Thermal Ablation in the Management for Colorectal Liver Metastases

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Metastasis".

Deadline for manuscript submissions: 20 March 2025 | Viewed by 7594

Special Issue Editors


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Guest Editor
Department of Radiology, Amsterdam UMC, Amsterdam, The Netherlands
Interests: interventional oncology; pancreatic ductal adenocarcinoma; irreversible electroporation; stereotactic ablative radiotherapy; immunotherapy
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Guest Editor
Department of Radiology, Amsterdam UMC, Amsterdam, The Netherlands
Interests: interventional radiology; computed tomography; interventional oncology

Special Issue Information

Dear Colleagues,

Targeted minimally invasive, image-guided therapies in the management of patients with colorectal liver metastases (CRLMs) play an increasingly important role in clinical oncology and health care in general. These rapidly evolving treatment modalities (e.g., microwave ablation, irreversible electroporation or stereotactic body radiation therapy) are characterized by the local delivery of (non-)thermal energy or radiation at a high dosage, directly affecting the tumor tissue in order to treat cancer more effectively. Their success is chiefly based on their minimally invasive nature, superior safety and toxicity profile, and often comparable or superior mid- and long-term oncologic outcomes, compared with conventional systemic therapy and surgical resection. The increasing role of minimally invasive, real-time, image-guided and/or navigated treatment techniques for CRLM is the primary topic of this Special Issue. We aim to procure high-quality original research and review articles that address the available kinds of (non-)thermal and radiation-related treatment options for CRLM in order to improve oncological outcomes in interventional and radiation oncology. Reports of studies highlighting the use of real-time image guiding or navigation tools or ablation confirmation techniques for volumetric assessment of the ablation zone are particularly welcome.

Prof. Dr. Martijn Meijerink
Dr. Robbert S. Puijk
Guest Editors

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Keywords

  • image-guided therapies
  • colorectal liver metastases (CRLMs)
  • thermal ablation
  • (non-)thermal and radiation-related treatment
  • interventional and radiation oncology

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Published Papers (5 papers)

