• CT fluoroscopy guidance
• X-ray fluoroscopy guidance
• challenging case
• computed tomography guidance
• image-guided puncture

• CT thermometry
• computed tomography
• interventional radiology
• microwave ablation
• spectral computed tomography
• thermal ablation
• thermometry

• Reproducibility of Results
• Thermometry/methods
• Temperature
• Liver/diagnostic imaging
• Liver/surgery
• Phantoms, Imaging
• Tomography, X-Ray Computed

• R01 EB030494 NIBIB NIH HHS
• Society of Interventional Radiology Foundation
• National Institutes of Health

• R50 CA276008 NCI NIH HHS

• Ablation
• Colorectal neoplasms
• Microwaves

• Colorectal cancer
• liver metastases
• liver resection
• percutaneous ablation

• Biological Factors
• Catheter Ablation/methods
• Colorectal Neoplasms/pathology
• Humans
• Liver Neoplasms/therapy
• Prospective Studies
• Treatment Outcome

• P30 CA016672 NCI NIH HHS
• R01 CA235564 NCI NIH HHS

• Colorectal cancer
• ablation
• hepatic metastasis
• liver targeted therapy
• treatment of metastasis

Local treatment remains the best option for recurrent colorectal liver metastasis (CRLM). The current study aimed to investigate predictive factors of survival outcomes and select candidates for local treatment for CRLM at first recurrence.

Data were collected retrospectively from CRLM patients who underwent hepatic resection and developed first recurrence between 2000 and 2019 at our institution.
A nomogram predicting overall survival was established based on a multivariable Cox model of clinicopathologic factors. The predictive accuracy and discriminative ability of the nomogram were determined by the concordance index and calibration curve.

Among 867 patients who underwent curative hepatic resection, 549 patients developed recurrence. Three hundred patients were evaluated and had resectable and liver-limited disease. Among them, repeat liver resection and percutaneous radiofrequency ablation were performed in 88 and 85 patients, respectively. The other 127 patients received only systemic chemotherapy. Multivariable analysis identified primary lymph node positivity, tumor size > 3 cm, early recurrence, RAS gene mutation and no local treatment as independent risk factors for survival outcomes. Integrating these five variables, the nomogram presented a good concordance index of 0.707. Compared with patients who received only systemic chemotherapy, radical local treatment did not significantly improve survival outcomes (median OS: 21 vs. 15 months, p = 0.126) in the high-risk group (total score ≥ 13).

Radical local treatment improved the survival of recurrent CRLM patients. The proposed model facilitates personalized assessments of prognosis for patients who develop first recurrence in the liver.

The online version contains supplementary material available at 10.1186/s12893-021-01323-y.

• CRLM
• RFA
• Recurrence
• Repeat
• Resection

• Nomogram
• chemotherapy response
• colorectal liver metastases
• radiofrequency ablation
• systemic chemotherapy

• chemotherapy
• colorectal cancer
• loco regional treatments
• oligometastatic disease
• surgery

• Biomarkers
• Interventional oncology
• Liver cancer
• Lung cancer
• Prognosis
• Recurrence

• Biomarkers, Tumor
• Carcinoma, Hepatocellular/therapy
• Colorectal Neoplasms/pathology
• Genes, ras
• Humans
• Ki-67 Antigen/analysis
• Liver Neoplasms/secondary
• Liver Neoplasms/therapy
• Lung Neoplasms/therapy
• Medical Oncology
• Mutation
• Prognosis

• Hepatic resection
• Liver metastases
• Meta-analysis
• Radiofrequency ablation

• ablation
• hepatic metastases
• liver reserve
• locoregional therapy
• transarterial therapy

• Colorectal cancer
• ablation
• liver metastasis
• resection
• simultaneous treatment

We retrospectively evaluated the effectiveness and safety of computed tomography-guided percutaneous microwave ablation (MWA) of metastatic liver disease in terms of 5-year overall survival and 5-year disease-free survival.

Institutional database research identified 32 colorectal cancer patients with oligometastatic liver-only disease who underwent percutaneous computed tomography-guided MWA. Contrast-enhanced computed tomography or magnetic resonance imaging was used for post-ablation follow up. Patient and tumor characteristics, MWA technique and complications were evaluated. In addition, the 5-year overall survival, the 5-year disease-free survival, and the potential factors affecting the survival of these patients were analyzed.

