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Title: 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

Abstract

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 consideredmore » 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.« less

Authors:
; ;  [1]; ; ;  [2]; ;  [3];  [4];  [5];  [6];  [2]
  1. VU University Medical Centre, Department of Radiology (Netherlands)
  2. Medical Evaluation and Technology Assessment (ME-TA) (Belgium)
  3. National Health Care Institute Netherlands (ZiNL) (Netherlands)
  4. University Medical Center Groningen, Department of Surgery (Netherlands)
  5. Medisch Spectrum Twente, Department of Oncology (Netherlands)
  6. Antoni van Leeuwenhoek Hospital, Department of Radiology (Netherlands)
Publication Date:
OSTI Identifier:
22749871
Resource Type:
Journal Article
Journal Name:
Cardiovascular and Interventional Radiology
Additional Journal Information:
Journal Volume: 41; Journal Issue: 8; Other Information: Copyright (c) 2018 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Article Copyright (c) 2018 The Author(s); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0174-1551
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABLATION; CHEMOTHERAPY; HEPATECTOMY; LIVER; MICROWAVE RADIATION; MULTIVARIATE ANALYSIS; RADIOWAVE RADIATION; REVIEWS

Citation Formats

Meijerink, Martijn R., E-mail: mr.meijerink@vumc.nl, Puijk, Robbert S., Tilborg, Aukje A. J. M. van, Henningsen, Kirsten Holdt, Fernandez, Llenalia Garcia, Neyt, Mattias, Heymans, Juanita, Frankema, Jacqueline S., Jong, Koert P. de, Richel, Dick J., Prevoo, Warner, and Vlayen, Joan. 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. United States: N. p., 2018. Web. doi:10.1007/S00270-018-1959-3.
Meijerink, Martijn R., E-mail: mr.meijerink@vumc.nl, Puijk, Robbert S., Tilborg, Aukje A. J. M. van, Henningsen, Kirsten Holdt, Fernandez, Llenalia Garcia, Neyt, Mattias, Heymans, Juanita, Frankema, Jacqueline S., Jong, Koert P. de, Richel, Dick J., Prevoo, Warner, & Vlayen, Joan. 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. United States. doi:10.1007/S00270-018-1959-3.
Meijerink, Martijn R., E-mail: mr.meijerink@vumc.nl, Puijk, Robbert S., Tilborg, Aukje A. J. M. van, Henningsen, Kirsten Holdt, Fernandez, Llenalia Garcia, Neyt, Mattias, Heymans, Juanita, Frankema, Jacqueline S., Jong, Koert P. de, Richel, Dick J., Prevoo, Warner, and Vlayen, Joan. Wed . "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". United States. doi:10.1007/S00270-018-1959-3.
@article{osti_22749871,
title = {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},
author = {Meijerink, Martijn R., E-mail: mr.meijerink@vumc.nl and Puijk, Robbert S. and Tilborg, Aukje A. J. M. van and Henningsen, Kirsten Holdt and Fernandez, Llenalia Garcia and Neyt, Mattias and Heymans, Juanita and Frankema, Jacqueline S. and Jong, Koert P. de and Richel, Dick J. and Prevoo, Warner and Vlayen, Joan},
abstractNote = {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.},
doi = {10.1007/S00270-018-1959-3},
journal = {Cardiovascular and Interventional Radiology},
issn = {0174-1551},
number = 8,
volume = 41,
place = {United States},
year = {2018},
month = {8}
}