Radiofrequency ablation for treatment of colorectal liver metastases: scientific evidence and clinical reality

• Published in: Zentralblatt fur Chirurgie Vol. 139; no. 2; p. 193
• Main Authors: Eisele, R M, Chopra, S S, Kubale, R, Glanemann, M
• Format: Journal Article
• Language: German
• Published: Germany 01.04.2014
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Catheter Ablation; Colorectal Neoplasms - mortality; Colorectal Neoplasms - pathology; Colorectal Neoplasms - therapy; Combined Modality Therapy; Evidence-Based Medicine; Hepatectomy; Humans; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - secondary; Liver Neoplasms - therapy; Neoadjuvant Therapy; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - therapy; Neoplasm Staging; Survival Rate; Treatment Outcome
• ISSN: 1438-9592
• DOI: 10.1055/s-0032-1328595

Radiofrequency ablation (RFA) of colorectal liver metastases is frequently reported, but, however, lacks clear criteria for indication and reliable, convincing results with 5-year survival ranging from 17 to 48 %. RFA may be the appropriate treatment modality in approximately 3 to 5 % of all patients suffering from colorectal liver metastases. To date, RFA seems to be limited to no more than three metastases, each smaller than 3 cm. The main indication remains irresectability due to number, site, distribution and/or marginal liver function. Tumours in the vicinity of larger vessels (predominantly branches of portal or hepatic veins) are a case for controversy, since advances in hepatobiliary surgery enable a proportion of patients to undergo resections which would have been declared irresectable until most recently, and the oncological value of a thermoablation is questioned, as a certain amount of temperature is lost due to convective heat sinks. RFA is not a curative alternative to hepatic resection unless small tumours appear during open or laparoscopic procedures in a patient with elevated risk for early recurrence or postoperative morbidity following liver resection. The inclusion of RFA into a holistic system of oncological therapy is mandatory. Early RFA followed by systemic (regional?) chemotherapy can rather be recommended than chemo only, RFA only or first-line chemo with subsequent RFA.