and blood vessels and select the best radiofrequency ablation path, so as to achieve accurate radiofrequency ablation.
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Affiliation(s)
- Haihao Du
- Department of Radiology, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan 450000, China
| | - Xiongmu Tan
- Department of Radiology, Sichuan Cancer Hospital, Chengdu, Sichuan 640041, China
| | - Liuhui Cheng
- Department of Radiology, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan 450000, China
| | - Baopeng Zhang
- Department of Radiology, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan 450000, China
| | - Daoqing Wang
- Department of Radiology, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan 450000, China
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Schlögl M, Pak ES, Bansal AD, Schell JO, Ganai S, Kamal AH, Swetz KM, Maguire JM, Perrakis A, Warraich HJ, Jones CA. Top Ten Tips Palliative Care Clinicians Should Know About Prognostication in Critical Illness and Heart, Kidney, and Liver Diseases. J Palliat Med 2021; 24:1561-1567. [PMID: 34283924 DOI: 10.1089/jpm.2021.0330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Specialty palliative care (PC) clinicians are frequently asked to discuss prognosis with patients and their families. When conveying information about prognosis, PC clinicians need also to discuss the likelihood of prolonged hospitalization, cognitive and functional disabilities, and death. As PC moves further and further upstream, it is crucial that PC providers have a broad understanding of curative and palliative treatments for serious diseases and can collaborate in prognostication with specialists. In this article, we present 10 tips for PC clinicians to consider when caring and discussing prognosis for the seriously ill patients along with their caregivers and care teams. This is the second in a three-part series around prognostication in adult and pediatric PC.
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Affiliation(s)
- Mathias Schlögl
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid Zurich, Zurich, Switzerland.,University Clinic for Acute Geriatric Care, City Hospital Waid Zurich, Zurich, Switzerland
| | - Esther S Pak
- Advanced Heart Failure/Transplantation, Philadelphia VA Medical Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amar D Bansal
- Section of Palliative Care and Medical Ethics, Department of General Medicine, Pittsburgh, Pennsylvania, USA.,Division of Renal-Electrolyte, University of Pittsburgh School of Medicine, UPMC Health System, Pittsburgh, Pennsylvania, USA
| | - Jane O Schell
- Section of Palliative Care and Medical Ethics, Department of General Medicine, Pittsburgh, Pennsylvania, USA.,Division of Renal-Electrolyte, University of Pittsburgh School of Medicine, UPMC Health System, Pittsburgh, Pennsylvania, USA
| | - Sabha Ganai
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Arif H Kamal
- Duke Cancer Institute, Duke University, Durham, North Carolina, USA.,Duke Fuqua School of Business, Duke University, Durham, North Carolina, USA
| | - Keith M Swetz
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer M Maguire
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aristotelis Perrakis
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Haider J Warraich
- Department of Medicine, Brigham and Women's Hospital and Veterans Affairs Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Synchronous Liver Resection, Cytoreductive Surgery, and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Liver and Peritoneal Metastases: A Systematic Review and Meta-analysis. Dis Colon Rectum 2021; 64:754-764. [PMID: 33742615 DOI: 10.1097/dcr.0000000000002027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Synchronous liver resection, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy for colorectal liver and peritoneal metastases have traditionally been contraindicated. More recent clinical practice has begun to promote this aggressive treatment in select patients. OBJECTIVE This study aimed to investigate the perioperative and oncological outcomes of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, with and without liver resection, in the management of metastatic colorectal cancer. DATA SOURCES Medline, Embase, and Cochrane Library databases were searched up to July 2020. STUDY SELECTION Cohort studies comparing outcomes following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with and without liver resection for metastatic colorectal cancer were reviewed. No randomized controlled trials were available. INTERVENTION Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with or without synchronous liver resection were compared. MAIN OUTCOME MEASURES The primary outcome measures were perioperative mortality and major morbidity. Secondary outcomes included 3- and 5-year overall survival and 1- and 3-year disease-free survival. RESULTS Fourteen studies fitted the inclusion criteria, with 8 studies included in the meta-analysis. On pooled analysis, there was no significant difference in perioperative morbidity and mortality between the two groups. Patients that underwent concomitant liver resection had worse 1- and 3-year disease-free survival and 3- and 5-year overall survival. LIMITATIONS Only a limited number of studies were available, with a moderate degree of heterogeneity. CONCLUSIONS The addition of synchronous liver resection to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for the treatment of resectable metastatic colorectal cancer was not associated with increased perioperative major morbidity and mortality in comparison with cytoreduction and hyperthermic intraperitoneal chemotherapy alone. However, the presence of liver metastases was associated with inferior disease-free and overall survival. These data support the continued practice of liver resection, cytoreductive surgery, and hyperthermic intraperitoneal chemotherapy in the management of select patients with such stage IV disease.
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Mikrowellenablation verlängert progressionsfreies Überleben. ROFO-FORTSCHR RONTG 2020. [DOI: 10.1055/a-1192-9598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kron P, Linecker M, Jones RP, Toogood GJ, Clavien PA, Lodge JPA. Ablation or Resection for Colorectal Liver Metastases? A Systematic Review of the Literature. Front Oncol 2019; 9:1052. [PMID: 31750233 PMCID: PMC6843026 DOI: 10.3389/fonc.2019.01052] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Successful use of ablation for small hepatocellular carcinomas (HCC) has led to interest in the role of ablation for colorectal liver metastases (CRLM). However, there remains a lack of clarity about the use of ablation for colorectal liver metastases (CRLM), specifically its efficacy compared with hepatic resection. Methods: A systematic review of the literature on ablation or resection of colorectal liver metastases was performed using MEDLINE, Cochrane Library, and Embase until December 2018. The aim of this study was to summarize the evidence for ablation vs. resection in the treatment of CRLM. Results: This review identified 1,773 studies of which 18 were eligible for inclusion. In the majority of the studies, overall survival (OS) and disease-free survival (DFS) were significantly higher and local recurrence (LR) rates were significantly lower in the resection groups. On subgroup analysis of solitary CRLM, resection was associated with improved OS, DFS, and reduced LR. Three series assessed the outcome of resection vs. ablation for technically resectable CRLM, and showed improved outcome in the resection group. In fact, there were no studies showing a survival advantage of ablation compared to resection in the treatment of CRLM. Conclusions: Resection remains the "gold standard" in the treatment of CRLM and should not be replaced by ablation at present. This review supports the use of ablation only as an adjunct to resection and as a single treatment option when resection is not safely possible.
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Affiliation(s)
- Philipp Kron
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
| | - Michael Linecker
- Department of Surgery and Transplantation, Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland
| | - Robert P Jones
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
| | - Giles J Toogood
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland
| | - J P A Lodge
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
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Wang LJ, Zhang ZY, Yan XL, Yang W, Yan K, Xing BC. Radiofrequency ablation versus resection for technically resectable colorectal liver metastasis: a propensity score analysis. World J Surg Oncol 2018; 16:207. [PMID: 30322402 PMCID: PMC6190664 DOI: 10.1186/s12957-018-1494-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/20/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Liver resection is the first-line treatment for patients with resectable colorectal liver metastasis (CRLM), while radiofrequency ablation (RFA) can be used for small unresectable CRLM because of disease extent, poor anatomical location, or comorbidities. However, the long-term outcomes are unclear for RFA treatment in resectable CRLM. This study aimed to compare the recurrence rates and prognosis between resectable CRLM patients receiving either liver resection or RFA. METHODS Consecutive patients who underwent RFA or hepatic resection from November 2010 to December 2015 were assigned in this retrospective study. Propensity score analysis was used to eliminate baseline differences between groups. Survival and recurrence rates were compared between patients receiving liver resection and RFA. RESULTS With 1:2 ratio of propensity scoring, 46 patients in the RFA group and 92 in the resection group were successfully matched. Overall survival was similar between the two groups, but the resection group had a higher disease-free survival (median, 22 months vs. 14 months). Whereas among patients with a tumor size of ≤ 3 cm, disease-free survival was similar in the two groups (median, 24 months vs. 21 months). Compared to the resection group, the RFA group had a higher rate of intrahepatic recurrence (34.8% vs. 12.0%) and a shorter recurrence free period. The local and systemic recurrence rate and recurrence-free period for the same were insignificant in the two groups. Poor disease-free survival was associated with RFA, T4, tumor diameter > 3 cm, and lymph node positivity. CONCLUSION Among patients with technically resectable CRLM, resection provided greater disease-free survival, although both treatment modalities provided similar overall survival.
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Affiliation(s)
- Li-Jun Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepatopancreatobiliary Surgery Unit I, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Zhong-Yi Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Xiao-Luan Yan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepatopancreatobiliary Surgery Unit I, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Wei Yang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Kun Yan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Bao-Cai Xing
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Hepatopancreatobiliary Surgery Unit I, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142 China
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Colorectal liver metastases: surgery versus thermal ablation (COLLISION) - a phase III single-blind prospective randomized controlled trial. BMC Cancer 2018; 18:821. [PMID: 30111304 PMCID: PMC6094448 DOI: 10.1186/s12885-018-4716-8] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/02/2018] [Indexed: 12/22/2022] Open
Abstract
Background Radiofrequency ablation (RFA) and microwave ablation (MWA) are widely accepted techniques to eliminate small unresectable colorectal liver metastases (CRLM). Although previous studies labelled thermal ablation inferior to surgical resection, the apparent selection bias when comparing patients with unresectable disease to surgical candidates, the superior safety profile, and the competitive overall survival results for the more recent reports mandate the setup of a randomized controlled trial. The objective of the COLLISION trial is to prove non-inferiority of thermal ablation compared to hepatic resection in patients with at least one resectable and ablatable CRLM and no extrahepatic disease. Methods In this two-arm, single-blind multi-center phase-III clinical trial, six hundred and eighteen patients with at least one CRLM (≤3 cm) will be included to undergo either surgical resection or thermal ablation of appointed target lesion(s) (≤3 cm). Primary endpoint is OS (overall survival, intention-to-treat analysis). Main secondary endpoints are overall disease-free survival (DFS), time to progression (TTP), time to local progression (TTLP), primary and assisted technique efficacy (PTE, ATE), procedural morbidity and mortality, length of hospital stay, assessment of pain and quality of life (QoL), cost-effectiveness ratio (ICER) and quality-adjusted life years (QALY). Discussion If thermal ablation proves to be non-inferior in treating lesions ≤3 cm, a switch in treatment-method may lead to a reduction of the post-procedural morbidity and mortality, length of hospital stay and incremental costs without compromising oncological outcome for patients with CRLM. Trial registration NCT03088150, January 11th 2017.
