From the Guidelines
Yes, radiofrequency ablation (RFA) is an established option for treating liver metastases from colorectal cancer according to oncology protocols, particularly for patients with limited hepatic disease who are not candidates for surgical resection. RFA is typically considered for patients with smaller metastases (generally less than 3-5 cm in diameter) and fewer lesions (usually less than 5), though specific criteria may vary between institutions 1. The procedure involves inserting a needle electrode into the tumor under imaging guidance (ultrasound, CT, or MRI) and using high-frequency electrical current to generate heat that destroys cancer cells. RFA may be performed percutaneously, laparoscopically, or during open surgery depending on tumor location and patient factors.
Key Considerations
- While surgical resection remains the gold standard treatment when feasible, RFA offers a less invasive alternative with shorter recovery times and the ability to preserve more healthy liver tissue 1.
- The effectiveness of RFA depends on complete tumor ablation with adequate margins, and patients typically require follow-up imaging every 3-6 months to monitor for local recurrence or new metastases.
- RFA may also be used in combination with systemic chemotherapy or as part of a multimodal treatment approach for patients with more extensive disease.
- In cases where patients have contraindications against surgery or unresectable oligometastases, local ablative measures like RFA should be considered, especially for tumors up to 3–4 cm in size 1.
Patient Selection
- Patients with limited hepatic disease who are not candidates for surgical resection are ideal candidates for RFA.
- Those with smaller metastases and fewer lesions are more likely to benefit from RFA.
- The decision to offer RFA should be made by a multidisciplinary team, including a radiologist, liver surgeon, and medical oncologist, to ensure the best possible outcome for the patient 1.
From the Research
Radiofrequency Ablation for Liver Metastases of Colorectal Cancer
- Radiofrequency ablation (RFA) is a treatment option for liver metastases of colorectal cancer, as indicated by several studies 2, 3, 4, 5, 6.
- RFA is emerging as a viable alternative to surgery for inoperable patients with limited hepatic metastatic disease, especially from colorectal cancer 2.
- The treatment can result in complete tumor eradication in properly selected candidates and has provided indirect evidence that it improves survival 2.
Comparison with Other Treatment Options
- RFA has been compared to microwave ablation (MWA) for colorectal liver metastases, with MWA showing better local tumor control rates 3.
- RFA combined with systemic chemotherapy has been shown to be superior to chemotherapy alone 4.
- Partial hepatectomy (PH) is superior to RFA alone but not to RFA + PH or to MWA 4.
Safety and Efficacy
- RFA has been shown to be safe and effective in the treatment of colorectal liver metastases, with minimal complications 6.
- The 1-, 3-, and 5-year survival rates after RFA and adjuvant systemic chemotherapy were 92.3%, 50.7%, and 41.6%, respectively 6.
- Age was found to be a significant independent prognostic factor, with better survival rates observed in patients aged ≥50 years than those aged <50 years 6.
Multidisciplinary Approach
- A multidisciplinary approach to patients with colorectal liver metastases is mandatory, integrating aggressive surgical treatments with non-surgical options to maximize disease control and patient survival 5.
- RFA can be a preferred treatment option for patients with solitary liver metastasis after surgery for colorectal cancer, especially when combined with systemic chemotherapy 6.