Skip to main content

Advertisement

Log in

Update on Treatment of Liver Metastases: Focus on Ablation Therapies

  • Gastrointestinal Cancers (B Czito, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

There is substantial and growing interest in the use of local therapies to treat patients with metastatic cancer, especially those deemed to have “oligometastatic” disease. Much of the literature to date consists of reports on metastasectomy for liver and lung metastases. Non-surgical minimally or non-invasive treatments including thermal ablation, irreversible electroporation, and high-dose radiation therapy (stereotactic ablative radiation therapy) can also be used in the treatment of primary and secondary tumors, including in the treatment of liver metastases. In this review, we discuss the rationale for using these ablative treatments in the treatment of liver metastases including similarities and differences between them.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Weiss L, Grundmann E, Torhorst J, Hartveit F, Moberg I, Eder M, et al. Haematogenous metastatic patterns in colonic carcinoma: an analysis of 1541 necropsies. J Pathol. 1986;150(3):195–203.

    Article  CAS  PubMed  Google Scholar 

  2. Rees M, Tekkis PP, Welsh FK, O’Rourke T, John TG. Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients. Ann Surg. 2008;247(1):125–35.

    Article  PubMed  Google Scholar 

  3. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13(1):8–10.

    CAS  PubMed  Google Scholar 

  4. Weichselbaum RR, Hellman S. Oligometastases revisited. Nat Rev Clin Oncol. 2011;8(6):378–82.

    CAS  PubMed  Google Scholar 

  5. Palma DA, Salama JK, Lo SS, Senan S, Treasure T, Govindan R, et al. The oligometastatic state—separating truth from wishful thinking. Nat Rev Clin Oncol. 2014;11(9):549–57. A very important overview of controversies regarding the concept of oligometastatic disease. Discusses important issues inherent in clinical trials addressing treatment of oligometastatic disease.

    Article  PubMed  Google Scholar 

  6. Foltz G. Image-guided percutaneous ablation of hepatic malignancies. Semin Intervent Radiol. 2014;31(2):180–6.

    Article  PubMed  Google Scholar 

  7. Chu KF, Dupuy DE. Thermal ablation of tumours: biological mechanisms and advances in therapy. Nat Rev Cancer. 2014;14(3):199–208.

    Article  CAS  PubMed  Google Scholar 

  8. Simon CJ, Dupuy DE, Mayo-Smith WW. Microwave ablation: principles and applications. Radiographics. 2005;25 Suppl 1:S69–83.

    Article  PubMed  Google Scholar 

  9. Ng KK, Lam CM, Poon RT, Shek TW, Ho DW, Fan ST. Safety limit of large-volume hepatic radiofrequency ablation in a rat model. Arch Sug. 2006;141(3):252–8.

    Article  Google Scholar 

  10. Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg. 2005;242(2):158–71.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Lu DS, Raman SS, Limanond P, Aziz D, Economou J, Busuttil R, et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol. 2003;14(1):1267–74.

    Article  PubMed  Google Scholar 

  12. Levit E, Bruners P, Gunther RW, Mahnken AH. Bile aspiration and hydrodissection to prevent complications in hepatic RFA close to the gallbladder. Acta Radiol. 2012;53(9):1045–8.

    Article  PubMed  Google Scholar 

  13. Wong SL, Mangu PB, Choti MA, Crocenzi TS, Dodd 3rd GD, et al. American society of clinical oncology 2009 clinical evidence review of radiofrequency ablation of hepatic metastases from colorectal cancer. J Clin Oncol. 2010;28(3):493–508.

    Article  PubMed  Google Scholar 

  14. Doyle MB, Chapman WC. Radiofrequency ablation for resectable colorectal hepatic metastases: is it time for a randomized controlled trial? Ann Surg. 2010;251(5):804–6.

    Article  PubMed  Google Scholar 

  15. Chen M-S, Li J-Q, Zheng Y, Guo R-P, Liang H-H, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg. 2006;243(3):321–8.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Groeschl RT, Pilgrim CH, Hanna EM, Simo KA, Swan RZ, Sindram D, et al. Microwave ablation for hepatic malignancies: a multiinstitutional analysis. Ann Surg. 2014;259(6):1195–200.

    Article  PubMed  Google Scholar 

  17. Davalos RV, Mir IL, Rubinsky B. Tissue ablation with irreversible electroporation. Ann Biomed Eng. 2005;33(2):223–31.