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Gurusamy K, Corrigan N, Croft J, Twiddy M, Morris S, Woodward N, Bandula S, Hochhauser D, Napp V, Pullan A, Jakowiw N, Prasad R, Damink SO, van Laarhoven CJHM, de Wilt JHW, Brown J, Davidson BR. Liver resection surgery versus thermal ablation for colorectal LiVer MetAstases (LAVA): study protocol for a randomised controlled trial. Trials 2018; 19:105. [PMID: 29439711 PMCID: PMC5811975 DOI: 10.1186/s13063-018-2499-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/24/2018] [Indexed: 12/22/2022] Open
Abstract
Background Although surgical resection has been considered the only curative option for colorectal liver metastases (CLM), thermal ablation has recently been suggested as an alternative curative treatment. A prospective randomised trial is required to define the efficacy of resection vs ablation for the treatment of colorectal liver metastases. Methods Design and setting: This is a multicentre, open, randomised controlled non-inferiority trial design with internal pilot and will be performed in tertiary liver centres in UK and The Netherlands. Participants: Eligible patients will be those with colorectal liver metastases at high surgical risk because of their age, co-morbidities or tumour burden and who would be suitable for liver resection or thermal ablation. Intervention: Thermal ablation as per local policy. Control: Surgical liver resection performed as per centre protocol. Co-interventions: Further chemotherapy will be offered to patients as per current practice. Outcomes Pilot study: Same as main study and in addition patients and clinicians’ acceptability of the trial to assist in optimisation of recruitment. Primary outcome: Disease-free survival (DFS) at two years post randomisation. Secondary outcomes: Overall survival, timing and site of recurrence, additional therapy after treatment failure, quality of life, complications, length of hospital stay, costs, trial acceptability, DFS measured from end of intervention. Follow-up: 24 months from randomisation; five-year follow-up for overall survival. Sample size: 330 patients to demonstrate non-inferiority of thermal ablation. Discussion This trial will determine the effectiveness and cost-effectiveness of thermal ablation vs surgical resection for high-risk people with colorectal liver metastases, and guide the optimal treatment for these patients. Trial registration ISRCTN Registry, ISRCTN52040363. Registered on 9 March 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2499-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kurinchi Gurusamy
- Royal Free Campus, Division of Surgery and Interventional Science, University College London, 9th Floor, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK
| | - Neil Corrigan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Julie Croft
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Maureen Twiddy
- Institute of Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Nick Woodward
- Department of Radiology, Royal Free Hospital, London, UK
| | - Steve Bandula
- Department of Radiology, University College London Hospital, London, UK
| | | | - Vicky Napp
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Alison Pullan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Nicholas Jakowiw
- Royal Free Campus, Division of Surgery and Interventional Science, University College London, 9th Floor, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK
| | - Raj Prasad
- Department of Surgery and Transplantation, Leeds Teaching Hospital, Leeds, UK
| | - Steven Olde Damink
- Department of General Surgery, Maastricht University, Maastricht, The Netherlands
| | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Radboud, The Netherlands
| | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Brian R Davidson
- Royal Free Campus, Division of Surgery and Interventional Science, University College London, 9th Floor, Royal Free Hospital, Rowland Hill Street, NW3 2PF, London, UK.
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11
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Petre EN, Sofocleous C. Thermal Ablation in the Management of Colorectal Cancer Patients with Oligometastatic Liver Disease. Visc Med 2017; 33:62-68. [PMID: 28612019 DOI: 10.1159/000454697] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Surgical resection of limited colorectal liver disease improves long-term survival and can be curative in a subset of selected cases. Image-guided percutaneous ablation therapies have emerged as safe and effective alternative options for selected patients with unresectable colorectal liver metastases (CLM) that can be ablated with margins. Ablation causes focal destruction of tissue and has increasingly been shown to provide durable eradication of tumors. METHODS A selective review of literature was conducted in PubMed, focusing on recent studies reporting on the safety, efficacy, and long-term outcomes of percutaneous ablation modalities in the treatment of CLM. The present work gives an overview of the different ablation techniques, their current clinical indications, and reported outcomes from most recently published studies. The 'test of time' concept for using ablation as a first local therapy is also described. RESULTS There are several thermal ablative tools currently available, including radiofrequency ablation (RFA), microwave ablation, and cryoablation. Most data to date originated from the application of RFA. Adjuvant thermal ablation in the treatment of oligometastatic colon cancer liver disease offers improved oncologic outcomes. The ideal CLM amenable to percutaneous ablation is a solitary tumor with the largest diameter up to 3 cm that can be completely ablated with a sufficient margin. 5-year overall survival rates up to 70% after ablation of unresectable CLM have been reported. Pathologic confirmation of complete tumor necrosis with margins over 5 mm provides best long-term local tumor control by thermal ablation. CONCLUSION Current evidence suggests that percutaneous ablation as adjuvant to chemotherapy improves oncologic outcomes of patients with CLM. For small tumors that can be ablated completely with clear margins, percutaneous ablation may offer outcomes similar to those of surgery.
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Affiliation(s)
- Elena Nadia Petre
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Constantinos Sofocleous
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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12
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Lee BC, Lee HG, Park IJ, Kim SY, Kim KH, Lee JH, Kim CW, Lee JL, Yoon YS, Lim SB, Yu CS, Kim JC. The role of radiofrequency ablation for treatment of metachronous isolated hepatic metastasis from colorectal cancer. Medicine (Baltimore) 2016; 95:e4999. [PMID: 27684857 PMCID: PMC5265950 DOI: 10.1097/md.0000000000004999] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We investigated recurrence pattern and oncologic outcomes after treatment of metachronous isolated liver metastases from colorectal cancer according to treatment modality.We retrospectively analyzed 123 patients treated with hepatic resection and 82 patients treated with radiofrequency ablation (RFA) for metachronous isolated hepatic metastasis from colorectal cancer (HMCRC). We compared clinicopathological data, recurrence pattern, and recurrence-free survival (RFS) rates after the treatment of hepatic metastasis between patients treated with RFA and resection.The patients in the 2 groups were similar in gender, location of primary tumor, disease-free interval to hepatic metastasis, pathologic stage of primary tumor, and number of hepatic metastasis. The age was older in RFA group but it was not statistically different. The mean diameter of the largest hepatic mass was greater in the resection group than in the RFA group (3.1 vs 1.9 cm, P < 0.001). Chemotherapy after the treatment of hepatic metastasis was more commonly given in hepatic resection group (76.4% vs 62.2%, P = 0.04). Recurrence after the treatment of hepatic metastasis was not significantly different between the 2 groups (54.5% vs 65.9% in the resection and RFA groups). However, intrahepatic recurrence without extra-hepatic metastases was more common in the RFA group than in the resection group (47.5% vs 12.1%, P < 0.001). The RFS rate after the treatment of hepatic metastasis was significantly higher in resection group (48.6% vs 33.7%, P = 0.015). The size and number of hepatic metastasis, primary tumor stage, disease-free interval to hepatic metastasis, and the modality of treatment (RFA vs resection) for hepatic metastasis were confirmed as associated factors with re-recurrence after the treatment of hepatic metastasis. Among patients with solitary hepatic metastases of ≤3 cm, marginal recurrence was higher in the RFA group (3% vs 17.2%) and re-RFA was performed to achieve comparable recurrence rate (3% vs 5.2%, P = 0.662), the RFS rate was not different between the resection and RFA group (52.4% vs 53.4%, P = 0.491).Surgical resection for HMCRC showed higher RFS. However, the RFS rate in patients with a solitary hepatic metastasis of ≤3 cm was similar between the resection and RFA groups.
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Affiliation(s)
| | | | - In Ja Park
- Division of Colon and Rectal Surgery
- Correspondence: In Ja Park, Department of Colon and Rectal Surgery, University of College of Medicine and Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea (e-mail: )
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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13
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Dervenis C, Xynos E, Sotiropoulos G, Gouvas N, Boukovinas I, Agalianos C, Androulakis N, Athanasiadis A, Christodoulou C, Chrysou E, Emmanouilidis C, Georgiou P, Karachaliou N, Katopodi O, Kountourakis P, Kyriazanos I, Makatsoris T, Papakostas P, Papamichael D, Pechlivanides G, Pentheroudakis G, Pilpilidis I, Sgouros J, Tekkis P, Triantopoulou C, Tzardi M, Vassiliou V, Vini L, Xynogalos S, Ziras N, Souglakos J. Clinical practice guidelines for the management of metastatic colorectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO). Ann Gastroenterol 2016; 29:390-416. [PMID: 27708505 PMCID: PMC5049546 DOI: 10.20524/aog.2016.0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 03/10/2016] [Indexed: 12/12/2022] Open
Abstract
There is discrepancy and failure to adhere to current international guidelines for the management of metastatic colorectal cancer (CRC) in hospitals in Greece and Cyprus. The aim of the present document is to provide a consensus on the multidisciplinary management of metastastic CRC, considering both special characteristics of our Healthcare System and international guidelines. Following discussion and online communication among the members of an executive team chosen by the Hellenic Society of Medical Oncology (HeSMO), a consensus for metastastic CRC disease was developed. Statements were subjected to the Delphi methodology on two voting rounds by invited multidisciplinary international experts on CRC. Statements reaching level of agreement by ≥80% were considered as having achieved large consensus, whereas statements reaching 60-80% moderate consensus. One hundred and nine statements were developed. Ninety experts voted for those statements. The median rate of abstain per statement was 18.5% (range: 0-54%). In the end of the process, all statements achieved a large consensus. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized. R0 resection is the only intervention that may offer substantial improvement in the oncological outcomes.
