Annals of Surgical Oncology

, Volume 14, Issue 3, pp 1161–1169 | Cite as

Comparison Between Local Ablative Therapy and Chemotherapy for Non-Resectable Colorectal Liver Metastases: A Prospective Study

  • Theo J. M. Ruers
  • Joris J. Joosten
  • Bastiaan Wiering
  • Barbara S. Langenhoff
  • Heleen M. Dekker
  • Theo Wobbes
  • Wim J. G. Oyen
  • Paul F. M. Krabbe
  • Cornelis J. A. Punt



There is a growing interest for the use of local ablative techniques in patients with non-resectable colorectal liver metastases. Evidence on the efficacy over systemic chemotherapy is, however, extremely weak. In this prospective study we aim to assess the additional benefits of local tumour ablation.


A consecutive series of 201 colorectal cancer patients, without extrahepatic disease, that underwent laparotomy for surgical treatment of liver metastases, were prospectively followed for survival and HRQoL. At laparotomy three groups were identified: patients in whom radical resection of metastases proved feasible, patients in whom resection was not feasible and received local ablative therapy, and patients in whom resection or local ablation was not feasible for technical reasons and who received systemic chemotherapy.


Patients in the chemotherapy and in local ablation group were comparable for all prognostic variables tested. For the local ablation group overall survival at 2 and 5 years was 56 and 27%, respectively (median 31 months, n = 45), for the chemotherapy group 51 and 15%, respectively (median 26 months, n = 39) (P = 0.252). After resection these figures were 83 and 51%, respectively (median 61 months, n = 117) (P < 0.001). The median DFS after local ablation was 9 months, HRQoL was restored within 3 months. Patients after local ablation gained far more QALY’s (317) than in the chemotherapy group (165) (P < 0.001).


Although overall survival did not reached statistical significance, the median DFS of 9 months suggests a beneficial effect of local tumour ablation for non-resectable colorectal liver metastases. Moreover, compared with systemic chemotherapy more QALY’s were gained after local ablative therapy.


