American Society of Clinical Oncology 2009 clinical evidence review on radiofrequency ablation of hepatic metastases from colorectal cancer.
OBJECTIVE
To review the evidence about the efficacy and utility of radiofrequency ablation (RFA) for hepatic metastases from colorectal cancer (CRHM).


METHODS
The American Society of Clinical Oncology (ASCO) convened a panel to conduct and analyze a comprehensive systematic review of the RFA literature from Medline and the Cochrane Collaboration Library.


RESULTS
Because data were considered insufficient to form the basis of a practice guideline, ASCO has instead published a clinical evidence review. The evidence is from single-arm, retrospective, and prospective trials. No randomized controlled trials have been included. The following three clinical issues were considered by the panel: the efficacy of surgical hepatic resection versus RFA for resectable tumors; the utility of RFA for unresectable tumors; and RFA approaches (open, laparoscopic, or percutaneous). Evidence suggests that hepatic resection improves overall survival (OS), particularly for patients with resectable tumors without extrahepatic disease. Careful patient and tumor selection is discussed at length in the literature. RFA investigators report a wide variability in the 5-year survival rate (14% to 55%) and local tumor recurrence rate (3.6% to 60%). The reported mortality rate was low (0% to 2%), and the major complications rate was commonly reported to be between 6% and 9%. RFA is currently performed with all three approaches.


CONCLUSIONS
There is a compelling need for more research to determine the efficacy and utility of RFA to increase local recurrence-free, progression-free, and disease-free survival as well as OS for patients with CRHM. Clinical trials have established that hepatic resection can improve OS for patients with resectable CRHM.
University of Michigan, AnnArbor, MI, USA.
Sandra L
SL
Wong
Pamela B
PB
Mangu
Michael A
MA
Choti
Todd S
TS
Crocenzi
Gerald D
GD
Dodd
Gary S
GS
Dorfman
Cathy
C
Eng
Yuman
Y
Fong
Andrew F
AF
Giusti
David
D
Lu
Thomas A
TA
Marsland
Rob
R
Michelson
Graeme J
GJ
Poston
Deborah
D
Schrag
Jerome
J
Seidenfeld
Al B
AB
Benson
D017115:Catheter Ablation / Q000379:methods*; D002986:Clinical Trials as Topic / Q000639:trends; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D054624:Health Status Disparities; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery / Q000628:therapy*