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Affiliation(s)
- Christos Dervenis
- General Surgery, "Konstantopouleio" Hospital of Athens, Greece (Christos Dervenis)
| | - Evaghelos Xynos
- General Surgery, "InterClinic" Hospital of Heraklion, Greece (Evangelos Xynos)
| | | | - Nikolaos Gouvas
- General Surgery, "METROPOLITAN" Hospital of Piraeus, Greece (Nikolaos Gouvas)
| | - Ioannis Boukovinas
- Medical Oncology, "Bioclinic" of Thessaloniki, Greece (Ioannis Boukovinas)
| | - Christos Agalianos
- General Surgery, Athens Naval & Veterans Hospital, Greece (Christos Agalianos, Ioannis Kyriazanos, George Pechlivanides)
| | - Nikolaos Androulakis
- Medical Oncology, "Venizeleion" Hospital of Heraklion, Greece (Nikolaos Androulakis)
| | | | | | - Evangelia Chrysou
- Radiology, University Hospital of Heraklion, Greece (Evangelia Chrysou)
| | - Christos Emmanouilidis
- Medical Oncology, "Interbalkan" Medical Center, Thessaloniki, Greece (Christos Emmanoulidis)
| | - Panagiotis Georgiou
- Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK (Panagiotis Georgiou, Paris Tekkis)
| | - Niki Karachaliou
- Medical Oncology, Dexeus University Institut, Barcelona, Spain (Niki Carachaliou)
| | - Ourania Katopodi
- Medical Oncology, "Iaso" General Hospital, Athens, Greece (Ourania Katopoidi)
| | - Panteleimon Kountourakis
- Medical Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Pandelis Kountourakis, Demetris Papamichael)
| | - Ioannis Kyriazanos
- General Surgery, Athens Naval & Veterans Hospital, Greece (Christos Agalianos, Ioannis Kyriazanos, George Pechlivanides)
| | - Thomas Makatsoris
- Medical Oncology, University Hospital of Patras, Greece (Thomas Makatsoris)
| | - Pavlos Papakostas
- Medical Oncology, "Ippokrateion" Hospital of Athens, Greece (Pavlos Papakostas)
| | - Demetris Papamichael
- Medical Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Pandelis Kountourakis, Demetris Papamichael)
| | - George Pechlivanides
- General Surgery, Athens Naval & Veterans Hospital, Greece (Christos Agalianos, Ioannis Kyriazanos, George Pechlivanides)
| | | | - Ioannis Pilpilidis
- Gastroenterology, "Theageneion" Cancer Hospital, Thessaloniki, Greece (Ioannis Pilpilidis)
| | - Joseph Sgouros
- Medical Oncology, "Agioi Anargyroi" Hospital of Athens, Greece (Joseph Sgouros)
| | - Paris Tekkis
- Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK (Panagiotis Georgiou, Paris Tekkis)
| | | | - Maria Tzardi
- Pathology, University Hospital of Heraklion, Greece (Maria Tzardi)
| | - Vassilis Vassiliou
- Radiation Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Vassilis Vassiliou)
| | - Louiza Vini
- Radiation Oncology, "Iatriko" Center of Athens, Greece (Lousa Vini)
| | - Spyridon Xynogalos
- Medical Oncology, "George Gennimatas" General Hospital, Athens, Greece (Spyridon Xynogalos)
| | - Nikolaos Ziras
- Medical Oncology, "Metaxas" Cancer Hospital, Piraeus, Greece (Nikolaos Ziras)
| | - John Souglakos
- Medical Oncology, University Hospital of Heraklion, Greece (John Souglakos)
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14
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Solomon SB, Sofocleous CT. The interventional radiologist role in treating liver metastases for colorectal cancer. Am Soc Clin Oncol Educ Book 2016:202-4. [PMID: 24451734 DOI: 10.14694/edbook_am.2012.32.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Interventional radiologists (IRs) have an expanding role in the treatment of liver metastases from colorectal cancer. Increasing data on the ability to treat liver metastases with locoregional therapies has solidified this position. Ablative approaches, such as radiofrequency ablation and microwave ablation, have shown durable eradication of tumors. Catheter-directed therapies-such as transarterial chemoembolization (TACE), drug-eluting beads (DEB), Y90 radioembolization, intra-arterial chemotherapy ports, and isolated hepatic perfusion (IHP)-are potential techniques for managing patients with unresectable liver metastases. Understanding the timing and role of these techniques in the multidisciplinary care of the patient is critical. Implementation of the IR clinic for consultation has enabled better integration of these therapies into the patient's overall care and has facilitated improved opportunities for clinical studies.
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15
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Ablative and catheter-directed therapies for colorectal liver and lung metastases. Hematol Oncol Clin North Am 2015; 29:117-33. [PMID: 25475575 DOI: 10.1016/j.hoc.2014.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Increasing data on treatment of liver metastases with locoregional therapies have solidified the expanding role of interventional radiologists (IRs) in the treatment of liver metastases from colorectal cancer. Ablative approaches such as radiofrequency ablation and microwave ablation have shown durable eradication of tumors. Catheter-directed therapies such as transarterial chemoembolization, drug-eluting beads, yttrium-90 radioembolization, and intra-arterial chemotherapy ports represent potential techniques for managing patients with unresectable liver metastases. Understanding the timing and role of these techniques in multidisciplinary care of patients is crucial. Implementation of IRs for consultation enables better integration of these therapies into patients' overall care.
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16
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Ahmed S, Bathe O, Berry S, Buie D, Davies J, Doll C, Dowden S, Gill S, Gordon V, Hebbard P, Jones E, Kennecke H, Koski S, Krahn M, Le D, Lim H, Lund C, Luo Y, Mcffadden A, Mcghie J, Mulder K, Park J, Rashidi F, Sami A, Tan KT, Wong R. Consensus statement: the 16th Annual Western Canadian Gastrointestinal Cancer Consensus Conference; Saskatoon, Saskatchewan; September 5-6, 2014. ACTA ACUST UNITED AC 2015; 22:e113-23. [PMID: 25908916 DOI: 10.3747/co.22.2362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The 16th annual Western Canadian Gastrointestinal Cancer Consensus Conference was held in Saskatoon, Saskatchewan, September 4-5, 2014. The Consensus Conference is an interactive, multidisciplinary event attended by health care professionals from across western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) involved in the care of gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals participated in presentation and discussion sessions for the purposes of developing the recommendations presented here. This consensus statement addresses current issues in the management of colorectal cancer.
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Affiliation(s)
- S Ahmed
- Saskatchewan: Medical Oncology (Ahmed, Sami) and Radiation Oncology (Le), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Pathology (Jones), University of Saskatchewan, Regina; Surgery (Luo), Diagnostic Radiology (Rashidi), and Interventional Radiology (Tan), University of Saskatchewan, Saskatoon
| | - O Bathe
- Alberta: Department of Surgery (Bathe, Buie), University of Calgary, Calgary; Radiation Oncology (Doll) and Medical Oncology (Dowden), Tom Baker Cancer Centre, University of Calgary, Calgary; Medical Oncology (Koski, Mulder), Cross Cancer Centre, University of Alberta, Edmonton
| | - S Berry
- Ontario: Medical Oncology (Berry), Sunnybrook Odette Cancer Centre, University of Toronto, Toronto
| | - D Buie
- Alberta: Department of Surgery (Bathe, Buie), University of Calgary, Calgary; Radiation Oncology (Doll) and Medical Oncology (Dowden), Tom Baker Cancer Centre, University of Calgary, Calgary; Medical Oncology (Koski, Mulder), Cross Cancer Centre, University of Alberta, Edmonton
| | - J Davies
- British Columbia: Medical Oncology (Davies), BC Cancer Agency-Centre for the Southern Interior, Kelowna; Medical Oncology (Gill, Kennecke, Lim, Mcghie), BC Cancer Agency, University of BC, Vancouver; Radiation Oncology (Lund), BC Cancer Agency-Fraser Valley Cancer Centre, Fraser Valley; Surgical Oncology (Mcffadden), BC Cancer Agency, Vancouver
| | - C Doll
- Alberta: Department of Surgery (Bathe, Buie), University of Calgary, Calgary; Radiation Oncology (Doll) and Medical Oncology (Dowden), Tom Baker Cancer Centre, University of Calgary, Calgary; Medical Oncology (Koski, Mulder), Cross Cancer Centre, University of Alberta, Edmonton
| | - S Dowden
- Alberta: Department of Surgery (Bathe, Buie), University of Calgary, Calgary; Radiation Oncology (Doll) and Medical Oncology (Dowden), Tom Baker Cancer Centre, University of Calgary, Calgary; Medical Oncology (Koski, Mulder), Cross Cancer Centre, University of Alberta, Edmonton
| | - S Gill
- British Columbia: Medical Oncology (Davies), BC Cancer Agency-Centre for the Southern Interior, Kelowna; Medical Oncology (Gill, Kennecke, Lim, Mcghie), BC Cancer Agency, University of BC, Vancouver; Radiation Oncology (Lund), BC Cancer Agency-Fraser Valley Cancer Centre, Fraser Valley; Surgical Oncology (Mcffadden), BC Cancer Agency, Vancouver
| | - V Gordon
- Manitoba: Medical Oncology (Gordon, Krahn, Wong), Cancer Care Manitoba, University of Manitoba, Winnipeg; Surgery (Hebbard, Park), University of Manitoba, Winnipeg
| | - P Hebbard
- Manitoba: Medical Oncology (Gordon, Krahn, Wong), Cancer Care Manitoba, University of Manitoba, Winnipeg; Surgery (Hebbard, Park), University of Manitoba, Winnipeg
| | - E Jones
- Saskatchewan: Medical Oncology (Ahmed, Sami) and Radiation Oncology (Le), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Pathology (Jones), University of Saskatchewan, Regina; Surgery (Luo), Diagnostic Radiology (Rashidi), and Interventional Radiology (Tan), University of Saskatchewan, Saskatoon
| | - H Kennecke
- British Columbia: Medical Oncology (Davies), BC Cancer Agency-Centre for the Southern Interior, Kelowna; Medical Oncology (Gill, Kennecke, Lim, Mcghie), BC Cancer Agency, University of BC, Vancouver; Radiation Oncology (Lund), BC Cancer Agency-Fraser Valley Cancer Centre, Fraser Valley; Surgical Oncology (Mcffadden), BC Cancer Agency, Vancouver
| | - S Koski
- Alberta: Department of Surgery (Bathe, Buie), University of Calgary, Calgary; Radiation Oncology (Doll) and Medical Oncology (Dowden), Tom Baker Cancer Centre, University of Calgary, Calgary; Medical Oncology (Koski, Mulder), Cross Cancer Centre, University of Alberta, Edmonton
| | - M Krahn
- Manitoba: Medical Oncology (Gordon, Krahn, Wong), Cancer Care Manitoba, University of Manitoba, Winnipeg; Surgery (Hebbard, Park), University of Manitoba, Winnipeg
| | - D Le
- Saskatchewan: Medical Oncology (Ahmed, Sami) and Radiation Oncology (Le), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Pathology (Jones), University of Saskatchewan, Regina; Surgery (Luo), Diagnostic Radiology (Rashidi), and Interventional Radiology (Tan), University of Saskatchewan, Saskatoon
| | - H Lim
