Radiofrequency and Microwave Ablation Compared to Systemic Chemotherapy and to Partial Hepatectomy in the Treatment of Colorectal Liver Metastases: A Systematic Review and Meta-Analysis

Journal Article · Wed Aug 15 04:00:00 EDT 2018 · Cardiovascular and Interventional Radiology

DOI:https://doi.org/10.1007/S00270-018-1959-3· OSTI ID:22749871

Puijk, Robbert S.; Henningsen, Kirsten Holdt; Fernandez, Llenalia Garcia; Neyt, Mattias ^[1]; Heymans, Juanita; Frankema, Jacqueline S. ^[2]; Jong, Koert P. de ^[3]; Richel, Dick J. ^[4]; Prevoo, Warner ^[5]; Vlayen, Joan ^[1]

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1. Medical Evaluation and Technology Assessment (ME-TA) (Belgium)
2. National Health Care Institute Netherlands (ZiNL) (Netherlands)
3. University Medical Center Groningen, Department of Surgery (Netherlands)
4. Medisch Spectrum Twente, Department of Oncology (Netherlands)
5. Antoni van Leeuwenhoek Hospital, Department of Radiology (Netherlands)

PurposeTo assess safety and outcome of radiofrequency ablation (RFA) and microwave ablation (MWA) as compared to systemic chemotherapy and partial hepatectomy (PH) in the treatment of colorectal liver metastases (CRLM).MethodsMEDLINE, Embase and the Cochrane Library were searched. Randomized trials and comparative observational studies with multivariate analysis and/or matching were included. Guidelines from National Guideline Clearinghouse and Guidelines International Network were assessed using the AGREE II instrument.ResultsThe search revealed 3530 records; 328 were selected for full-text review; 48 were included: 8 systematic reviews, 2 randomized studies, 26 comparative observational studies, 2 guideline-articles and 10 case series; in addition 13 guidelines were evaluated. Literature to assess the effectiveness of ablation was limited. RFA + systemic chemotherapy was superior to chemotherapy alone. PH was superior to RFA alone but not to RFA + PH or to MWA. Compared to PH, RFA showed fewer complications, MWA did not. Outcomes were subject to residual confounding since ablation was only employed for unresectable disease.ConclusionThe results from the EORTC-CLOCC trial, the comparable survival for ablation + PH versus PH alone, the potential to induce long-term disease control and the low complication rate argue in favour of ablation over chemotherapy alone. Further randomized comparisons of ablation to current-day chemotherapy alone should therefore be considered unethical. Hence, the highest achievable level of evidence for unresectable CRLM seems reached. The apparent selection bias from previous studies and the superior safety profile mandate the setup of randomized controlled trials comparing ablation to surgery.

• OSTI ID: 22749871
• Journal Information: Cardiovascular and Interventional Radiology, Journal Name: Cardiovascular and Interventional Radiology Journal Issue: 8 Vol. 41; ISSN 0174-1551; ISSN CAIRDG
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ABLATION
CHEMOTHERAPY
HEPATECTOMY
LIVER
MICROWAVE RADIATION
MULTIVARIATE ANALYSIS
RADIOWAVE RADIATION
REVIEWS