Mean patient age was 72 years (male: female 21:11). In total 58 lesions were treated in 45 ablation sessions. Average lesion size was 2 cm (range 0.8-3.9 cm). The primary tumor for the majority of patients was in the colon (n=27), while in 5 patients it was located in the rectum. The majority of patients had 1 liver metastasis (n=16), 11 patients had 2, 4 patients had 3, and 1 patient had 4. Primary local tumor control was achieved in 91.3% (53/58) of the ablated lesions. Overall survival at 1, 3 and 5 years was 96.8%, 68.7% and 34.3%, respectively.

Computed tomography-guided percutaneous MWA for metastatic liver-only disease in oligometastatic patients is a feasible, safe and effective therapy with satisfactory long-term survival rates.

• Colorectal cancer
• hepatic metastases
• microwave ablation

Surgical resection is considered the standard treatment option for long-term survival in colorectal cancer liver metastasis (CRLM) patients, but only a small number of patients are suitable for resection following diagnosis. Radiofrequency ablation (RFA) is an accepted alternative therapy for CRLM patients who are not suitable for resection. However, the relatively high rate of local tumor progression (LTP) is an obstacle to the more widespread use of RFA.

To determine the oncological outcomes and predictors of RFA in CRLM patients.

A retrospective analyze was performed on the clinical data of 85 consecutive CRLM patients with a combined total of 138 liver metastases, who had received percutaneous RFA treatment at our institution from January 2013 to December 2018. Contrast-enhanced computed tomography was performed the first month after RFA to assess the technique effectiveness of the RFA and to serve as a baseline for subsequent evaluations. The Kaplan-Meier method was used to calculate overall survival (OS) and LTP-free survival (LTPFS). The log-rank test and Cox regression model were used for univariate and multivariate analyses to determine the predictors of the oncological outcomes.

There were no RFA procedure-related deaths, and the technique effectiveness of the treatment was 89.1% (123/138). The median follow-up time was 30 mo. The LTP rate was 32.6% (45/138), and the median OS was 36 mo. The 1-, 3-, and 5-year OS rates were 90.6%, 45.6%, and 22.9%, respectively. Univariate analysis revealed that tumor size and ablative margin were the factors influencing LTPFS, while extrahepatic disease (EHD), tumor number, and tumor size were the factors influencing OS. Multivariate analysis showed that tumor size larger than 3 cm and ablative margin of 5 mm or smaller were the independent predictors of shorter LTPFS, while tumor number greater than 1, size larger than 3 cm, and presence of EHD were the independent predictors of shorter OS.

RFA is a safe and effective treatment method for CRLM. Tumor size and ablative margin are the important factors affecting LTPFS. Tumor number, tumor size, and EHD are also critical factors for OS.

• Colorectal cancer liver metastasis
• Radiofrequency ablation
• Local tumor progression
• Local tumor progression-free survival
• Overall survival

Surgical resection is the standard local therapy for patients with colorectal liver metastases (CRLM). However, elderly and vulnerable patients sometimes have various organ dysfunctions. We have to conduct nonsurgical local therapies for those patients who might not tolerate surgery or systemic chemotherapy.

We retrospectively reviewed medical records of 254 patients who underwent local therapies, including surgery, radiofrequency ablation (RFA), and stereotactic body radiation therapy (SBRT), for CRLM from January 2010 to December 2016, at seven tertiary‐care institutions in Japan. This study was designed to include elderly, vulnerable patients who received local therapy for CRLM. For those undergoing liver resection, only those having one or more points of the Charlson comorbidity index (CCI) were enrolled.

Of the total 169 enrolled patients, 122 patients underwent surgery, 42 RFA, and 5 SBRT as the first local therapy for CRLM. Median overall survival from the first local therapy was 5.9 years for the surgery group, 2.7 years for the RFA group, and 3.8 years for the SBRT group. The proportion of the patients with CCI ≧3 was significantly higher in the group of RFA/SBRT than surgery (P < 0.0001). In selected patients with CCI ≧3, there was no difference of the median survival time between the surgery group and the RFA group.

We could have other treatment options to provide nonsurgical local therapies (RFA/SBRT) for elderly, vulnerable CRLM patients who have risks for surgery.