Resection Group Colorectal Liver Metastasis Local Tumour Control Chemotherapy Group Extrahepatic Disease 
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  1. 1.
    Fernandez FG, Drebin JA, Linehan DC, Dehdashti F, Siegel BA, Strasberg SM. Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg 2004; 240(3):438–47PubMedCrossRefGoogle Scholar
  2. 2.
    Fong Y, Cohen AM, Fortner JG, Enker WE, Turnbull AD, Coit DG, et al. Liver resection for colorectal metastases. J Clin Oncol 1997;15(3):938–46PubMedGoogle Scholar
  3. 3.
    Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer 1996;77(7):1254–62PubMedCrossRefGoogle Scholar
  4. 4.
    Ruers T, Bleichrodt RP. Treatment of liver metastases, an update on the possibilities and results. Eur J Cancer 2002;38(7):1023–33PubMedCrossRefGoogle Scholar
  5. 5.
    Minagawa M, Makuuchi M, Torzilli G, Takayama T, Kawasaki S, Kosuge T, et al. Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg 2000;231(4):487–99PubMedCrossRefGoogle Scholar
  6. 6.
    Goldberg RM, Sargent DJ, Morton RF, Fuchs CS, Ramanathan RK, Williamson SK, et al. A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 2004;22(1):23–30PubMedCrossRefGoogle Scholar
  7. 7.
    Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth J, Heim W, et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 2004;350(23):2335–42PubMedCrossRefGoogle Scholar
  8. 8.
    Punt JCA. New options and old dilemmas in the treatment of patients with advanced colorectal cancer. Ann Oncol 2004;15:1453–59PubMedCrossRefGoogle Scholar
  9. 9.
    Folprecht G, Grothey A, Alberts S, Raab HR, Kohne CH. Neoadjuvant treatment of unresectable colorectal liver metastases: correlation between tumour response and resection rates. Ann Oncol 2005;16:1311–9PubMedCrossRefGoogle Scholar
  10. 10.
    Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004;239(6):818–25PubMedCrossRefGoogle Scholar
  11. 11.
    Adam R, Hagopian EJ, Linhares M, Krissat J, Savier E, Azoulay D et al. A comparison of percutaneous cryosurgery and percutaneous radiofrequency for unresectable hepatic malignancies. Arch Surg 2002;137(12):1332–9PubMedCrossRefGoogle Scholar
  12. 12.
    Berber E, Pelley R, Siperstein AE. Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: a prospective study. J Clin Oncol 2005;23(7):1358–64PubMedCrossRefGoogle Scholar
  13. 13.
    Bilchik AJ, Faries M. Radiofrequency ablation of hepatic malignancies: inexpensive and minimally invasive but should it replace resection? Ann Surg Oncol 2003;10(9):1002–4PubMedCrossRefGoogle Scholar
  14. 14.
    Bleicher RJ, Allegra DP, Nora DT, Wood TF, Foshag LJ, Bilchik AJ. Radiofrequency ablation in 447 complex unresectable liver tumors: lessons learned. Ann Surg Oncol 2003;10(1):52–8PubMedCrossRefGoogle Scholar
  15. 15.
    Bowles BJ, Machi J, Limm WM, Severino R, Oishi AJ, Furumoto NL, et al. Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors. Arch Surg 2001;136(8):864–9PubMedCrossRefGoogle Scholar
  16. 16.
    Pawlik TM, Izzo F, Cohen DS, Morris JS, Curley SA. Combined resection and radiofrequency ablation for advanced hepatic malignancies: results in 172 patients. Ann Surg Oncol 2003;10(9):1059–69PubMedCrossRefGoogle Scholar
  17. 17.
    Poston GJ. Radiofrequency ablation of colorectal liver metastases: where are we really going? J Clin Oncol 2005;23(7):1342–4PubMedCrossRefGoogle Scholar
  18. 18.
    Ruers TJ, Joosten J, Jager GJ, Wobbes T. Long-term results of treating hepatic colorectal metastases with cryosurgery. Br J Surg 2001;88(6):844–9PubMedCrossRefGoogle Scholar
  19. 19.
    Seifert JK, Junginger T, Morris DL. A collective review of the world literature on hepatic cryotherapy. J R Coll Surg Edinb 1998;43(3):141–54PubMedGoogle Scholar
  20. 20.
    Mulier S, Mulier P, Ni Y, Miao Y, Dupas B, Marchal G, et al. Complications of radiofrequency coagulation of liver tumours. Br J Surg 2002;89(10):1206–22PubMedCrossRefGoogle Scholar
  21. 21.
    de Baere T, Elias D, Dromain C, Din MG, Kuoch V, Ducreux M, et al. Radiofrequency ablation of 100 hepatic metastases with a mean follow-up of more than 1 year. AJR Am J Roentgenol 2000;175(6):1619–25PubMedGoogle Scholar
  22. 22.
    Solbiati L, Livraghi T, Goldberg SN, Ierace T, Meloni F, Dellanoce M, et al. Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. Radiology 2001;221(1):159–66PubMedGoogle Scholar
  23. 23.
    Dolan P. Modeling valuations for EuroQol health states. Med Care 1997;35(11):1095–108PubMedCrossRefGoogle Scholar
  24. 24.
    Pham B, Cranney A, Boers M, Verhoeven AC, Wells G, Tugwell P. Validity of area-under-the-curve analysis to summarize effect in rheumatoid arthritis clinical trials. J Rheumatol 1999;26(3):712–6PubMedGoogle Scholar
  25. 25.
    Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999;230(3):309–18PubMedCrossRefGoogle Scholar
  26. 26.
    Alberts S. “OncoSurge: a strategy for long-term survival in metastatic colorectal cancer. Poston G Colorectal Dis 2005;5:20–28CrossRefGoogle Scholar
  27. 27.
    Bilchik AJ, Wood TF, Allegra D, Tsioulias GJ, Chung M, Rose DM, et al. Cryosurgical ablation and radiofrequency ablation for unresectable hepatic malignant neoplasms: a proposed algorithm. Arch Surg 2000;135(6):657–62PubMedCrossRefGoogle Scholar
  28. 28.
    Joosten J, Jager G, Oyen W, Wobbes T, Ruers T. Cryosurgery and radiofrequency ablation for unresectable colorectal liver metastases: a comparison of long term results. Eur J Surg Oncol 2005; August 26Google Scholar
  29. 29.
    Pearson AS, Izzo F, Fleming RY, Ellis LM, Delrio P, Roh MS, et al. Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies. Am J Surg 1999;178(6):592–9PubMedCrossRefGoogle Scholar
  30. 30.
    Benoist S, Nordlinger B. Radiofrequency ablation in liver tumors. Ann Oncol 2004;15(suppl iv):313–7Google Scholar
  31. 31.
    Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 2005;242(2):158–71PubMedCrossRefGoogle Scholar
  32. 32.
    Adam R, Akpinar E, Johann M, Kunstlinger F, Majno P, Bismuth H. Place of cryosurgery in the treatment of malignant liver tumors. Ann Surg 1997;225(1):39–8PubMedCrossRefGoogle Scholar
  33. 33.
    Seifert JK, Junginger T. Prognostic factors for cryotherapy of colorectal liver metastases. Eur J Surg Oncol 2004;30(1):34–40PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2006

Authors and Affiliations

  • Theo J. M. Ruers
    • 1
  • Joris J. Joosten
    • 1
  • Bastiaan Wiering
    • 1
  • Barbara S. Langenhoff
    • 1
  • Heleen M. Dekker
    • 2
  • Theo Wobbes
    • 1
  • Wim J. G. Oyen
    • 3
  • Paul F. M. Krabbe
    • 4
  • Cornelis J. A. Punt
    • 5
  1. 1.Department of Surgery, Division of Surgical OncologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  2. 2.Department of RadiologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  3. 3.Department of Nuclear MedicineRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  4. 4.Department of Medical Technology AssessmentRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  5. 5.Department of Medical OncologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands

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