Diagnostic and Interventional Radiology
Interventional Radiology - Review

Combination of ablation and embolisation for intermediate-sized liver metastases from colorectal cancer: what can we learn from treating primary liver cancer?


Interventional Oncology Service, University College Hospital, London, UK


Clinic of Interventional Radiology, Hospital Barmherzige Brueder, Munich, Germany


National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK


Centre for Medical Imaging, University College London, London, UK

Diagn Interv Radiol 2020; 1: -
Read: 47 Published: 02 October 2020

Colorectal cancer liver metastases (CRLMs) are common. Treating CRLMs with thermal ablation can prolong survival, but compared to lesions smaller than 3 cm, local control rates and overall survival are relatively worse with larger, intermediate (3-5 cm) lesions. Local recurrence rates range between 1.7-20.2% and 6.7-68.9% for CRLMs less than 3 cm and greater than 3 cm respectively. 
Worse outcomes are also present when ablating intermediate size hepatocellular carcinoma (HCC) and there are some pathological similarities with CRLMs, namely the presence of micrometastatic disease. Combining ablation with trans-arterial chemoembolisation is more effective in treating intermediate-size HCC than ablation alone. A meta-analysis of robust randomised controlled trials demonstrated long term improved survival with combination therapy compared to ablation alone (odds ratio at 1, 3 and 5 years of 2.74, 2.77 and 5.23 respectively). There is however minimal evidence for combination therapy in CRLMs, limited to a handful of studies that are predominantly retrospective and have heterogenous inclusion criteria.
Given the difficulty in successfully treating intermediate CRLMs, the strong evidence for combination therapy in intermediate HCC and potential pathological similarities, formal evaluation of combination treatment in CRLM is merited. This review highlights existing evidence for treatment of intermediate-size liver lesions and highlights where trials in CRLMs should focus. 


EISSN 1305-3612