- British Columbia: Medical Oncology (Davies), BC Cancer Agency-Centre for the Southern Interior, Kelowna; Medical Oncology (Gill, Kennecke, Lim, Mcghie), BC Cancer Agency, University of BC, Vancouver; Radiation Oncology (Lund), BC Cancer Agency-Fraser Valley Cancer Centre, Fraser Valley; Surgical Oncology (Mcffadden), BC Cancer Agency, Vancouver
| | - C Lund
- British Columbia: Medical Oncology (Davies), BC Cancer Agency-Centre for the Southern Interior, Kelowna; Medical Oncology (Gill, Kennecke, Lim, Mcghie), BC Cancer Agency, University of BC, Vancouver; Radiation Oncology (Lund), BC Cancer Agency-Fraser Valley Cancer Centre, Fraser Valley; Surgical Oncology (Mcffadden), BC Cancer Agency, Vancouver
| | - Y Luo
- Saskatchewan: Medical Oncology (Ahmed, Sami) and Radiation Oncology (Le), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Pathology (Jones), University of Saskatchewan, Regina; Surgery (Luo), Diagnostic Radiology (Rashidi), and Interventional Radiology (Tan), University of Saskatchewan, Saskatoon
| | - A Mcffadden
- British Columbia: Medical Oncology (Davies), BC Cancer Agency-Centre for the Southern Interior, Kelowna; Medical Oncology (Gill, Kennecke, Lim, Mcghie), BC Cancer Agency, University of BC, Vancouver; Radiation Oncology (Lund), BC Cancer Agency-Fraser Valley Cancer Centre, Fraser Valley; Surgical Oncology (Mcffadden), BC Cancer Agency, Vancouver
| | - J Mcghie
- British Columbia: Medical Oncology (Davies), BC Cancer Agency-Centre for the Southern Interior, Kelowna; Medical Oncology (Gill, Kennecke, Lim, Mcghie), BC Cancer Agency, University of BC, Vancouver; Radiation Oncology (Lund), BC Cancer Agency-Fraser Valley Cancer Centre, Fraser Valley; Surgical Oncology (Mcffadden), BC Cancer Agency, Vancouver
| | - K Mulder
- Alberta: Department of Surgery (Bathe, Buie), University of Calgary, Calgary; Radiation Oncology (Doll) and Medical Oncology (Dowden), Tom Baker Cancer Centre, University of Calgary, Calgary; Medical Oncology (Koski, Mulder), Cross Cancer Centre, University of Alberta, Edmonton
| | - J Park
- Manitoba: Medical Oncology (Gordon, Krahn, Wong), Cancer Care Manitoba, University of Manitoba, Winnipeg; Surgery (Hebbard, Park), University of Manitoba, Winnipeg
| | - F Rashidi
- Saskatchewan: Medical Oncology (Ahmed, Sami) and Radiation Oncology (Le), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Pathology (Jones), University of Saskatchewan, Regina; Surgery (Luo), Diagnostic Radiology (Rashidi), and Interventional Radiology (Tan), University of Saskatchewan, Saskatoon
| | - A Sami
- Saskatchewan: Medical Oncology (Ahmed, Sami) and Radiation Oncology (Le), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Pathology (Jones), University of Saskatchewan, Regina; Surgery (Luo), Diagnostic Radiology (Rashidi), and Interventional Radiology (Tan), University of Saskatchewan, Saskatoon
| | - K T Tan
- Saskatchewan: Medical Oncology (Ahmed, Sami) and Radiation Oncology (Le), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Pathology (Jones), University of Saskatchewan, Regina; Surgery (Luo), Diagnostic Radiology (Rashidi), and Interventional Radiology (Tan), University of Saskatchewan, Saskatoon
| | - R Wong
- Manitoba: Medical Oncology (Gordon, Krahn, Wong), Cancer Care Manitoba, University of Manitoba, Winnipeg; Surgery (Hebbard, Park), University of Manitoba, Winnipeg
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17
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Joo I. The role of intraoperative ultrasonography in the diagnosis and management of focal hepatic lesions. Ultrasonography 2015; 34:246-57. [PMID: 25971896 PMCID: PMC4603208 DOI: 10.14366/usg.15014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 04/06/2015] [Accepted: 04/06/2015] [Indexed: 12/12/2022] Open
Abstract
Intraoperative ultrasonography (IOUS) has been widely utilized in hepatic surgery both as a diagnostic technique and in the course of treatment. Since IOUS involves direct-contact imaging of the target organ, it can provide high spatial resolution without interference from the surrounding structures. Therefore, IOUS may improve the detection, characterization, localization, and local staging of hepatic tumors. IOUS is also a real-time imaging modality capable of providing interactive information and valuable guidance in a range of procedures. Recently, contrast-enhanced IOUS, IOUS elastography, and IOUS-guided hepatic surgery have attracted increasing interest and are expected to lead to the broader implementation of IOUS. Herein, we review the various applications of IOUS in the diagnosis and management of focal hepatic lesions.
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Affiliation(s)
- Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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18
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Shan CC, Shi LR, Ding MQ, Zhu YB, Li XD, Xu B, Jiang JT, Wu CP. Cytokine-induced killer cells co-cultured with dendritic cells loaded with the protein lysate produced by radiofrequency ablation induce a specific antitumor response. Oncol Lett 2015; 9:1549-1556. [PMID: 25788999 PMCID: PMC4356333 DOI: 10.3892/ol.2015.2977] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 12/16/2014] [Indexed: 02/07/2023] Open
Abstract
Radiofrequency ablation (RFA) causes coagulative necrosis of tumor tissue and the production of local tumor protein debris. These fragments of tumor protein debris contain a large number of various antigens, which can stimulate a specific cellular immune response. In the present study, dendritic cells (DCs) were loaded with tumor protein lysate antigens that were produced in situ by RFA, and were used to treat murine colon carcinoma in combination with cytokine-induced killer (CIK) cells. Subsequent to the treatment of murine colon carcinoma by RFA, the in situ supernatant of tumor lysis was collected and the DCs were loaded with the lysate antigen to generate Ag-DCs. CIK cells induced from the spleen cells of mice were co-cultured with Ag-DCs to generate Ag-DC-CIK cells. The results revealed that the Ag-DC-CIK cells exhibited strong antitumor activity in vitro and in vivo. The morphology and immunophenotypes of these cells were determined using microscopy and flow cytometry, respectively. The cytotoxic activity of Ag-DC-CIK cells was determined using a CCK-8 assay. To establish a mouse model, mice were randomized into Ag-DC-CIK, DC-CIK, CIK and PBS control groups and monitored for tumor growth and survival time. ANOVA was used to compare the trends in the three groups for implanted tumor volumes. The log-rank test was used to compare the survival time. The present findings indicated that DCs loaded with the protein lysate antigens of tumors, produced in situ by RFA, combined with CIK cells may be a novel strategy for cancer treatment.
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Affiliation(s)
- Chan-Chan Shan
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, P.R. China
| | - Liang-Rong Shi
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, P.R. China
| | - Mei-Qian Ding
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, P.R. China
| | - Yi-Bei Zhu
- Institute of Biotechnology, Soochow University, Suzhou, Jiangsu, P.R. China
| | - Xiao-Dong Li
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, P.R. China
| | - Bin Xu
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, P.R. China
| | - Jing-Ting Jiang
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, P.R. China
| | - Chang-Ping Wu
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, P.R. China ; Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, P.R. China
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19
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Ringe KI, Wacker F, Raatschen HJ. Is there a need for MRI within 24 hours after CT-guided percutaneous thermoablation of the liver? Acta Radiol 2015; 56:10-7. [PMID: 24445091 DOI: 10.1177/0284185114520858] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Radiofrequency (RFA) and microwave ablation (MWA) are established minimally invasive techniques for treatment of hepatic tumors. PURPOSE To compare technical success and accuracy of hepatic thermoablation using computed tomography (CT) and magnetic resonance imaging (MRI) acquired 24 h after ablation with regard to evaluation of the post-interventional ablation zone and local tumor recurrence (LTR), and to assess whether additional MRI within 24 h is beneficial. MATERIAL AND METHODS Thirty-two patients (23 men, 9 women; mean age, 60 years) with 48 lesions were included in this retrospective study. CT was performed immediately and MRI was performed 24 h after ablation. Diameter and volume calculations of the ablation zone were compared (T-Test). Technical success and ablation margin distinction, shape, and configuration were evaluated (κ-statistic). Local effectiveness was calculated based on follow-up imaging. Technical success and ablation margin features were correlated with LTR (log-rank test, Fisher's exact test). RESULTS Ablation zone volumes were significantly higher with MRI compared to CT (P < 0.05; mean volume, 55.19 and 45.97 mL). Agreement between CT and MRI for technical success was good (κ = 0.801) and for margin conspicuity fair (κ = 0.289). LTR was 26.1% (mean follow-up, 11.7 months). LTR showed no correlation with technical success or margin conspicuity. CONCLUSION CT and MRI are suited for early evaluation of technical success after thermoablation. Within 24 h a significant increase of the ablation volume is observed, which has to be taken into account when interpreting immediate postprocedural imaging and treating lesions near critical structures. Additional MRI 24 h after ablation seems of limited value regarding prognosis of LTR, especially with regards to evaluation of ablation margin shape and conspicuity.
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Affiliation(s)
- Kristina Imeen Ringe
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
| | - Frank Wacker
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
| | - Hans-Jürgen Raatschen
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
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20
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Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, Chen MH, Choi BI, de Baère T, Dodd GD, Dupuy DE, Gervais DA, Gianfelice D, Gillams AR, Lee FT, Leen E, Lencioni R, Littrup PJ, Livraghi T, Lu DS, McGahan JP, Meloni MF, Nikolic B, Pereira PL, Liang P, Rhim H, Rose SC, Salem R, Sofocleous CT, Solomon SB, Soulen MC, Tanaka M, Vogl TJ, Wood BJ, Goldberg SN. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. J Vasc Interv Radiol 2014; 25:1691-705.e4. [PMID: 25442132 PMCID: PMC7660986 DOI: 10.1016/j.jvir.2014.08.027] [Citation(s) in RCA: 346] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/11/2014] [Accepted: 03/26/2014] [Indexed: 12/12/2022] Open
Abstract
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.
