Liver Cancer pp 117-131 | Cite as

Unresectable Liver Metastases from Colorectal Cancer: Methodology and Prognosis with Radiofrequency Ablation

  • Junji Machi
Part of the Methods of Cancer Diagnosis, Therapy and Prognosis book series (HAYAT, volume 5)

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.


Liver Metastasis Hepatic Resection Radiofrequency Ablation Portal Vein Embolization Extrahepatic Metastasis 
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  1. Abdalla, E.K., Vauthey, J.N., Ellis, L.M., Ellis, V., Pollock, R., Broglio, K.R., Hess, K., and Curley, S.A. 2004. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann. Surg. 239:818–827.PubMedCrossRefGoogle Scholar
  2. Berber, E., Flesher, N., and Siperstein, A.E. 2002. Laparoscopic radiofrequency ablation of neuroendocrine liver metastases. World J. Surg. 26:985–990.PubMedCrossRefGoogle Scholar
  3. Berber, E., Pelley, R., and Siperstein, A.E. 2005. Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: a prospective study. J. Clin. Oncol. 23:1358–1364.PubMedCrossRefGoogle Scholar
  4. Bilchik, A.J., Rose, D.M., and Allegra, D.P. 1999. Radiofrequency ablation: A minimally invasive technique with multiple applications. Cancer J. Sci. Am. 5:356–361.PubMedGoogle Scholar
  5. Bowles, B.J., Machi, J., Limm, W.M.L., Severino, R., Oishi, A.J., Furumoto, N.L., Wong, L.L., and Oishi, R.H. 2001. Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors. Arch. Surg. 136:864–869.PubMedCrossRefGoogle Scholar
  6. Choti, M.A., Sitzmann, J.V., Tiburi, M.F., Sumetchotimetha, W., Rangsin, R., Schulick, R.D., Lillemoe, K.D., Yeo, C.J., and Cameron, J.L. 2002. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann. Surg. 235:759–766.PubMedCrossRefGoogle Scholar
  7. Curley, S.A., Izzo, F., Delrio, P., Ellis, L.M., Granchi, J., Vallone, P., Fiore, F., Pignata, S., Daniele, B., and Cremona, F. 1999. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies. Results in 123 patients. Ann. Surg. 230:1–8.PubMedCrossRefGoogle Scholar
  8. Curley, S.A., Marra, P., Beaty, K., Ellis, L.M., Vauthey, J.N., Abdalla, E.K., Scaite, C., Rant, C., Wolff, R., Choi, H., Loyer, E., Vallone, P., Fiore, F., Scardino, F., DeRosa, V., Orlando, R., Pignata, S., Daniele, B., and Izzo, F. 2004. Early and late complications after radiofre-quency ablation of malignant liver tumors in 608 patients. Ann. Surg. 239:450–458.PubMedCrossRefGoogle Scholar
  9. De Baere, T.J., Elias, D., Ducreux, M., Kuoch, V., Boige, V., Dromain, C., Lasser, P., and Tursz, T. 2003. Percutaneous radiofrequency of liver metastases: single center experience over a five year period. Proc. Am. Soc. Clin. Oncol. 22:345 (Abstract 1387).Google Scholar
  10. De Meijer, V.E., Verhoef, C., Kuiper, J.W., Alwayn, I.P.J., Kazemier, G., and Ijzermans, J.N.M. 2006. Radiofrequency ablation in patients with primary and secondary hepatic malignancies. J. Gastrointest. Surg. 10:960–973.PubMedCrossRefGoogle Scholar
  11. Fernandez, F.G., Drebin, J.A., Linehan, D.C., Dehdashti, F., Siegel, B.A., and Strasberg, S.M. 2004. 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. 240:438–450.PubMedCrossRefGoogle Scholar
  12. Fong, Y., Fortner, J., Sun, R.L., Brennan, M.F., and Blumgart, L.H. 1999. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer. Analysis of 1001 consecutive cases. Ann. Surg. 230:309–321.PubMedCrossRefGoogle Scholar
