Review article
Ablation of Liver Metastases: Current Status

https://doi.org/10.1016/j.jvir.2010.01.046Get rights and content

Local ablative therapy for the treatment of metastatic disease to the liver has been evaluated most extensively in colorectal cancer with 5-year survival rates up to 55% after RF ablation. Recent findings suggest selected patients with other malignant processes may benefit as well, but conclusive evidence is limited. This article reviews the available literature regarding the use of radiofrequency ablation, microwave ablation, and cryoablation in the treatment of metastatic disease to the liver. The published results of each of these modalities in the treatment of metastatic disease to the liver are promising, and outcomes continue to be evaluated.

Section snippets

Radiofrequency Ablation

Using RF energy in the treatment of malignancies is nothing new. This technology, in its most rudimentary form, has been around for nearly a century. The first report of using RF was in neurosurgery as an electrocautery device. This application of RF energy would end up becoming a staple in every operating room, as the Bovie knife (11). As this technology evolved, other uses came to light. In the 1980s, RF energy was shown to cause coagulative necrosis in hepatic tissue. This was translated

Ablation of Colorectal Liver Metastasis

Although the incidence of colorectal cancer continues to decrease, it still remains the third most common cause of cancer mortality (14). The mean survival time for patients with untreated liver metastasis from CRC is 6–13 months, and the median survival time on the most effective chemotherapy is 20 months, whereas resecting hepatic metastases increases the 5-year survival rate from 0%–1% to 31%–58% (7, 8, 9, 10, 15, 16). There is also a recent report of 5-year survival rate of 71% and 10-year

Other Liver Metastasis

Up to 50% of patients with a malignancy will have metastatic disease to the liver; however, focal therapy or resection does not uniformly affect survival as with colorectal metastasis. Usually this therapy is reserved for liver-only metastatic disease; for symptomatic relief, ie, neuroendocrine metastasis; or with a malignant processes in which cytoreduction has been shown to positively affect outcome, ie, ovarian carcinoma (45, 46, 47, 48, 49). However, very few reports examine the outcome of

Other Ablative Techniques

The two other most frequently available ablative technologies in the United States are cryoablation and microwave. To date, there have been no studies directly comparing all three in the treatment of metastatic disease to the liver. Instead, like with RF ablation, most of the published data are in reference to HCC.

Complications

Ablative techniques share many of the same major complications, with the most common including bleeding, hepatic abscess, bile duct injuries, injury to the adjacent bowel, hepatic failure, and the late complication of track seeding (94, 95). Given the variety of study design and limited case reports, it is difficult to accurately address the individual complication incidence between the different ablative techniques in treating liver metastasis. The complication rate appears to be proportional

Follow-up

Imaging protocols after ablative therapy are widely variable and institution dependent. Most centers report initial imaging either immediately before discharge or up to one month after the procedure. Subsequent imaging is variable, but a typical protocol might be follow-up imaging every three months for two years, then biannually (36, 37, 40, 56). Berber and Siperstein (38) found that 84% of local progression was evident by one year, and 96% were evident by two years. The modality is typically

Conclusion

Local ablative therapy for the treatment of metastatic disease to the liver has been evaluated most extensively in CRC with 5-year survival rates up to 55% after RF ablation. (23) Recent findings suggest selected patients with other malignant processes may benefit as well, but conclusive evidence is limited. Multiple modalities are used to accomplish local tumor control via a surgical or percutaneous approach, of which, RF ablation, cryoablation, and microwave ablation have been evaluated the

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    D.A.G. is a paid consultant for, and received a research grant from, Covidien; it was not used to fund this paper. V.L.F. has not identified a conflict of interest.

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