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Affiliation(s)
- Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center 1 Deaconess Rd, WCC-308B, Boston, MA 02215.
| | - Luigi Solbiati
- Department of Radiology, Ospedale Generale, Busto Arsizio, Italy
| | - Christopher L Brace
- Departments of Radiology, Biomedical Engineering, and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David J Breen
- Department of Radiology, Southampton University Hospitals, Southampton, England
| | | | | | - Min-Hua Chen
- Department of Ultrasound, School of Oncology, Peking University, Beijing, China
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Thierry de Baère
- Department of Imaging, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Gerald D Dodd
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Damian E Dupuy
- Department of Diagnostic Radiology, Rhode Island Hospital, Providence, Rhode Island
| | - Debra A Gervais
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Gianfelice
- Medical Imaging, University Health Network, Laval, Quebec, Canada
| | | | - Fred T Lee
- Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Edward Leen
- Department of Radiology, Royal Infirmary, Glasgow, Scotland
| | - Riccardo Lencioni
- Department of Diagnostic Imaging and Intervention, Cisanello Hospital, Pisa University Hospital and School of Medicine, University of Pisa, Pisa, Italy
| | - Peter J Littrup
- Department of Radiology, Karmonos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | - David S Lu
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John P McGahan
- Department of Radiology, Ambulatory Care Center, UC Davis Medical Center, Sacramento, California
| | | | - Boris Nikolic
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Philippe L Pereira
- Clinic of Radiology, Minimally-Invasive Therapies and Nuclear Medicine, Academic Hospital Ruprecht-Karls-University Heidelberg, Heilbronn, Germany
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Hyunchul Rhim
- Department of Diagnostic Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Steven C Rose
- Department of Radiology, University of California, San Diego, San Diego, California
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, Illinois
| | | | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael C Soulen
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Bradford J Wood
- Radiology and Imaging Science, National Institutes of Health, Bethesda, Maryland
| | - S Nahum Goldberg
- Department of Radiology, Image-Guided Therapy and Interventional Oncology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Sofocleous CT, Sideras P, Petre EN. "How we do it" - a practical approach to hepatic metastases ablation techniques. Tech Vasc Interv Radiol 2014; 16:219-29. [PMID: 24238377 DOI: 10.1053/j.tvir.2013.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Secondary liver malignancies are associated with significant mortality and morbidity if left untreated. Colorectal cancer is the most frequent origin of hepatic metastases. A multidisciplinary approach to the treatment of hepatic metastases includes medical, surgical, radiation and interventional oncology. The role of interventional oncology in the management of hepatic malignancies continues to evolve and applies to a large and continuous spectrum of metastatic disease, from the relatively small solitary metastasis to larger tumors and multifocal liver disease. Within the past 10 years, several publications of percutaneous image-guided ablation indicated the effectiveness and safety of this minimally invasive therapy for selected patients with limited number (arguably up to 4 metastases) of relatively small (less than 5cm) hepatic metastases. Different image-guided procedures such radiofrequency, microwave, and laser cause thermal ablation and coagulation necrosis or cell death of the target tumor. Cryoablation, causing cell death via cellular freezing, has also been used. Recently, irreversible electroporation, a nonthermal modality, has also been used for liver tumor ablation. In the following section, we review the different liver ablation techniques, as well as indications for ablation, specific patient preparations, and different "tricks of the trade" that we use to achieve safe and effective liver tumor ablation. We also discuss appropriate imaging and clinical patient follow-up and potential complications of liver tumor ablation.
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Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, Chen MH, Choi BI, de Baère T, Dodd GD, Dupuy DE, Gervais DA, Gianfelice D, Gillams AR, Lee FT, Leen E, Lencioni R, Littrup PJ, Livraghi T, Lu DS, McGahan JP, Meloni MF, Nikolic B, Pereira PL, Liang P, Rhim H, Rose SC, Salem R, Sofocleous CT, Solomon SB, Soulen MC, Tanaka M, Vogl TJ, Wood BJ, Goldberg SN. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. Radiology 2014; 273:241-60. [PMID: 24927329 DOI: 10.1148/radiol.14132958] [Citation(s) in RCA: 826] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes. Online supplemental material is available for this article .
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Affiliation(s)
- Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center 1 Deaconess Rd, WCC-308B, Boston, MA 02215 (M.A.); Department of Radiology, Ospedale Generale, Busto Arsizio, Italy (L.S.); Departments of Radiology, Biomedical Engineering, and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.L.B.); Department of Radiology, Southampton University Hospitals, Southampton, England (D.J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.R.C., J.W.C.); Department of Ultrasound, School of Oncology, Peking University, Beijing, China (M.H.C.); Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea (B.I.C.); Department of Imaging, Institut de Cancérologie Gustave Roussy, Villejuif, France (T.d.B.); Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo (G.D.D.); Department of Diagnostic Radiology, Rhode Island Hospital, Providence, RI (D.E.D.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.A.G.); Medical Imaging, University Health Network, Laval, Quebec, Canada (D.G.); Imaging Department, the London Clinic, London, England (A.R.G.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (F.T.L.); Department of Radiology, Royal Infirmary, Glasgow, Scotland (E.L.); Department of Diagnostic Imaging and Intervention, Cisanello Hospital, Pisa University Hospital and School of Medicine, University of Pisa, Pisa, Italy (R.L.); Department of Radiology, Karmonos Cancer Institute, Wayne State University, Detroit, Mich (P.J.L.); Busto Arsizio, Italy (T.L.); Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (D.S.L.); Department of Radiology, Ambulatory Care Center, UC Davis Medical Center, Sacramento, Calif (J.P.M.); Department of Radiology, Ospedale Valduce, Como, Italy (M.F.M.); Department of Radiology, Albert Einstein Medical Center, Phil
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Evolving ablative therapies for hepatic malignancy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:230174. [PMID: 24877069 PMCID: PMC4022034 DOI: 10.1155/2014/230174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 03/28/2014] [Indexed: 02/07/2023]
Abstract
The liver is a common site for both primary and secondary malignancy. Hepatic resection and transplantation are the two treatment modalities that have been shown to achieve complete cure, but only 10 to 20% of patients are candidates for these treatments. For the remaining patients, tumor ablation has emerged as the most promising alternative modality. In addition to providing local control and improving survival outcomes, tumor ablation also helps to down stage patients for potential curative treatments, both alone as well as in combination with other treatments. While tumor ablation can be achieved in multiple ways, the introduction of newer ablative techniques has shifted the focus from palliation to potentially curative treatment. Because the long-term safety and survival benefits are not substantive at present, it is important that we strive to evaluate the results from these studies using appropriate comparative outcome methodologies.
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Rueb GR, Brady WJ, Gilliland CA, Patrie JT, Saad WE, Sabri SS, Park AW, Stone JR, Angle JF. Characterizing Cardiopulmonary Arrest during Interventional Radiology Procedures. J Vasc Interv Radiol 2013; 24:1774-8. [DOI: 10.1016/j.jvir.2013.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/15/2013] [Accepted: 07/17/2013] [Indexed: 12/21/2022] Open
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Rempp H, Loh H, Hoffmann R, Rothgang E, Pan L, Claussen CD, Clasen S. Liver lesion conspicuity during real-time MR-guided radiofrequency applicator placement using spoiled gradient echo and balanced steady-state free precession imaging. J Magn Reson Imaging 2013; 40:432-9. [PMID: 24677447 DOI: 10.1002/jmri.24371] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 07/26/2013] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To retrospectively evaluate the conspicuity of liver lesions in a fluoroscopic spoiled gradient echo (GRE) and a balanced steady-state free precession (SSFP) magnetic resonance imaging (MRI) sequence. MATERIALS AND METHODS In all, 103 patients with hepatocellular carcinomas (HCC) (41) or liver metastases (67) were treated using MR-guided radiofrequency ablation in a wide-bore 1.5 T scanner. A multislice real-time spoiled GRE sequence allowing for a T1 weighting (T1W) and a balanced SSFP sequence allowing for a T2/T1W contrast were used for MR guidance. The contrast-to-noise-ratio (CNR) of the lesions was calculated and lesion conspicuity was assessed retrospectively (easily detectable / difficult to detect / not detectable). RESULTS HCC was easily detectable in 33/52% (GRE/SSFP), difficult to detect in 30/18%, and not detectable in 37/30% of the cases. Mean CNR varied widely (9.1 for GRE vs. 16.4 for SSFP). Liver metastases were easily detectable in 58/41% (GRE/SSFP), difficult to detect in 14/21%, and not detectable in 28/38% of the cases. Mean CNR for liver metastases was 11.5 (GRE) vs. 12.7 (SSFP). Twenty percent of all lesions could not be detected with either of the MR fluoroscopy sequences. CONCLUSION MR fluoroscopy using GRE and SSFP contrast enabled real-time detectability of 80% of the liver lesions.
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Affiliation(s)
- Hansjörg Rempp
- Eberhard Karls University of Tübingen, Department of Diagnostic and Interventional Radiology, Tübingen, Germany
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Gameiro SR, Higgins JP, Dreher MR, Woods DL, Reddy G, Wood BJ, Guha C, Hodge JW. Combination therapy with local radiofrequency ablation and systemic vaccine enhances antitumor immunity and mediates local and distal tumor regression. PLoS One 2013; 8:e70417. [PMID: 23894654 PMCID: PMC3722166 DOI: 10.1371/journal.pone.0070417] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/23/2013] [Indexed: 02/06/2023] Open
Abstract
Purpose Radiofrequency ablation (RFA) is a minimally invasive energy delivery technique increasingly used for focal therapy to eradicate localized disease. RFA-induced tumor-cell necrosis generates an immunogenic source of tumor antigens known to induce antitumor immune responses. However, RFA-induced antitumor immunity is insufficient to control metastatic progression. We sought to characterize (a) the role of RFA dose on immunogenic modulation of tumor and generation of immune responses and (b) the potential synergy between vaccine immunotherapy and RFA aimed at local tumor control and decreased systemic progression. Experimental Design Murine colon carcinoma cells expressing the tumor-associated (TAA) carcinoembryonic antigen (CEA) (MC38-CEA+) were studied to examine the effect of sublethal hyperthermia in vitro on the cells’ phenotype and sensitivity to CTL-mediated killing. The effect of RFA dose was investigated in vivo impacting (a) the phenotype and growth of MC38-CEA+ tumors and (b) the induction of tumor-specific immune responses. Finally, the molecular signature was evaluated as well as the potential synergy between RFA and poxviral vaccines expressing CEA and a TRIad of COstimulatory Molecules (CEA/TRICOM). Results In vitro, sublethal hyperthermia of MC38-CEA+ cells (a) increased cell-surface expression of CEA, Fas, and MHC class I molecules and (b) rendered tumor cells more susceptible to CTL-mediated lysis. In vivo, RFA induced (a) immunogenic modulation on the surface of tumor cells and (b) increased T-cell responses to CEA and additional TAAs. Combination therapy with RFA and vaccine in CEA-transgenic mice induced a synergistic increase in CD4+ T-cell immune responses to CEA and eradicated both primary CEA+ and distal CEA– s.c. tumors. Sequential administration of low-dose and high-dose RFA with vaccine decreased tumor recurrence compared to RFA alone. These studies suggest a potential clinical benefit in combining RFA with vaccine in cancer patients, and augment support for this novel translational paradigm.