  13. Giantonio, B.J., Catalano, P.J., and Meropol, N.J. 2005. High-dose bevacizumab improves survival when combined with FOLFOX 4 in previously treated advanced colorectal cancer: results from ECOG study E3200. Proc. Am. Soc. Clin. Oncol. (Abstract 2). 23: Part 1.Google Scholar
  14. Gillams, A.R., and Lees, W.R. 2004. Radio-frequency ablation of colorectal liver metastases in 167 patients. Eur. Radiol. 14:2261–2267.PubMedCrossRefGoogle Scholar
  15. Grothey, A., Sargent, D., Goldberg R.M., and Schmell, H.J. 2004. Survival of patients with advanced colorectal cancer improves with availability of fluorouracil-leucovorin, irinotecan, and oxaliplatin in the course of treatment. J. Clin. Oncol. 22:1209–1214.PubMedCrossRefGoogle Scholar
  16. Hellman, P., Ladjevardi, S., Skogseid, B., Akerstrom, G., and Elvin, A. 2002. Radiofrequency tissue ablation using cooled tip for liver metastases of endocrine tumors. World J. Surg. 26:1052– 1056.PubMedCrossRefGoogle Scholar
  17. Hurwitz, H., Fehrenbacher, L., Novotny, W., Cartwright, T., Hainsworth, J., Heim, W., Berlin, J., Baron, A., Griffing, S., Holmgren, E., Ferrara, N., Fyfe, G., Rogers, B., Ross, R., and Kabbinavar, F. 2004. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N. Engl. J. Med. 350:2335–2342.PubMedCrossRefGoogle Scholar
  18. Iannitti, D.A., Dupuy, D.E., Mayo-Smith, W.W., and Murphy, B. 2002. Hepatic radiofrequency ablation. Arch. Surg. 137:422–427.PubMedCrossRefGoogle Scholar
  19. Jaeck, D., Oussoultzoglou, E., Rosso, E., Greget, M., Weber, J.C., and Bachellier, P. 2004. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann. Surg. 240:1037–1051.PubMedCrossRefGoogle Scholar
  20. Jiao, L.R., Hansen, P.D., Havlik, R., Mitry, R.R., Pignatelli, M., and Habib, N. 1999. Clinical short-term results of radiofrequency ablation in primary and secondary liver tumors. Am. J. Surg. 177:303–306.PubMedCrossRefGoogle Scholar
  21. Lencioni, R., Crocetti, L., Cioni, D., Dellapina, C., and Bartolozzi, C. 2004. Percutaneous radiofrequency ablation of hepatic colorectal metastases. Technique, indications, results, and new promises. Invest. Radiol. 39:689–697.PubMedCrossRefGoogle Scholar
  22. Lencioni, R., Goletti, O., Armillotta, N., Paolicchi, A., Moretti, M., Cioni, D., and Donati, F. 1998. Radio-frequency thermal ablation of liver metastases with cooled-tip electrode needle: results of a pilot clinical trial. Eur. Radiol. 8:1205–1211.PubMedCrossRefGoogle Scholar
  23. Machi, J., Oishi, A.J., Morioka, W.K., Yu, M., Hundahl, S.A., Furumoto, N.L., and Oishi, R.H. 2000. Radiofrequency thermal ablation of synchronous metastatic liver tumors can be performed safely in conjunction with colorectal cancer resection. Cancer J. 6(Suppl 4):S344–S350.Google Scholar
  24. Machi, J., Uchida, S., Sumida, K., Limm, W.M.L., Hundahl, S.A., Oishi, A.J., Furumoto, N.L., and Oishi, R.H. 2001. Ultrasound-guided radi-ofrequency thermal ablation of liver tumors: percutaneous, laparoscopic, and open surgical approaches. J. Gastrointest. Surg. 5:477–489.PubMedCrossRefGoogle Scholar
  25. Machi, J., Oishi, A.J., Mossing, A.J., Furumoto, N.L., and Oishi, R.H. 2002. Hand-assisted laparo-scopic ultrasound-guided radiofrequency thermal ablation of liver tumors: a technical report. Surg. Laparosc. Endosc. Percutan. Tech. 12:160–164.PubMedCrossRefGoogle Scholar
  26. Machi, J., Oishi, A.J., Sumida, K., Sakamoto, K., Furumoto, N.L., Oishi, R.H., and Kylstra, J.W. 2006. Long-term outcome of radiofrequency ablation for unresectable liver metastases from colorectal cancer: evaluation of prognostic factors and effectiveness in first- and second-line management. Cancer J. 12:318–326.PubMedCrossRefGoogle Scholar
