title: Percutaneous radiofrequency ablation for unresectable colorectal liver metastases: time for shadows to disperse.
abstract: BACKGROUND
  Despite the advent of combination chemotherapy regimens achieved within the last decade, long term survival of patients with unresectable metastatic disease from colorectal cancer remains poor. Thermal ablation procedures, including radiofrequency ablation (RFA), are considered feasible options in treating unresectable hepatic tumors either primary (hepatocellular carcinoma) or metastatic, the latter mainly arising from colorectal cancer. Percutaneous access is the least invasive RFA procedure.
  
  
  RESULTS
  A MEDLINE review unfolded a significant clinical heterogeneity among published series reporting on percutaneous RFA in hepatic metastatic disease from colorectal cancer, regarding study population, optimal time and treatment schemes pre- and post-RFA intervention. Notwithstanding, percutaneous RFA survival figures were consistently better than front line chemotherapy. Furthermore, a pooled analysis of larger series demonstrated a clear benefit in overall survival (HR 0.51, 95% CI 0.44 to 0.58).
  
  
  CONCLUSIONS
  Albeit optimal indications are still pending, percutaneous RFA should nonetheless be considered a viable option in patients with unresectable metastatic disease, as it may prolong survival rates achieved with standard chemotherapy.
authors.affiliation: Department of Medical Imaging and Interventional Radiology, General Hospital of Chest Diseases Sotiria, Mesogeion Av. 152, Athens 11527, Greece. ploukia@hotmail.com
authors.forename: Loukia S
authors.initials: LS
authors.lastname: Poulou
authors.forename: Panayiotis D
authors.initials: PD
authors.lastname: Ziakas
authors.forename: Vassilia
authors.initials: V
authors.lastname: Xila
authors.forename: George
authors.initials: G
authors.lastname: Vakrinos
authors.forename: Katerina
authors.initials: K
authors.lastname: Malagari
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Syrigos
authors.forename: Loukas
authors.initials: L
authors.lastname: Thanos
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D015641:Radiography, Interventional; D016019:Survival Analysis; D018084:Ultrasonography, Interventional