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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 8/2018

Open Access 01-08-2018 | Review

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

Authors: Martijn R. Meijerink, Robbert S. Puijk, Aukje A. J. M. van Tilborg, Kirsten Holdt Henningsen, Llenalia Garcia Fernandez, Mattias Neyt, Juanita Heymans, Jacqueline S. Frankema, Koert P. de Jong, Dick J. Richel, Warner Prevoo, Joan Vlayen

Published in: CardioVascular and Interventional Radiology | Issue 8/2018

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Abstract

Purpose

To 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).

Methods

MEDLINE, 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.

Results

The 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.

Conclusion

The 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.
Appendix
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Metadata
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
Authors
Martijn R. Meijerink
Robbert S. Puijk
Aukje A. J. M. van Tilborg
Kirsten Holdt Henningsen
Llenalia Garcia Fernandez
Mattias Neyt
Juanita Heymans
Jacqueline S. Frankema
Koert P. de Jong
Dick J. Richel
Warner Prevoo
Joan Vlayen
Publication date
01-08-2018
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 8/2018
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-018-1959-3

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