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Research

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12 pages, 1870 KiB  
Article
Ablation of Small Liver Metastases Presenting as Foci of Diffusion Restriction on MRI–Results from the Prospective Minimally Invasive Thermal Ablation (MITA) Study
by Niek Wijnen, Rutger C. G. Bruijnen, Annelou A. B. Thelissen, Hugo W. A. M. de Jong, Rachel S. van Leeuwaarde, Jeroen Hagendoorn, Guus M. Bol and Maarten L. J. Smits
Cancers 2024, 16(13), 2409; https://doi.org/10.3390/cancers16132409 - 29 Jun 2024
Viewed by 1070
Abstract
Purpose: Liver metastases presenting as small hyperintense foci on diffusion-weighted imaging (DWI) pose a therapeutic challenge. Ablation is generally not possible since these lesions are often occult on ultrasound and CT. The purpose of this prospective study was to assess if small liver [...] Read more.
Purpose: Liver metastases presenting as small hyperintense foci on diffusion-weighted imaging (DWI) pose a therapeutic challenge. Ablation is generally not possible since these lesions are often occult on ultrasound and CT. The purpose of this prospective study was to assess if small liver metastases (≤10 mm) detected on DWI can be successfully localized and ablated with the Hepatic Arteriography and C-Arm CT-Guided Ablation technique (HepACAGA). Materials and Methods: All consecutive patients with small liver metastases (≤10 mm), as measured on DWI, referred for ablation with HepACAGA between 1 January 2021, and 31 October 2023, were included. Re-ablations and ablations concomitant with another local treatment were excluded. The primary outcome was the technical success rate, defined as the intraprocedural detection and subsequent successful ablation of small liver metastases using HepACAGA. Secondary outcomes included the primary and secondary local tumor progression (LTP) rates and the complication rate. Results: A total of 15 patients (26 tumors) were included, with liver metastases from colorectal cancer (73%), neuro-endocrine tumors (15%), breast cancer (8%) and esophageal cancer (4%). All 26 tumors were successfully identified, punctured and ablated (a technical success rate of 100%). After a median follow-up of 9 months, primary and secondary LTP were 4% and 0%, respectively. No complications occurred. Conclusion: In this proof-of-concept study, the HepACAGA technique was successfully used to detect and ablate 100% of small liver metastases identified on DWI with a low recurrence rate and no complications. This technique enables the ablation of subcentimeter liver metastases detected on MRI. Full article
(This article belongs to the Special Issue Thermal Ablation in the Management for Colorectal Liver Metastases)
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13 pages, 1977 KiB  
Article
Conventional versus Hepatic Arteriography and C-Arm CT-Guided Ablation of Liver Tumors (HepACAGA): A Comparative Analysis
by Niek Wijnen, Rutger C. G. Bruijnen, Evert-Jan P. A. Vonken, Hugo W. A. M. de Jong, Joep de Bruijne, Guus M. Bol, Jeroen Hagendoorn, Martijn P. W. Intven and Maarten L. J. Smits
Cancers 2024, 16(10), 1925; https://doi.org/10.3390/cancers16101925 - 18 May 2024
Cited by 1 | Viewed by 1207
Abstract
Purpose: Hepatic Arteriography and C-Arm CT-Guided Ablation of liver tumors (HepACAGA) is a novel technique, combining hepatic–arterial contrast injection with C-arm CT-guided navigation. This study compared the outcomes of the HepACAGA technique with patients treated with conventional ultrasound (US) and/or CT-guided ablation. Materials [...] Read more.
Purpose: Hepatic Arteriography and C-Arm CT-Guided Ablation of liver tumors (HepACAGA) is a novel technique, combining hepatic–arterial contrast injection with C-arm CT-guided navigation. This study compared the outcomes of the HepACAGA technique with patients treated with conventional ultrasound (US) and/or CT-guided ablation. Materials and Methods: In this retrospective cohort study, all consecutive patients with hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLM) treated with conventional US-/CT-guided ablation between 1 January 2015, and 31 December 2020, and patients treated with HepACAGA between 1 January 2021, and 31 October 2023, were included. The primary outcome was local tumor recurrence-free survival (LTRFS). Secondary outcomes included the local tumor recurrence (LTR) rate and complication rate. Results: 68 patients (120 tumors) were included in the HepACAGA cohort and 53 patients (78 tumors) were included in the conventional cohort. In both cohorts, HCC was the predominant tumor type (63% and 73%, respectively). In the HepACAGA cohort, all patients received microwave ablation. Radiofrequency ablation was the main ablation technique in the conventional group (78%). LTRFS was significantly longer for patients treated with the HepACAGA technique (p = 0.015). Both LTR and the complication rate were significantly lower in the HepACAGA cohort compared to the conventional cohort (LTR 5% vs. 26%, respectively; p < 0.001) (complication rate 4% vs. 15%, respectively; p = 0.041). Conclusions: In this study, the HepACAGA technique was safer and more effective than conventional ablation for HCC and CRLM, resulting in lower rates of local tumor recurrence, longer local tumor recurrence-free survival and fewer procedure-related complications. Full article
(This article belongs to the Special Issue Thermal Ablation in the Management for Colorectal Liver Metastases)
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14 pages, 1822 KiB  
Article
Local Treatment of Colorectal Liver Metastases in the Presence of Extrahepatic Disease: Survival Outcomes from the Amsterdam Colorectal Liver Met Registry (AmCORE)
by Hannah H. Schulz, Madelon Dijkstra, Susan van der Lei, Danielle J. W. Vos, Florentine E. F. Timmer, Robbert S. Puijk, Hester J. Scheffer, M. Petrousjka van den Tol, Birgit I. Lissenberg-Witte, Tineke E. Buffart, Kathelijn S. Versteeg, Rutger-Jan Swijnenburg and Martijn R. Meijerink
Cancers 2024, 16(6), 1098; https://doi.org/10.3390/cancers16061098 - 8 Mar 2024
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Abstract
Background: The simultaneous presence of colorectal liver metastases (CRLMs) and extrahepatic metastases in patients with colorectal cancer (CRC) can be considered a relative contraindication for local treatment with curative intent. This study aims to assess the survival outcomes of patients with CRLMs and [...] Read more.
Background: The simultaneous presence of colorectal liver metastases (CRLMs) and extrahepatic metastases in patients with colorectal cancer (CRC) can be considered a relative contraindication for local treatment with curative intent. This study aims to assess the survival outcomes of patients with CRLMs and extrahepatic metastases after comprehensive local treatment of all metastatic sites. Methods: Patients with CRLMs who received local treatment of all metastatic sites were extracted from the prospective AmCORE registry database and subdivided into two groups: CRLM only vs. CRLM and extrahepatic metastasis. To address potential confounders, multivariate analysis was performed. The primary endpoint was overall survival (OS). Results: In total, 881 patients with CRLM only and 60 with CRLM and extrahepatic disease were included, and the median OS was 55.7 months vs. 42.7 months, respectively. Though OS was significantly lower in patients with concomitant extrahepatic metastases (HR 1.477; 95% CI 1.029–2.121; p = 0.033), the survival curve plateaued after 6.2 years. Extrahepatic manifestations were pulmonary (43.3%), peritoneal (16.7%) and non-regional lymph node metastases (10.0%). In patients with pulmonary and non-regional lymph node metastases, OS did not significantly differ from patients with CRLM-only disease; concomitant peritoneal metastases showed an inferior OS (HR 1.976; 95% CI 1.017–3.841, p = 0.041). Conclusions: In this comparative series, OS was inferior for patients with multi-organ metastatic CRC versus patients with CRLMs alone. Nonetheless, the long-term survival curve plateau seemed to justify local treatment in a subset of patients with multi-organ metastatic CRC, especially for patients with CRLMs and pulmonary or lymph node metastases. Full article
(This article belongs to the Special Issue Thermal Ablation in the Management for Colorectal Liver Metastases)
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15 pages, 1306 KiB  
Article
Efficacy of Thermal Ablation for Small-Size (0–3 cm) versus Intermediate-Size (3–5 cm) Colorectal Liver Metastases: Results from the Amsterdam Colorectal Liver Met Registry (AmCORE)
by Madelon Dijkstra, Susan van der Lei, Robbert S. Puijk, Hannah H. Schulz, Danielle J. W. Vos, Florentine E. F. Timmer, Hester J. Scheffer, Tineke E. Buffart, M. Petrousjka van den Tol, Birgit I. Lissenberg-Witte, Rutger-Jan Swijnenburg, Kathelijn S. Versteeg and Martijn R. Meijerink
Cancers 2023, 15(17), 4346; https://doi.org/10.3390/cancers15174346 - 31 Aug 2023
Cited by 5 | Viewed by 1968
Abstract
Purpose: Thermal ablation is widely recognized as the standard of care for small-size unresectable colorectal liver metastases (CRLM). For larger CRLM safety, local control and overall efficacy are not well established and insufficiently validated. The purpose of this comparative series was to analyze [...] Read more.
Purpose: Thermal ablation is widely recognized as the standard of care for small-size unresectable colorectal liver metastases (CRLM). For larger CRLM safety, local control and overall efficacy are not well established and insufficiently validated. The purpose of this comparative series was to analyze outcomes for intermediate-size versus small-size CRLM. Material and methods: Patients treated with thermal ablation between December 2000 and November 2021 for small-size and intermediate-size CRLM were included. The primary endpoints were complication rate and local control (LC). Secondary endpoints included local tumor progression-free survival (LTPFS) and overall survival (OS). Results: In total, 59 patients were included in the intermediate-size (3–5 cm) group and 221 in the small-size (0–3 cm) group. Complications were not significantly different between the two groups (p = 0.546). No significant difference between the groups was found in an overall comparison of OS (HR 1.339; 95% CI 0.824–2.176; p = 0.239). LTPFS (HR 3.388; p < 0.001) and LC (HR 3.744; p = 0.004) were superior in the small-size group. Nevertheless, the 1-, 3-, and 5-year LC for intermediate-size CRLM was still 93.9%, 85.4%, and 81.5%, and technical efficacy improved over time. Conclusions: Thermal ablation for intermediate-size unresectable CRLM is safe and induces long-term LC in the vast majority. The results of the COLLISION-XL trial (unresectable colorectal liver metastases: stereotactic body radiotherapy versus microwave ablation—a phase II randomized controlled trial for CRLM 3–5 cm) are required to provide further clarification of the role of local ablative methods for intermediate-size unresectable CRLM. Full article
(This article belongs to the Special Issue Thermal Ablation in the Management for Colorectal Liver Metastases)
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Other

