Thermal ablation and systemic therapies in the metastatic liver: time for a “glocal” approach

Excerpt

Minami et al [1] highlighted the relative high rate of local tumor progression (LTP) after radiofrequency ablation (RFA) for unresectable colorectal liver metastases (CRLM), ranging from 8.8 to 40%. Furthermore, the phase II CLOCC trial (NCT00043004) results demonstrated a significant improvement in disease-free survival (DFS) and overall survival (OS) in case of a combined approach compared with chemotherapy alone [2]. Thus, low LTP rate is desirable since it ultimately impacts on OS; an effective and complete local therapy with subsequent low LTP rate is the primary and prominent goal for interventional radiologists. For this purpose, both technical skills (improved by technological advancements such as ablation confirmation software development) and oncological expertise are required. Indeed, LTP rates are affected by adequate ablation margins (required margins of at least 5 mm in CRC metastases [3]) and patients’ selection considering tumor biological characteristics [4]. …