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. 2015 Dec;25(12):3438-54.
doi: 10.1007/s00330-015-3779-z. Epub 2015 May 22.

Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, The Interventional Oncology Sans Frontières meeting 2013

Alice Gillams  1 , Nahum Goldberg  2 , Muneeb Ahmed  2 , Reto Bale  3 , David Breen  4 , Matthew Callstrom  5 , Min Hua Chen  6 , Byung Ihn Choi  7 , Thierry de Baere  8 , Damian Dupuy  9 , Afshin Gangi  10 , Debra Gervais  11 , Thomas Helmberger  12 , Ernst-Michael Jung  13 , Fred Lee  14 , Riccardo Lencioni  15 , Ping Liang  16 , Tito Livraghi  17 , David Lu  18 , Franca Meloni  19 , Philippe Pereira  20 , Fabio Piscaglia  21 , Hyunchul Rhim  22 , Riad Salem  23 , Constantinos Sofocleous  24 , Stephen B Solomon  24 , Michael Soulen  25 , Masatoshi Tanaka  26 , Thomas Vogl  27 , Brad Wood  28 , Luigi Solbiati  29
Affiliations

Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, The Interventional Oncology Sans Frontières meeting 2013

Alice Gillams et al. Eur Radiol. 2015 Dec.

Abstract

Objectives: Previous attempts at meta-analysis and systematic review have not provided clear recommendations for the clinical application of thermal ablation in metastatic colorectal cancer. Many authors believe that the probability of gathering randomised controlled trial (RCT) data is low. Our aim is to provide a consensus document making recommendations on the appropriate application of thermal ablation in patients with colorectal liver metastases.

Methods: This consensus paper was discussed by an expert panel at The Interventional Oncology Sans Frontières 2013. A literature review was presented. Tumour characteristics, ablation technique and different clinical applications were considered and the level of consensus was documented.

Results: Specific recommendations are made with regard to metastasis size, number, and location and ablation technique. Mean 31 % 5-year survival post-ablation in selected patients has resulted in acceptance of this therapy for those with technically inoperable but limited liver disease and those with limited liver reserve or co-morbidities that render them inoperable.

Conclusions: In the absence of RCT data, it is our aim that this consensus document will facilitate judicious selection of the patients most likely to benefit from thermal ablation and provide a unified interventional oncological perspective for the use of this technology.

Key points: • Best results require due consideration of tumour size, number, volume and location. • Ablation technology, imaging guidance and intra-procedural imaging assessment must be optimised. • Accepted applications include inoperable disease due to tumour distribution or inadequate liver reserve. • Other current indications include concurrent co-morbidity, patient choice and the test-of-time approach. • Future applications may include resectable disease, e.g. for small solitary tumours.

Keywords: Ablation techniques; Clinical protocols; Colorectal neoplasms; Consensus; Liver neoplasms.

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Figures

Fig. 1
Fig. 1
Crude tumour volume (product of mean size and mean number of liver metastases) vs. 5-year survival
Fig. 2
Fig. 2
Management algorithm for patients presenting with colorectal liver metastases
See this image and copyright information in PMC

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