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Affiliation(s)
- Sofia R. Gameiro
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jack P. Higgins
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Matthew R. Dreher
- Center for Interventional Oncology, Radiology, and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, United States of America
| | - David L. Woods
- Center for Interventional Oncology, Radiology, and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Goutham Reddy
- Center for Interventional Oncology, Radiology, and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Bradford J. Wood
- Center for Interventional Oncology, Radiology, and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Chandan Guha
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, United States of America
| | - James W. Hodge
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
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van Dijk TH, Tamas K, Beukema JC, Beets GL, Gelderblom AJ, de Jong KP, Nagtegaal ID, Rutten HJ, van de Velde CJ, Wiggers T, Hospers GA, Havenga K. Evaluation of short-course radiotherapy followed by neoadjuvant bevacizumab, capecitabine, and oxaliplatin and subsequent radical surgical treatment in primary stage IV rectal cancer. Ann Oncol 2013; 24:1762-1769. [PMID: 23524865 DOI: 10.1093/annonc/mdt124] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and tolerability of preoperative short-course radiotherapy followed by capecitabine and oxaliplatin treatment in combination with bevacizumab and subsequent radical surgical treatment of all tumor sites in patients with stage IV rectal cancer. PATIENTS AND METHODS Adults with primary metastasized rectal cancer were enrolled. They received radiotherapy (5 × 5 Gy) followed by bevacizumab (7.5 mg/kg, day 1) and oxaliplatin (130 mg/m(2), day 1) intravenously and capecitabine (1000 mg/m(2) twice daily orally, days 1-14) for up to six cycles. Surgery was carried out 6-8 weeks after the last bevacizumab dose. The percentage of radical surgical treatment, 2-year survival and recurrence rates, and treatment-related toxicity was evaluated. RESULTS Of 50 included patients, 42 (84%) had liver metastases, 5 (10%) lung metastases, and 3 (6%) both liver and lung metastases. Radical surgical treatment was possible in 36 (72%) patients. The 2-year overall survival rate was 80% [95% confidence interval (CI) 66.3%-90.0%]. The 2-year recurrence rate was 64% (95% CI 49.8%-84.5%). Toxic effects were tolerable. No treatment-related deaths occurred. CONCLUSIONS Radical surgical treatment of all tumor sites carried out after short-course radiotherapy, and bevacizumab-capecitabine-oxaliplatin combination therapy is a feasible and potentially curative approach in primary metastasized rectal cancer.
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Affiliation(s)
| | - K Tamas
- Department of Medical Oncology
| | - J C Beukema
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen
| | - G L Beets
- Department of Surgery, University Hospital Maastricht
| | - A J Gelderblom
- Department of Clinical Oncology, Leiden University Medical Center
| | - K P de Jong
- Department of Hepato-pancreato-biliary Surgery, University of Groningen, University Medical Center Groningen
| | - I D Nagtegaal
- Department of Pathology, University Medical Center St Radboud, Nijmegen
| | - H J Rutten
- Department of Surgery, Catharina Hospital, Eindhoven
| | - C J van de Velde
- Department of Surgery, Leiden University Medical Center, The Netherlands
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Zhang SJ, Hu P, Wang N, Shen Q, Sun AX, Kuang M, Qian GJ. Thermal ablation versus repeated hepatic resection for recurrent intrahepatic cholangiocarcinoma. Ann Surg Oncol 2013; 20:3596-602. [PMID: 23715967 DOI: 10.1245/s10434-013-3035-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Repeated hepatic resection (HR) and thermal ablation therapy (TAT) are increasingly being used to treat recurrent intrahepatic cholangiocarcinoma (RICC). This study compared the efficacy and safety of these procedures for RICC treatment. METHODS Patients were studied retrospectively after curative resection of RICCs by repeated HR (n = 32) or TAT (n = 77). Treatment effectiveness and prognosis were compared between the two treatment groups. RESULTS The repeated HR and TAT groups did not differ in their overall survival (OS; p = 0.996) or disease-free survival (DFS; p = 0.692) rates. However, among patients with recurrent tumors >3 cm in diameter, patients in the repeated HR group had a higher OS rate than patients in the TAT group (p = 0.037). The number of recurrent tumors and the recurrence interval were significant prognostic factors for OS. The major complications incidence rate was greater in the repeated HR group than in the TAT group (p < 0.001). CONCLUSIONS Repeated HR and TAT are both effective treatments for RICC with similar overall efficacies. TAT should be preferred in any cases when the RICC is ≤3 cm in diameter and technically feasible. However, for large tumors (>3 cm), repeated HR may be a better choice.
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Affiliation(s)
- Shao-Jun Zhang
- Minimal Invasion Therapy Department 1, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
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30
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Aggressive Treatment for Hepatic Metastases from Breast Cancer: Results from a Single Center. World J Surg 2013; 37:1322-32. [DOI: 10.1007/s00268-013-1986-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Roy S. Focal hydrothermal ablation: preliminary investigation of a new concept. Cardiovasc Intervent Radiol 2013; 36:1112-9. [PMID: 23377238 DOI: 10.1007/s00270-013-0562-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine whether focal tissue ablation is possible with interstitial instillation of steam. METHODS Fresh swine livers were used. Through a 20 gauge needle, steam was instilled every 5 s, 3 (n = 5), 6 (n = 5), 9 (n = 5), or 12 (n = 5 + 5) times in a liver lobe. The ablated zones were sectioned parallel (n = 20) or perpendicular (n = 5) to the needle track. The longitudinal long and short axis diameters, or transverse long and short axis diameters of areas with discoloration on macroscopic examination, were measured. The experiment was repeated in vivo on a pig. Steam instillation was performed once every 5 s for 5 min in the liver (n = 3) and in muscle (n = 4), and temperature changes at three neighboring sites were monitored. Long and short axis diameters of the discolored areas were measured. RESULTS A well-defined area of discoloration was invariably present at the site of steam instillation. The median longitudinal long axis diameter were 2.0, 2.5, 2.5, and 3.5 cm for 3, 6, 9, and 12 steam instillations in vitro, while median short axis diameters were 1.0, 1.5, 1.5, and 1.5 cm, respectively. Six attempts at ablation in vivo could be successfully completed. The long axis diameters of the ablated zones in the liver were 7.0 and 8.0 cm, while in muscle it ranged from 5.5 to 7.0 cm. CONCLUSION Instillation of steam in the liver in vitro and in vivo, and in muscle in vivo rapidly leads to circumscribed zones of coagulation necrosis.
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Affiliation(s)
- Sumit Roy
- Department of Radiology, Stavanger University Hospital, Postboks 8100, 4011, Stavanger, Norway.
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Thaker AA, Razjouyan F, Woods DL, Haemmerich D, Sekhar K, Wood BJ, Dreher MR. Combination therapy of radiofrequency ablation and bevacizumab monitored with power Doppler ultrasound in a murine model of hepatocellular carcinoma. Int J Hyperthermia 2012; 28:766-75. [PMID: 23043501 DOI: 10.3109/02656736.2012.724517] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The purpose of this study was to monitor tumour blood flow with power Doppler ultrasound following antiangiogenic therapy with bevacizumab in order to optimally time the application of radiofrequency (RF) ablation to increase ablation diameter. MATERIALS AND METHODS Athymic nude mice bearing human hepatocellular carcinoma xenografts were treated with bevacizumab and imaged daily with power Doppler ultrasound to quantify tumour blood flow. Mice were treated with RF ablation alone or in combination with bevacizumab at the optimal time, as determined by ultrasound. Ablation diameter was measured with histology and tumour microvascular density was calculated with immunohistochemistry. A computational thermal model of RF ablation was used to estimate ablation volume. RESULTS A maximum reduction of 27.8 ± 8.6% in tumour blood flow occurred on day 2 following antiangiogenic therapy, while control tumours increased 29.3 ± 17.1% (p < 0.05). Tumour microvascular density was similarly reduced by 45.1 ± 5.9% on day 2 following antiangiogenic therapy. Histology demonstrated a 13.6 ± 5.6% increase in ablation diameter (40 ± 21% increase in volume) consistent with a computational model. CONCLUSION Quantitative power Doppler ultrasound is a useful biomarker to monitor tumour blood flow following antiangiogenic treatment and to guide the application of RF ablation as a drug plus device combination therapy.
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Affiliation(s)
- Ashesh A Thaker
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
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Weng M, Zhang Y, Zhou D, Yang Y, Tang Z, Zhao M, Quan Z, Gong W. Radiofrequency ablation versus resection for colorectal cancer liver metastases: a meta-analysis. PLoS One 2012; 7:e45493. [PMID: 23029051 PMCID: PMC3448670 DOI: 10.1371/journal.pone.0045493] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 08/20/2012] [Indexed: 02/05/2023] Open
Abstract
Background No randomized controlled trial (RCT) has yet been performed to provide the evidence to clarify the therapeutic debate on liver resection (LR) and radiofrequency ablation (RFA) in treating colorectal liver metastases (CLM). The meta-analysis was performed to summarize the evidence mostly from retrospective clinical trials and to investigate the effect of LR and RFA. Methodology/Principal Findings Systematic literature search of clinical studies was carried out to compare RFA and LR for CLM in Pubmed, Embase and the Cochrane Library Central databases. The meta-analysis was performed using risk ratio (RR) and random effect model, in which 95% confidence intervals (95% CI) for RR were calculated. Primary outcomes were the overall survival (OS) and disease-free survival (DFS) at 3 and 5 years plus mortality and morbidity. 1 prospective study and 12 retrospective studies were finally eligible for meta-analysis. LR was significantly superior to RFA in 3 -year OS (RR 1.377, 95% CI: 1.246–1.522); 5-year OS (RR: 1.474, 95%CI: 1.284–1.692); 3-year DFS (RR 1.735, 95% CI: 1.483–2.029) and 5-year DFS (RR 2.227, 95% CI: 1.823–2.720). The postoperative morbidity was higher in LR (RR: 2.495, 95% CI: 1.881–3.308), but no significant difference was found in mortality between LR and RFA. The data from the 3 subgroups (tumor<3 cm; solitary tumor; open surgery or laparoscopic approach) showed significantly better OS and DFS in patients who received surgical resection. Conclusions/Significances Although multiple confounders exist in the clinical trials especially the bias in patient selection, LR was significantly superior to RFA in the treatment of CLM, even when conditions limited to tumor<3 cm, solitary tumor and open surgery or laparoscopic (lap) approach. Therefore, caution should be taken when treating CLM with RFA before more supportive evidences for RFA from RCTs are obtained.