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28 pages, 3985 KiB  
Systematic Review
Computational Modeling of Thermal Ablation Zones in the Liver: A Systematic Review
by Gonnie C. M. van Erp, Pim Hendriks, Alexander Broersen, Coosje A. M. Verhagen, Faeze Gholamiankhah, Jouke Dijkstra and Mark C. Burgmans
Cancers 2023, 15(23), 5684; https://doi.org/10.3390/cancers15235684 - 1 Dec 2023
Cited by 3 | Viewed by 1370
Abstract
Purpose: This systematic review aims to identify, evaluate, and summarize the findings of the literature on existing computational models for radiofrequency and microwave thermal liver ablation planning and compare their accuracy. Methods: A systematic literature search was performed in the MEDLINE and Web [...] Read more.
Purpose: This systematic review aims to identify, evaluate, and summarize the findings of the literature on existing computational models for radiofrequency and microwave thermal liver ablation planning and compare their accuracy. Methods: A systematic literature search was performed in the MEDLINE and Web of Science databases. Characteristics of the computational model and validation method of the included articles were retrieved. Results: The literature search identified 780 articles, of which 35 were included. A total of 19 articles focused on simulating radiofrequency ablation (RFA) zones, and 16 focused on microwave ablation (MWA) zones. Out of the 16 articles simulating MWA, only 2 used in vivo experiments to validate their simulations. Out of the 19 articles simulating RFA, 10 articles used in vivo validation. Dice similarity coefficients describing the overlap between in vivo experiments and simulated RFA zones varied between 0.418 and 0.728, with mean surface deviations varying between 1.1 mm and 8.67 mm. Conclusion: Computational models to simulate ablation zones of MWA and RFA show considerable heterogeneity in model type and validation methods. It is currently unknown which model is most accurate and best suitable for use in clinical practice. Full article
(This article belongs to the Special Issue Thermal Ablation in the Management for Colorectal Liver Metastases)
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Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: treatment of liver- and lungmetastases with Stereotactic Ablative Radiotherapy
Authors: Mark De Ridder
Affiliation: Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium

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