• colorectal liver metastases
• elderly patients
• radiofrequency ablation
• stereotactic body radiation therapy
• vulnerable patients

• Intrahepatic metastases
• Local control
• Oligometastases.
• RFA
• SBRT

• Fusion imaging
• Hepatocellular carcinoma
• Thermal ablation

• Colorectal cancer
• Liver metastasis
• Radiofrequency ablation
• Resection
• Survival

• Aged
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Female
• Follow-Up Studies
• Hepatectomy/mortality
• Humans
• Liver Neoplasms/mortality
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Prognosis
• Radiofrequency Ablation/mortality
• Retrospective Studies
• Survival Rate

• 81371868 National Natural Science Foundation of China
• Z151100004015186 Beijing Municipal Science and Technology Commission

The treatment of liver metastases with local procedures is a fast progressing field. For the most, long-term survival data is missing raising questions with regard to the efficacy of such modalities when compared to surgical resection. Radiosurgery using the CyberKnife device enables the treatment of liver lesions with a single-session approach. Here we present long-term survival data to explore the curative potential of this strategy.

Patients with oligo-metastatic disease limited to the liver have been treated with single-session or hypo-fractioned radiosurgery in curative intent and prospectively followed until death. Follow-up (FU) was performed using magnetic resonance imaging (MRI) 2 months after radiation and at 3-month intervals for the first 2 years. After that annual computed tomography or MRI scans were performed until 5 years post-treatment. Local recurrence in the radiated volume and recurrence outside the treated volume were used to define local and distant progression. Survival times were censored at the time of the last FU.

One hundred twenty-six patients treated between 2005 and 2015 with 194 lesions were included into this study. Median FU was 30.0 months. According to Response Evaluation Criteria in Solid Tumors, 55.2% had a complete remission and 11.3% a partial remission. Seventy-two point two percent recurred outside the radiated lesion and median overall survival was 35.2 months with a 3-year survival rate of 47.7%.

This is currently the largest cohort of stereotactic body radiation therapy treated liver lesions with a median long-term follow of 30 months. Robotic radiosurgery using a single session approach has a high efficacy to control the radiated lesion with the potential to cure patients.

• Colonic neoplasms
• Liver
• Liver metastases
• Radiation
• Radiosurgery

• chemoembolization
• interventional radiology
• liver metastases
• locoregional therapy
• radioembolization
• thermal ablation

• Advanced metastatic disease
• Complete ablation
• Image-guided percutaneous ablation

• Colorectal liver metastases
• comparative study
• hepatocellular carcinoma
• local efficacy
• thermal ablation

• Chemoembolization
• Colorectal cancer
• Liver metastasis
• Local recurrence
• Radiofrequency ablation

• Aged
• Aged, 80 and over
• Catheter Ablation/methods
• Chemoembolization, Therapeutic/methods
• Colorectal Neoplasms/pathology
• Combined Modality Therapy/methods
• Female
• Humans
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Liver Neoplasms/therapy
• Male
• Middle Aged
• Mitomycin/administration & dosage
• Neoplasms, Second Primary/surgery
• Neoplasms, Second Primary/therapy
• Prospective Studies
• Starch/administration & dosage
• Survival Rate
• Treatment Outcome

• colorectal cancer
• hepatic metastasis
• resection
• rfa

• Adult
• Aged
• Aged, 80 and over
• Catheter Ablation/methods
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/surgery
• Female
• Follow-Up Studies
• Hepatectomy/methods
• Humans
• Liver Neoplasms/diagnosis
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Neoplasms, Second Primary
• Retrospective Studies
• Treatment Outcome
• Young Adult

Colorectal cancer metastasizes predictably, with liver predominance in most cases. Because liver involvement has been shown to be a major determinant of survival in this population, liver-directed therapies are increasingly considered even in cases where there is (limited) extrahepatic disease. Unfortunately, these patients carry a known risk of recurrence in the liver regardless of initial therapy choice. Therefore, there is a demand for minimally invasive, non-surgical, personalized cancer treatments to preserve quality of life in the induction, consolidation, and maintenance phases of cancer therapy. This report aims to review evidence-based conceptual, pharmacological, and technological paradigm shifts in parenteral and percutaneous treatment strategies as well as forthcoming evidence regarding next-generation systemic, locoregional, and local treatment approaches for this patient population.