    Article  CAS  PubMed  Google Scholar 

  18. Lee EW, Wong D, Tafti BA, Prieto V, Totonchy M, Hilton J, et al. Irreversible electroporation in eradication of rabbit VX2 liver tumor. J Vasc Interv Radiol. 2012;23(6):833–40.

    Article  PubMed  Google Scholar 

  19. Rubinsky B, Onik G, Mikus P. Irreversible electroporation: a new ablation modality—clinical implications. Technol Cancer Res Treat. 2007;6(1):37–48.

    Article  PubMed  Google Scholar 

  20. Li W, Fan Q, Ji Z, Qiu X, Li Z. The effects of irreversible electroporation (IRE) on nerves. PLoS One. 2011;6(4):e18831.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Lee EW, Chen C, Prieto EV, Dry SM, Loh CT, Kee ST. Advanced hepatic ablation technique for creating complete cell death: irreversible electroporation. Radiology. 2010;255(2):426–33.

    Article  PubMed  Google Scholar 

  22. Ball C, Thomson KR, Kavnoudias H. Irreversible electroporation: a new challenge in “out of operating theater” anesthesia. Anesth Analg. 2010;110(50):1305–9.

    Article  PubMed  Google Scholar 

  23. Thomson KR, Cheung W, Ellis SJ, Federman D, Kavnoudias H, Loader-Oliver D, et al. Investigation of the safety of irreversible electroporation in humans. J Vasc Interv Radiol. 2011;22(5):611–21.

    Article  PubMed  Google Scholar 

  24. Charpentier KP, Wolf F, Noble L, Winn B, Resnick M, Dupuy DE. Irreversible electroporation of the liver and liver hilum in swine. HPB (Oxford). 2011;13(3):168–73.

    Google Scholar 

  25. Silk M, Wimmer T, Lee KS, Srimathveeravalli G, Brown KT, Kingham PT, et al. Percutaneous ablation of peribiliary tumors with irreversible electroporation. J Vasc Interv Radiol. 2014;25(1):112–8. Early clinical results of irreversible electroporation in the treatment of liver tumors located near critical structures.

    Article  PubMed  Google Scholar 

  26. Cannon R, Ellis S, Hayes D, Narayanan G, Martin 2nd RC. Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures. J Surg Oncol. 2013;107(5):544–9. Early clinical results of irreversible electroporation for tumors near critical structures.

    Article  PubMed  Google Scholar 

  27. Pan CC, Kavanagh BD, Dawson LA, Li XA, Das SK, Miften M, et al. Radiation-associated liver injury. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S94–100.

    Article  PubMed  Google Scholar 

  28. Reed Jr GB. The human liver after radiation injury. A form of veno-occlusive disease. Am J Pathol. 1966;48(4):597–611.

    PubMed Central  PubMed  Google Scholar 

  29. Timmerman RD, Herman J, Cho LC. Emergence of stereotactic body radiation therapy and its impact on current and future clinical practice. J Clin Oncol. 2014;32(26):2847–54.

    Article  PubMed  Google Scholar 

  30. Radiobiology for the Radiologist. 7th ed. In: Hall EJ, Giaccia AJ, editors. Philadelphia, PA: Lippincott Williams & Wilkins; 2012. p. 41–42.

  31. Brown JM, Carlson DJ, Brenner DJ. Dose escalation, not “new biology”, can account for the efficacy of stereotactic body radiation therapy with non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2013;85(5):1159–60.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Song CW, Park I, Cho LC, Yuan J, Dusenbery KE, Griffin RJ, et al. Is indirect cell death involved in response of tumors to stereotactic radiosurgery and stereotactic body radiation therapy? Int J Radiat Oncol Biol Phys. 2014;89(4):924–5.

    Article  PubMed  Google Scholar 

  33. Garcia-Barros M, Paris F, Cordon-Cardo C, Lyden D, Rafii S, Haimovitz-Friedman A, et al. Tumor response to radiotherapy regulated by endothelial cell apoptosis. Science. 2003;300(5622):1155–9.

    Article  CAS  PubMed  Google Scholar 

  34. Lee Y, Auh SL, Wang Y, Burnette B, Wang Y, Meng Y, et al. Therapeutic effects of ablative radiation on local tumor require CD8+ T cells: changing strategies for cancer treatment. Blood. 2009;114(3):589–95.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Lo SS, Teh BS, Wang JZ, Huang Z, Zook J, Price T, et al. Imaging changes after stereotactic body radiation therapy for lung and liver tumors. Expert Rev Anticancer Ther. 2011;11(4):613–20.