  27. Nordlinger, B., Guiguet, M., Vaillant, J.C., Balladur, P., Boudjema, K., Bachellier, P., and Jaeck, D. 1996. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Cancer 77:1254–1262.PubMedCrossRefGoogle Scholar
  28. Oshowo, A., Gillams, A., Harrison, E., Lees, W.R., and Taylor, I. 2003. Comparison of resection and radiofrequency ablation for treatment of solitary colorectal liver metastases. Br. J. Surg. 90:1240–1243.PubMedCrossRefGoogle Scholar
  29. Parikh, A.A., Curley, S.A., Fornage, B.D., and Ellis, L.M. 2002. Radiofrequency ablation of hepatic metastases. Semin. Oncol. 29:168–182.PubMedCrossRefGoogle Scholar
  30. Pawlik, T.M., Izzo, F., Cohen, D.S., Morris, J.S., and Curley, S.A. 2003. Combined resection and radiofrequency ablation for advanced hepatic malignancies: results in 172 patients. Ann. Surg. Oncol. 10:1059–1069.PubMedCrossRefGoogle Scholar
  31. Pitot, H.C., Rowland, K.M., Sargent, D.J., Philip, P.A., Mitchell, E.P., Goldberg, R.M., and Alberts, S.R. 2005. N9841: a randomized, phase III equivalence trial of irinotecan (CPT-11) versus oxaliplatin/5-fluorouracil (FU)/leucovorin (FOLFOX4) in patients with advanced colorectal cancer previously treated with 5FU. Proc. Am. Soc. Clin. Oncol. 24 (Abstract 3506), page 3506.Google Scholar
  32. Registry of hepatic metastases. 1988. Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of indications for resection. Surgery 103:278–288.Google Scholar
  33. Rougier, P., Lepille, D., Bennouna, J., Marre, A., Ducreux, M., Mignot, L., Hua, A., and Mery-Mignard, D. 2002. Antitumour activity of three second-line treatment combinations in patients with metastatic colorectal cancer after optimal 5-FU regimen failure: a randomized, multicentre phase II study. Ann. Oncol. 13:1558–1567.PubMedGoogle Scholar
  34. Scheele, J., Stang, R., Altendorf-Hofmann, A., and Paul, M. 1995. Resection of colorectal liver metastases. World J. Surg. 19:59–71.PubMedCrossRefGoogle Scholar
  35. Seidenfeld, J., Korn, A., and Aronson, N. 2002. Radiofrequency ablation of unresectable liver metastases. J. Am. Coll. Surg. 195:378–386.PubMedCrossRefGoogle Scholar
  36. Siperstein, A., Garland, A., Engle, K., Rogers, S., Barbar, E., Foroutani, A., String, A., Ryan, T., and Ituarte, P. 2000. Local recurrence after laparoscopic radiofrequency thermal ablation of hepatic tumors. Ann. Surg. Oncol. 7:106–113.PubMedCrossRefGoogle Scholar
  37. Solbiati, L., Goldberg, S.N., Ierace, T., Livraghi, T., Meloni, F., Dellanoce, M., Sironi, S., and Gazelle, G.S. 1997. Hepatic metastases: Percutaneous radio-frequency ablation with cooled-tip electrodes. Radiology 205:367–373.PubMedGoogle Scholar
  38. Solbiati, L., Ierace, T., Tonolini, M., Bellobuono, A., and Cova, L. 2003. Long-term survival of patients treated with radiofrequency ablation for liver colorectal metastases: improved outcome with increasing experience. Radiology 229:411–412.Google Scholar
  39. White, T.J., Roy-Choudhury, S.H., Breen, D.J., Cast, J., Maraveyas, A., Smyth, E.F., Hartley, J.E., and Monson, J.R.T. 2004. Percutaneous radiofrequency ablation of colorectal hepatic metastases — initial experience. Dig. Surg. 21:314–320.PubMedCrossRefGoogle Scholar

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© Springer Science + Business Media B.V. 2009

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  • Junji Machi

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