Ablation Effective for Colorectal Cancer Spread to Liver

The addition of ablation to surgery for colorectal cancer spread to the liver improves outcomes immediately following surgery without compromising long-term survival compared with surgery alone. These results were recently published in JAMA Surgery.

Colorectal cancer is the third leading cause of cancer-related deaths in the United States. The liver is a common site for colorectal cancer to spread once it is in advanced stages.

Treatment for colorectal cancer spread to the liver, referred to as hepatic metastases, often includes surgery to remove the sites of cancer. However, surgery is often associated with side effects and significant downtime following the procedure for patients. Therefore, different strategies for treatment of hepatic metastases continue to be evaluated.

Ablative therapies are becoming more widely used for the treatment of hepatic metastases and are being compared to surgery in this treatment setting. Ablation typically utilizes a hand-held probe that is placed through the skin and into the site(s) of cancer. Often, forms of heat or energy, such as radiofrequency, are delivered from the probe to the specific sites and kill the cancer cells. A benefit of ablation is that it tends to leave the surrounding healthy tissue intact and therefore, reduces side effects associated with other therapies.

Researchers recently conducted a clinical trial to compare ablation to surgery among patients with hepatic metastases from colorectal cancer. The trial included 2,123 patients who underwent either surgery for hepatic metastases, ablation (radiofrequency or microwave ablation), or both ablation and surgery. Each patient had multiple sites of cancer in their liver.

Blood loss was significantly lower in patients who underwent ablation (either with or without surgery), compared to those who underwent only surgery.
Hospital stay following the procedure was significantly longer for those undergoing surgery compared to those undergoing ablation.
The 5-year overall survival was not significantly different between the treatment groups.
Patients who underwent ablation had a significantly poorer prognosis than those who underwent surgery.
The researchers concluded that the addition of ablation to treatment for multiple hepatic metastases may provide an important therapeutic option for patients with colorectal cancer. Patients with colorectal cancer and hepatic metastases should speak with their physician regarding their individual risks and benefits of all treatment options with their physician.

Reference: Karanicolas P, Jarnagin W, Gonen M, et al. Long-term Outcomes Following Tumor Ablation for Treatment of Bilateral Colorectal Liver Metastases. JAMA Surgery. On-line publication doi:10.1001/jamasurg.2013.1431.