We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
from Section IV - Organ-specific cancers – liver metastases
Published online by Cambridge University Press: 05 September 2016
Introduction
Colorectal cancer (CRC) is the third most frequently diagnosed cancer and the third leading cause of cancer-related death in the USA. About 10–25% of patients present with synchronous liver metastases at the time of primary diagnosis and another 20–25% develop metachronous liver metastases during the course of the disease. Surgical resection of distant CRC metastases may result in improved long-term survival and even cure in a subset of selected patients. The 5-year survival rates after curative resection of liver metastases range from 35% to 58%. However, only 25% of patients with colorectal liver metastases (CLM) are candidates for liver resection, while the majority remain unresectable. Chemotherapy and newer therapies can extend survival of patients with non-resectable CLM up to 24 months.
In recent years, image-guided percutaneous ablation therapies have flourished as alternative treatment options for selected patients with unresectable CLM. Different ablation technologies include radiofrequency, microwave, laser, and cryoablation, that use heat or freezing as a means of causing cell damage and death of the target tumor. More recently, irreversible electroporation (IRE), a non-thermal technology, has been applied for liver tumor ablation, including CLM.
The goal of local tumor ablation is to efficiently destroy the malignant tumor with surrounding margins while minimizing the destruction of non-affected liver. This is an important parameter for patients with low volume of healthy functioning parenchyma as those with underlying cirrhosis or steatohepatitis from prolonged chemotherapy exposure as well as those who have previously undergone extensive liver resection and present for ablation as a salvage therapy for postsurgical recurrences.
The safety and effectiveness of local tumor ablation in patients with CLM have been demonstrated in several uncontrolled studies. Patient survival after percutaneous ablation seems comparable to that of surgical series (up to 55% at 5 years) in selected patients with small-volume disease that can be treated with sufficient margins. This observation may suggest that image-guided ablation could be an equally effective and less morbid alternative to surgery for a subset of selected patients.
To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Find out more about the Kindle Personal Document Service.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.