• Colonic neoplasms
• Rectal neoplasms
• Neoplasm metastasis
• Antineoplastic agents
• FOLFOX protocol
• Irinotecan, 5-flurouracil, and leucovorin protocol
• Radiofrequency ablation
• Microwave ablation
• Chemoembolization
• Therapeutic
• Immunotherapy

• Ablation Techniques
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Chemoembolization, Therapeutic
• Chemotherapy, Adjuvant
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/therapy
• Evidence-Based Medicine
• Humans
• Immunotherapy
• Liver Neoplasms/mortality
• Liver Neoplasms/secondary
• Liver Neoplasms/therapy
• Medical Oncology
• Neoplasm Staging
• Radiography, Interventional
• Radiology, Interventional
• Treatment Outcome

• Colorectal cancer
• HCC
• Hepatocellular carcinoma
• Microwave
• Neuroendocrine cancer
• Radiofrequency
• Tumor ablation

Previous attempts at meta-analysis and systematic review have not provided clear recommendations for the clinical application of thermal ablation in metastatic colorectal cancer. Many authors believe that the probability of gathering randomised controlled trial (RCT) data is low. Our aim is to provide a consensus document making recommendations on the appropriate application of thermal ablation in patients with colorectal liver metastases.

This consensus paper was discussed by an expert panel at The Interventional Oncology Sans Frontières 2013. A literature review was presented. Tumour characteristics, ablation technique and different clinical applications were considered and the level of consensus was documented.

Specific recommendations are made with regard to metastasis size, number, and location and ablation technique. Mean 31 % 5-year survival post-ablation in selected patients has resulted in acceptance of this therapy for those with technically inoperable but limited liver disease and those with limited liver reserve or co-morbidities that render them inoperable.

In the absence of RCT data, it is our aim that this consensus document will facilitate judicious selection of the patients most likely to benefit from thermal ablation and provide a unified interventional oncological perspective for the use of this technology.

• Best results require due consideration of tumour size, number, volume and location.

• Ablation technology, imaging guidance and intra-procedural imaging assessment must be optimised.

• Accepted applications include inoperable disease due to tumour distribution or inadequate liver reserve.

• Other current indications include concurrent co-morbidity, patient choice and the test-of-time approach.

• Future applications may include resectable disease, e.g. for small solitary tumours.

• Ablation techniques
• Clinical protocols
• Colorectal neoplasms
• Consensus
• Liver neoplasms

• Ablation
• Colorectal liver metastasis
• Cryotherapy
• Hepatocellular cancer
• Liver
• Microwave
• Radiofrequency

• Colorectal cancer (CRC)
• hepatectomy
• liver metastases
• portal vein embolization (PVE)
• radiofrequency ablation (RFA)

• Adult
• Aged
• Aged, 80 and over
• Catheter Ablation/methods
• Colorectal Neoplasms/pathology
• Female
• Humans
• Liver Neoplasms/secondary
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Radiosurgery/methods
• Retrospective Studies
• Robotics/methods
• Salvage Therapy/methods
• Treatment Outcome

• Ablation Techniques/methods
• Carcinoma, Hepatocellular/mortality
• Carcinoma, Hepatocellular/pathology
• Carcinoma, Hepatocellular/therapy
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/secondary
• Colorectal Neoplasms/therapy
• Contraindications
• Electroporation/methods
• Embolization, Therapeutic/methods
• Hepatectomy/methods
• Humans
• Laparoscopy/methods
• Liver Neoplasms/mortality
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy
• Postoperative Complications
• Robotics
• Treatment Outcome

Although the frontiers of liver resection for colorectal liver metastases have broadened in recent decades, approximately 75% of these patients present with unresectable metastases at the time of their diagnosis. In the past, these patients underwent only palliative treatment, without the chance of a cure. In the previous two decades, several therapeutic strategies have been developed that render resectable those metastases that were initially unresectable, thus offering the chance of long-term survival and even a cure to these patients. The oncosurgical modalities that are available include liver resection following portal vein ligation/embolization, “two-stage” liver resection, one-stage ultrasonically guided liver resection, hepatectomy following conversion chemotherapy, and liver resection combined with thermal ablation. Moreover, in recent years, certain authors have recommended the revisiting of the concept of liver transplantation in highly selected patients with unresectable colorectal liver metastases and favorable prognostic factors. By employing such therapies, the number of patients with colorectal liver metastases who undergo a potentially curative treatment could increase to 40%. The safety profile of these approaches is acceptable (morbidity rates as high as 45%, mortality rates of less than 5%). Furthermore, the 5-year survival rates (approximately 30%) are significantly increased over those that were achieved with palliative treatment.