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Affiliation(s)
| | | | | | | | | | | | - Zhiwei Quan
- Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- * E-mail: (ZWQ); (WG)
| | - Wei Gong
- Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- * E-mail: (ZWQ); (WG)
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Cirocchi R, Trastulli S, Boselli C, Montedori A, Cavaliere D, Parisi A, Noya G, Abraha I. Radiofrequency ablation in the treatment of liver metastases from colorectal cancer. Cochrane Database Syst Rev 2012:CD006317. [PMID: 22696357 DOI: 10.1002/14651858.cd006317.pub3] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the most common malignant tumour and the third leading cause of cancer deaths in USA. For advanced CRC, the liver is the first site of metastatic disease; approximately 50 % of patients with CRC will develop liver metastases either synchronously or metachronously within 2 years after primary diagnosis. Hepatic resection (HR) is the only curative option, but only 15-20% of patients with liver metastases from CRC (CRLMs) are suitable for surgical standard treatment. In patients with unresectable CRLMs downsizing chemotherapy can improve resectability (16%). Modern systemic chemotherapy represents the only significant treatment for unresectable CRLMs. However several loco-regional treatments have been developed: hepatic arterial infusion (HAI), cryosurgical ablation (CSA), radiofrequency ablation (RFA), microwave ablation and selective internal radion treatment (SIRT). During the past decade RFA has superseded other ablative therapies, due to its low morbidity, mortality, safety and patient acceptability. OBJECTIVES The objective of this study was to systematically review the role of radiofrequency ablation (RFA) in the treatment of CRLMs. SEARCH METHODS We performed electronic searches in the following databases:CENTRAL, MEDLINE and EMBASE. Current trials were identified through the Internet using the Clinical-Trials.gov site (to January 2, 2012) and ASCO Proceedings. The reference lists of identified trials were reviewed for additional studies. SELECTION CRITERIA Randomized clinical trials (RCTs), quasi-randomised or controlled clinical trials (CCTs) comparing RFA to any other therapy for CRLMs were included. Observational study designs including comparative cohort studies comparing RFA to another intervention, single arm cohort studies or case control studies have been included if they have: prospectively collected data, ten or more patients; and have a mean or median follow-up time of 24 months. Patients with CRLMs who have no contraindications for RFA. Patients with unresectable extra-hepatic disease were also included.Trials have been considered regardless of language of origin. DATA COLLECTION AND ANALYSIS A total of 1144 records were identified through the above electronic searching. We included 18 studies: 10 observational studies, 7 Clinical Controlled Trials (CCTs) and an additional 1 Randomized Clinical Trial (RCT) (abstract) identified by hand searching in the 2010 ASCO Annual Meeting. The most appropriate way of summarizing time-to-event data is to use methods of survival analysis and express the intervention effect as a hazard ratio. In the included studies these outcome are mostly reported as dichotomous data so we should have asked authors research data for each participant and perform Individual Patient Data (IPD) meta-analysis. Given the study design and low quality of included studies we decided to give up and not to summarize these data. MAIN RESULTS Seventeen studies were not randomised and this increases the potential for selection bias. In addition, there was imbalance in the baseline characteristics of the participants included in all studies. All studies were classified as having a elevate risk of bias. The assessment of methodological quality of all non-randomized studies included in meta-analysis performed by the STROBE checklist has allowed us to identify several methodological limits in most of the analysed studies. At present, the information from the single RCT included (Ruers 2010) comes from an abstract of 2010 ASCO Annual Meeting where the allocation concealment was not reported; however in original protocol allocation concealment was adequately reported (EORTC 40004 protocol). The heterogeneity regarding interventions, comparisons and outcomes rendered the data not suitable. AUTHORS' CONCLUSIONS This systematic review gathers information from several controlled clinical trials and observational studies which are vulnerable to different types of bias. The imbalance between characteristics of patients in the allocated groups appears to be the main concern. Only one randomised clinical trial (published as an abstract), comparing 60 patients receiving RFA plus CT versus 59 patients receiving CT alone, was identified. This study showed that PFS was significantly higher in the group that received RFA. However, it was not able to provide information on overall survival. In conclusion, evidence from the included studies are insufficient to recommend RFA for a radical oncological treatment of CRLMs.
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Affiliation(s)
- Roberto Cirocchi
- Department of General Surgery, University of Perugia, Terni, Italy.
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Expanding the Role of Surgical Therapy for Colorectal Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2012. [DOI: 10.1007/s11888-012-0126-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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MR-guided radiofrequency ablation using a wide-bore 1.5-T MR system: clinical results of 213 treated liver lesions. Eur Radiol 2012; 22:1972-82. [DOI: 10.1007/s00330-012-2438-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 01/26/2012] [Accepted: 02/13/2012] [Indexed: 01/18/2023]
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Rempp H, Boss A, Helmberger T, Pereira P. The current role of minimally invasive therapies in the management of liver tumors. ACTA ACUST UNITED AC 2012; 36:635-47. [PMID: 21562884 DOI: 10.1007/s00261-011-9749-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This is a review of minimally invasive therapy options for liver tumors, such as highly focused ultrasound, microwave ablation, and irreversible electroporation, as well as new aspects of radiofrequency ablation. Radiofrequency ablation is recommended for patients with early-stage HCC with up to 3 lesions with a tumor diameter within 3 cm and for patients with non-resectable liver metastasis. Indications and contraindications to treatment are designated, and different modalities for image-based therapy guidance are compared. Options for therapy monitoring and controlling are reviewed, namely intraprocedural tools, imaging and functional parameters and their evolution during therapy. Prevention and control of local recurrences is discussed. We also present a short review of current clinical results in treating liver metastasis and primary liver tumors.
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Affiliation(s)
- Hansjörg Rempp
- Department on Diagnostic and Interventional Radiology, Eberhard Karls University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
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Outcome of laparoscopic major liver resection for colorectal metastases. Surg Endosc 2012; 26:2451-5. [PMID: 22358126 DOI: 10.1007/s00464-012-2209-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 01/31/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Minimally invasive liver resection (MILR) for colorectal liver metastases (CRLM) is gaining widespread acceptance. However, data are still lacking on the feasibility, long- and short-term outcomes of laparoscopic major hepatectomy (i.e., three or more liver segments). METHODS Between October 2002 and December 2008, prospectively collected data of 117 patients who underwent major liver resection [97 open (OMLR) and 20 laparoscopic (LMLR) procedures] for CRLM were analyzed. Twenty patients in the LMLR group were matched with 20 patients of the OMLR based on 13 parameters. We compared the long- and short-term outcomes between these two groups. RESULTS Median duration of surgery was 257.5 (range 75-360) min in LMLR versus 232.5 (range 120-400) min in OMLR (P = 0.228). Median blood loss during surgery was 550 ml in each group (range 100-4,000 vs. 100-2,500 ml, P = 0.884). There was no statistically significant difference in the rate of postoperative complications (both severity and location). Median magnitude of tumor-free resection margin was 7.5 versus 5.5 mm in the laparoscopy versus open group, respectively (P = 0.651). Median disease-free survival (DFS) of the entire study population was 18.4 months [95% confidence interval (CI) 11.9-50.0 months]. Median overall survival (OS) was 50.7 months (95% CI 36.2 months to undetermined). The estimated DFS and OS rates at 1, 2, and 5 years were comparable in the two groups (P = 0.637 and 0.872, respectively). CONCLUSION Laparoscopic MLR for selected CRLM is feasible and might result in comparable oncologic outcomes as in open liver resection.
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Zhang Y, Peng Z, Chen M, Liu F, Huang J, Xu L, Zhang Y, Chen M. Elevated neutrophil to lymphocyte ratio might predict poor prognosis for colorectal liver metastasis after percutaneous radiofrequency ablation. Int J Hyperthermia 2012; 28:132-40. [DOI: 10.3109/02656736.2011.654374] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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40
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Minimally invasive evaluation and treatment of colorectal liver metastases. Int J Surg Oncol 2012; 2011:686030. [PMID: 22312518 PMCID: PMC3263653 DOI: 10.1155/2011/686030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 05/05/2011] [Indexed: 12/07/2022] Open
Abstract
Minimally invasive techniques used in the evaluation and treatment of colorectal liver metastases (CRLMs) include ultrasonography (US), computed tomography, magnetic resonance imaging, percutaneous and operative ablation therapy, standard laparoscopic techniques, robotic techniques, and experimental techniques of natural orifice endoscopic surgery. Laparoscopic techniques range from simple staging laparoscopy with or without laparoscopic intraoperative US, through intermediate techniques including simple liver resections (LRs), to advanced techniques such as major hepatectomies. Hereins, we review minimally invasive evaluation and treatment of CRLM, focusing on a comparison of open LR (OLR) and minimally invasive LR (MILR). Although there are no randomized trials comparing OLR and MILR, nonrandomized data suggest that MILR compares favorably with OLR regarding morbidity, mortality, LOS, and cost, although significant selection bias exists. The future of MILR will likely include expanding criteria for resectability of CRLM and should include both a patient registry and a formalized process for surgeon training and credentialing.
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Minimally invasive liver surgery for metastases from colorectal cancer: oncologic outcome and prognostic factors. Surg Endosc 2012; 26:2288-98. [PMID: 22311303 DOI: 10.1007/s00464-012-2176-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 01/10/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few reports exist on long-term survival after minimally invasive liver surgery (MILS) for colorectal liver metastases (CRLM). No data are available assessing prognostic factors in the era of current modern treatment strategies. METHODS Between October 2002 and December 2008, 274 consecutive patients were analyzed on an intention-to-treat basis. Open liver surgery (OLS) was performed in 193 patients for a total of 437 metastases, and MILS was performed in 81 patients for 176 metastases. Systemic chemotherapy was administered preoperatively in 173 and postoperatively in 174 patients. The impact of 23 potential prognostic factors on disease-free (DFS) and overall survival (OS) was evaluated using univariable and multivariable Cox regression models. RESULTS Postoperative complications were observed in 54 patients after OLS and in 11 after MILS (p = 0.016). The median postoperative length of hospital stay was 9 days after OLS and 5 days after MILS (p < 0.0001). For the entire patient population, the 5 year DFS and OS rates were 29.9 and 59.5%, respectively. No differences in survival between patients treated with MILS and OLS were observed (p = 0.63). In univariable analyses, the number of liver metastases and the overall Fong's clinical risk score (CRS) were the only two variables that predicted DFS (p ≤ 0.0035) and OS (p ≤ 0.0005). In multivariable analyses, the total CRS was the only independent predictor of both DFS (p = 0.0002) and OS (p = 0.002). CONCLUSION The long-term oncologic outcome of surgically treated patients with CRLM is determined by the Fong's CRS. Although MILS does not influence long-term survival, it has a beneficial impact on the immediate postoperative clinical outcome.