    Article  PubMed  Google Scholar 

  36. Timmerman R, Paulus R, Galvin J, Michalski J, Straube W, Bradely J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA. 2010;303(11):1070–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Rusthoven KE, Kavanagh BD, Cardenes H, Stieber VW, Burri SH, Feigenberg SJ, et al. Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol. 2009;27(10):1572–8.

    Article  PubMed  Google Scholar 

  38. Scorsetti M, Arcangeli S, Tozzi A, Comito T, Alongi F, Navarria P, et al. Is stereotactic body radiation therapy an attractive option for unresectable liver metastases? A preliminary report from a phase 2 trial. Int J Radiat Oncol Biol Phys. 2013;86(2):336–42. Preliminary results from a trial of high-dose radiation for the treatment of liver metastases.

    Article  PubMed  Google Scholar 

  39. Yaes RJ, Kalend A. Local stem cell depletion model for radiation myelitis. Int J Radiat Oncol Biol Phys. 1998;14(6):1247–59.

    Article  Google Scholar 

  40. Lee MT, Kim JJ, Dinniwell R, Brierley J, Lockwood G, Wong R, et al. Phase I study of individualized stereotactic body radiotherapy of liver metastases. J Clin Oncol. 2009;27(10):1585–91.

    Article  PubMed  Google Scholar 

  41. Herfarth KK, Debus J, Lohr F, Bahner ML, Rhein B, Fritz P, et al. Stereotactic single-dose radiation therapy of liver tumors: results of a phase I/II trial. J Clin Oncol. 2001;19(1):164–70.

    CAS  PubMed  Google Scholar 

  42. Goodman KA, Wiegner EA, Maturen KE, Zhang Z, Mo Q, Yang G, et al. Dose-escalation study of single-fraction stereotactic body radiotherapy for liver malignancies. Int J Radiat Oncol Biol Phys. 2010;78(2):486–93.

    Article  PubMed  Google Scholar 

  43. http://clinicaltrials.gov, Study NCT01233544.

  44. Timmerman R, McGarry R, Yiannoutsos C, Papiez L, Tudor K, DeLuca J, et al. Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol. 2006;24(30):4833–9.

    Article  PubMed  Google Scholar 

  45. Vokes EE, Weichselbaum RR. Concurrent chemoradiotherapy: rationale and clinical experience in patients with solid tumors. J Clin Oncol. 1990;8(5):911–34.

    CAS  PubMed  Google Scholar 

  46. Timmerman RD, Kavanagh BD, Cho LC, et al. Stereotactic body radiation therapy in multiple organ sites. J Clin Oncol. 2007;25(8):947–52.

    Article  PubMed  Google Scholar 

  47. Yang W, Ahmed M, Elian M, el-SA H, Levchenko TS, Sawant RR, et al. Do liposomal apoptotic enhancers increase tumor coagulation and end-point survival in percutaneous radiofrequency ablation of tumors in a rat tumor model? Radiology. 2010;257(3):685–96.

    Article  PubMed Central  PubMed  Google Scholar 

  48. Formenti SC, Demaria S. Radiation therapy to convert the tumor to an in situ vaccine. Int J Radiat Oncol Biol Phys. 2012;84(4):879–90. An important overview of word studying the interactions of radiation and the immune system.

    Article  PubMed  Google Scholar 

  49. den Brok MH, Sutmuller RP, Nierkens S, Bennink EJ, Frielink C, Toonen LW, et al. Efficient loading of dendritic cells following cryo and radiofrequency ablation in combination with immune modulation induces anti-tumor immunity. Br J Cancer. 2006;95(7):896–905.

    Article  Google Scholar 

  50. Dewan MZ, Galloway AE, Kawashima N, Dewyngaert JK, Babb JS, Formenti SC, et al. Fractionated but not single-dose radiotherapy induces an immune-mediated abscopal effect when combined with anti-CTLA-4 antibody. Clin Cancer Res. 2009;15(17):5379–88.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Seth Toomay declares that he has no conflict of interest.

Jeffrey Meyer reports a clinical trial support from Peregrine Pharmaceuticals, Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jeffrey Meyer.

Additional information

This article is part of the Topical Collection on Gastrointestinal Cancers

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meyer, J., Toomay, S. Update on Treatment of Liver Metastases: Focus on Ablation Therapies. Curr Oncol Rep 17, 420 (2015). https://doi.org/10.1007/s11912-014-0420-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11912-014-0420-2

Keywords

Navigation