Unresectable Liver Metastases from Colorectal Cancer: Methodology and Prognosis with Radiofrequency Ablation
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Liver metastases from colorectal cancer, although it is a stage 4 disease, has more treatment options and has better prognosis than liver metastases from other cancers. Multimodality treatment is required for colorectal liver metastases, including local and systemic treatment. Systemic treatment is mainly chemotherapy, that is described in detail in other chapters of this book. Local treatment includes surgical resection, ablation, and hepatic artery infusion therapy. Surgical resection is the established curative local therapy; however, only 10–20% of patients with colorectal liver metastases have resectable tumors at the time of diagnosis. Resection cannot be performed even in patients with liver only metastases because of various reasons including multiple bilobar tumors, invasion or close proximity to major blood vessels or bile ducts, limited liver function, or high surgical risk due to comorbidity.
Ablation therapy was introduced initially in the hope of achieving local control of unresectable liver tumors; however, more lately it has been used for curative intent. Chemical ablation such as ethanol injection is effective for hepatomas, but not for metastatic tumors. Cryoablation was extensively investigated in 1980s to early 1990s. Although less invasive than resection and applicable for unresectable metastases, cryoablation is associated with various complications and usually requires laparotomy. Thermal ablation is a newer modality, which can be achieved by various methods: microwave, laser, and high-intensity ultrasound are under investigation, but sufficient clinical data are not available. On the other hand, radiofrequency ablation (RFA) has been increasingly used during the last decade, and has almost replaced cryoablation.
KeywordsLiver Metastasis Hepatic Resection Radiofrequency Ablation Portal Vein Embolization Extrahepatic Metastasis
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