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Janne d'Othée B, Sofocleous CT, Hanna N, Lewandowski RJ, Soulen MC, Vauthey JN, Cohen SJ, Venook AP, Johnson MS, Kennedy AS, Murthy R, Geschwind JF, Kee ST. Development of a research agenda for the management of metastatic colorectal cancer: proceedings from a multidisciplinary research consensus panel. J Vasc Interv Radiol 2012; 23:153-63. [PMID: 22264550 PMCID: PMC4352314 DOI: 10.1016/j.jvir.2011.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 12/07/2011] [Indexed: 12/12/2022] Open
Affiliation(s)
- Bertrand Janne d'Othée
- Department of Diagnostic Radiology and Nuclear Medicine, Division of Vascular and Interventional Radiology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Multipolar radiofrequency ablation using 4-6 applicators simultaneously: a study in the ex vivo bovine liver. Eur J Radiol 2012; 81:2568-75. [PMID: 22297178 DOI: 10.1016/j.ejrad.2011.10.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 10/21/2011] [Indexed: 02/03/2023]
Abstract
In this study the volume and shape of coagulation zones after multipolar radiofrequency ablation (RFA) with simultaneous use of 4-6 applicators in the ex vivo bovine liver were investigated. The RF-applicators were positioned in 13 different configurations to simulate ablation of large solitary tumors and simultaneous ablation of multiple lesions with 120 kJ of applied energy/session. In total, 110 coagulation zones were induced. Standardized measurements of the volume and shape of the coagulation zones were carried out on magnetic resonance images and statistically analyzed. The coagulation zones induced with solitary applicators and with 2 applicators were imperceptibly small and incomplete, respectively. At 20mm applicator distance, the total ablated volume was significantly larger if all applicators were arranged in a single group compared to placement in 2 distant applicator groups, each consisting of 3 applicators (p=.001). The mean total coagulated volume ranged from immeasurably small (if 6 solitary applicators were applied simultaneously) to 74.7 cc (if 6 applicators at 30 mm distance between neighboring applicators were combined to a single group). Applicator distance, number and positioning array impacted time and shape. The coagulation zones surrounding groups with 4-6 applicators were regularly shaped, homogeneous and completely fused, and the axial diameters were almost constant. In conclusion, multipolar RFA with 4-6 applicators is feasible. The multipolar simultaneous mode should be applied for large and solitary lesions only, small and multiple tumors should be ablated consecutively in standard multipolar mode with up to 3 applicators.
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den Brok MH, Nierkens S, Wagenaars JA, Ruers TJ, Schrier CC, Rijke EO, Adema GJ. Saponin-based adjuvants create a highly effective anti-tumor vaccine when combined with in situ tumor destruction. Vaccine 2012; 30:737-44. [PMID: 22138178 DOI: 10.1016/j.vaccine.2011.11.080] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 11/15/2011] [Accepted: 11/18/2011] [Indexed: 11/16/2022]
Affiliation(s)
- Martijn H den Brok
- Department of Tumor Immunology, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Geert Grooteplein 28, 6525 GA Nijmegen, The Netherlands
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Rieder C, Kröger T, Schumann C, Hahn HK. GPU-based real-time approximation of the ablation zone for radiofrequency ablation. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2011; 17:1812-1821. [PMID: 22034298 DOI: 10.1109/tvcg.2011.207] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Percutaneous radiofrequency ablation (RFA) is becoming a standard minimally invasive clinical procedure for the treatment of liver tumors. However, planning the applicator placement such that the malignant tissue is completely destroyed, is a demanding task that requires considerable experience. In this work, we present a fast GPU-based real-time approximation of the ablation zone incorporating the cooling effect of liver vessels. Weighted distance fields of varying RF applicator types are derived from complex numerical simulations to allow a fast estimation of the ablation zone. Furthermore, the heat-sink effect of the cooling blood flow close to the applicator's electrode is estimated by means of a preprocessed thermal equilibrium representation of the liver parenchyma and blood vessels. Utilizing the graphics card, the weighted distance field incorporating the cooling blood flow is calculated using a modular shader framework, which facilitates the real-time visualization of the ablation zone in projected slice views and in volume rendering. The proposed methods are integrated in our software assistant prototype for planning RFA therapy. The software allows the physician to interactively place virtual RF applicator models. The real-time visualization of the corresponding approximated ablation zone facilitates interactive evaluation of the tumor coverage in order to optimize the applicator's placement such that all cancer cells are destroyed by the ablation.
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Brouquet A, Andreou A, Vauthey JN. The management of solitary colorectal liver metastases. Surgeon 2011; 9:265-72. [PMID: 21843821 DOI: 10.1016/j.surge.2010.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 12/16/2010] [Indexed: 02/07/2023]
Abstract
Surgical resection of solitary colorectal liver metastases is associated with long-term survival. Radiofrequency ablation used as the primary treatment option of solitary resectable colorectal liver metastases is associated with an increased risk of local recurrence that generally leads to worse survival compared to resection. In contrast with treatment of other hepatic malignancies, radiofrequency ablation is not equivalent to resection for colorectal liver metastases and should not be used as an alternative but limited to inoperable patients. Although overall survival rate after resection can be up to 71% at 5 years, the majority of patients develop recurrence. Preoperative chemotherapy contributes to decrease the risk of recurrence after resection of colorectal liver metastases. In patients with advanced solitary colorectal liver metastasis initially non suitable for resection, chemotherapy and portal vein embolization contribute to increase the number of surgical candidates whereas radiofrequency is rarely an option.
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Affiliation(s)
- Antoine Brouquet
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030, United States
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Wu YZ, Li B, Wang T, Wang SJ, Zhou YM. Radiofrequency ablation vs hepatic resection for solitary colorectal liver metastasis: A meta-analysis. World J Gastroenterol 2011; 17:4143-8. [PMID: 22039331 PMCID: PMC3203368 DOI: 10.3748/wjg.v17.i36.4143] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 01/19/2011] [Accepted: 01/26/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the comparative therapeutic efficacy of radiofrequency ablation (RFA) and hepatic resection (HR) for solitary colorectal liver metastases (CLM).
METHODS: A literature search was performed to identify comparative studies reporting outcomes for both RFA and HR for solitary CLM. Pooled odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using either the fixed effects model or random effects model.
RESULTS: Seven nonrandomized controlled trials studies were included in this analysis. These studies included a total of 847 patients: 273 treated with RFA and 574 treated with HR. The 5 years overall survival rates in the HR group were significantly better than those in the RFA group (OR: 0.41, 95% CI: 0.22-0.90, P = 0.008). RFA had a higher rate of local intrahepatic recurrence compared to HR (OR: 4.89, 95% CI: 1.73-13.87, P = 0.003). No differences were found between the two groups with respect to postoperative morbidity and mortality.
CONCLUSION: HR was superior to RFA in the treatment of patients with solitary CLM. However, the findings have to be carefully interpreted due to the lower level of evidence.
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Seror O. [Percutaneous radiofrequency and other liver ablation techniques: 2011 update]. JOURNAL DE RADIOLOGIE 2011; 92:763-773. [PMID: 21944235 DOI: 10.1016/j.jradio.2011.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 07/13/2011] [Indexed: 05/31/2023]
Abstract
Percutaneous ablation of liver tumors was initially limited to patients that were not surgical candidates and with a limited number of relatively small liver lesions. Because of the diversification of techniques and technologies, percutaneous liver ablation has progressively been integrating to more and more complex therapeutic strategies available to a wider group of patients. Local knowledge and expertise with these techniques, largely dominated by radiofrequency ablation, often dictate the role of these techniques in the management of patients with liver tumors. We will review the clinical indications of percutaneous ablation techniques for liver tumors based on clinical considerations as well as ablation techniques.
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Affiliation(s)
- O Seror
- Service de radiologie, hôpital Jean-Verdier, avenue du 14-Juillet, 93143 Bondy, France.
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Kim KH, Yoon YS, Yu CS, Kim TW, Kim HJ, Kim PN, Ha HK, Kim JC. Comparative analysis of radiofrequency ablation and surgical resection for colorectal liver metastases. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:25-34. [PMID: 22066097 PMCID: PMC3204557 DOI: 10.4174/jkss.2011.81.1.25] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 04/23/2011] [Indexed: 12/22/2022]
Abstract
Purpose To evaluate the comparative therapeutic efficacy of radiofrequency ablation (RFA) and hepatic resection for the treatment of colorectal liver metastasis (CRLM). Methods Between 1996 and 2008, 177 patients underwent RFA, 278 underwent hepatic resection and 27 underwent combination therapy for CRLM. Comparative analysis of clinical outcomes was performed including number of liver metastases, tumor size, and time of CRLM. Results Based on multivariate analysis, overall survival (OS) correlated with the number of liver metastases and the use of combined chemotherapy (P < 0.001, respectively). Disease-free survival (DFS) also correlated with the number of liver metastases (P < 0.001). In the 226 patients with solitary CRLM < 3 cm, OS and DFS rates did not differ between the RFA group and the resection group (P = 0.962 and P = 0.980). In the 70 patients with solitary CRLM ≥ 3 cm, DFS was significantly lower in the RFA group as compared with the resection group (P = 0.015). Conclusion The results indicate that RFA may be a safe alternative treatment for solitary CRLM less than 3 cm, with outcomes equivalent to those achieved with hepatic resection. A randomized controlled study comparing RFA and resection for patients with single small metastasis would help to determine the most efficient treatment modalities for CRLM.
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Affiliation(s)
- Kyung Ho Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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In vivo validation of a therapy planning system for laser-induced thermotherapy (LITT) of liver malignancies. Int J Colorectal Dis 2011; 26:799-808. [PMID: 21404055 DOI: 10.1007/s00384-011-1175-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE In situ ablation is increasingly being used for the treatment of liver malignancies. The application of these techniques is limited by the lack of a precise prediction of the destruction volume. This holds especially true in anatomically difficult situations, such as metastases in the vicinity of larger liver vessels. We developed a three-dimensional (3D) planning system for laser-induced thermotherapy (LITT) of liver tumors. The aim of the study was to validate the system for calculation of the destruction volume. METHODS LITT (28 W, 20 min) was performed in close contact to major hepatic vessels in six pigs. After explantation of the liver, the coagulation area was documented. The liver and its vascular structures were segmented from a pre-interventional CT scan. Therapy planning was carried out including the cooling effect of adjacent liver vessels. The lesions in vivo and the simulated lesions were compared with a morphometric analysis. RESULTS The volume of lesions in vivo was 6,568.3 ± 3,245.9 mm(3), which was not different to the simulation result of 6,935.2 ± 2,538.5 mm(3) (P = 0.937). The morphometric analysis showed a sensitivity of the system of 0.896 ± 0.093 (correct prediction of destructed tissue). The specificity was 0.858 ± 0.090 (correct prediction of vital tissue). CONCLUSIONS A 3D computer planning system for the prediction of thermal lesions in LITT was developed. The calculation of the directional cooling effect of intrahepatic vessels is possible for the first time. The morphometric analysis showed a good correlation under clinical conditions. The pre-therapeutic calculation of the ablation zone might be a valuable tool for procedure planning.
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