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Thermal Ablation versus Stereotactic Ablative Body Radiotherapy to Treat Unresectable Colorectal Liver Metastases: A Comparative Analysis from the Prospective Amsterdam CORE Registry

1
Department of Radiology and Nuclear Medicine, Amsterdam UMC, Cancer Center Amsterdam, VU University, 1081 HV Amsterdam, The Netherlands
2
Department of Radiology and Nuclear Medicine, Noordwest Ziekenhuisgroep, 1815 JD Alkmaar, The Netherlands
3
Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, VU University, 1081 HV Amsterdam, The Netherlands
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Department of Medical Oncology, Amsterdam UMC, Cancer Center Amsterdam, VU University, 1081 HV Amsterdam, The Netherlands
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Department of Epidemiology and Data Science, Amsterdam UMC, Cancer Center Amsterdam, VU University, 1081 HV Amsterdam, The Netherlands
6
Department of Radiation Oncology, Amsterdam UMC, Cancer Center Amsterdam, VU University, 1081 HV Amsterdam, The Netherlands
*
Author to whom correspondence should be addressed.
Academic Editor: David Wong
Cancers 2021, 13(17), 4303; https://doi.org/10.3390/cancers13174303
Received: 12 July 2021 / Revised: 18 August 2021 / Accepted: 20 August 2021 / Published: 26 August 2021
(This article belongs to the Special Issue Management of Colorectal Cancer Metastatic Disease)
Approximately 30–50% of colorectal cancer patients will develop colorectal liver metastases (CRLM) in the course of their disease. Though partial hepatectomy is considered the historical gold standard, complete removal of all metastases is only feasible in 20–30% of patients. Thermal ablation and stereotactic ablative radiotherapy (SABR) are techniques to eradicate unresectable CRLM. This AmCORE based study compares the safety, efficacy and survival outcomes of these treatment methods. In this study thermal ablation was superior to SABR with regard to overall survival, local tumor progression-free survival and local control. However, there was a slightly higher risk of serious adverse events after thermal ablation. Further studies are required to assess whether the worse outcomes following SABR were the effect of true differences in ablative treatment or a result of residual confounding.
Thermal ablation and stereotactic ablative radiotherapy (SABR) are techniques to eradicate colorectal liver metastases (CRLM). This study compares the safety, efficacy and long-term oncological outcomes of these treatment methods. All prospectively registered patients (AmCORE registry) treated with thermal ablation or SABR alone for unresectable CRLM between 2007 and 2020 were analyzed using multivariate Cox-proportional hazard regression. In total 199 patients were included for analysis: 144 (400 CRLM) thermal ablation; 55 (69 CRLM) SABR. SABR patients were characterized by older age (p = 0.006), extrahepatic disease at diagnosis (p = 0.004) and larger tumors (p < 0.001). Thermal ablation patients were more likely to have synchronous disease, higher clinical risk scores (p = 0.030) and higher numbers of CRLMs treated (p < 0.001). Mortality was zero and morbidity low in both groups: no serious adverse events were recorded following SABR (n = 0/55) and nine (n = 9/144 [6.3%]; all CTCAE grade 3) after thermal ablation. SABR was associated with an inferior overall survival (OS) (median OS 53.0 months vs. 27.4 months; HR = 1.29, 95% CI 1.12–1.49; p = 0.003), local tumor progression-free survival (LTPFS) per-tumor (HR = 1.24, 95% CI 1.01–1.52; p = 0.044) and local control per-patient (HR = 1.57, 95% CI 1.20–2.04; p = 0.001) and per-tumor (HR = 1.89, 95% CI 1.44–2.49; p < 0.001). In this study thermal ablation was superior to SABR with regard to OS, LTPFS and local control, albeit at the cost of a limited risk of serious adverse events. Further studies are required to assess whether the worse outcomes following SABR were the effect of true differences in ablative treatment or a result of residual confounding. View Full-Text
Keywords: colorectal liver metastases (CRLM); thermal ablation; microwave ablation (MWA); radiofrequency ablation (RFA); stereotactic ablative radiotherapy (SABR) colorectal liver metastases (CRLM); thermal ablation; microwave ablation (MWA); radiofrequency ablation (RFA); stereotactic ablative radiotherapy (SABR)
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MDPI and ACS Style

Nieuwenhuizen, S.; Dijkstra, M.; Puijk, R.S.; Timmer, F.E.F.; Nota, I.M.; Opperman, J.; van den Bemd, B.; Geboers, B.; Ruarus, A.H.; Schouten, E.A.C.; de Vries, J.J.J.; Scheffer, H.J.; van Geel, A.M.; van Waesberghe, J.H.T.M.; Swijnenburg, R.-J.; Versteeg, K.S.; Lissenberg-Witte, B.I.; van den Tol, M.P.; Haasbeek, C.J.A.; Meijerink, M.R. Thermal Ablation versus Stereotactic Ablative Body Radiotherapy to Treat Unresectable Colorectal Liver Metastases: A Comparative Analysis from the Prospective Amsterdam CORE Registry. Cancers 2021, 13, 4303. https://doi.org/10.3390/cancers13174303

AMA Style

Nieuwenhuizen S, Dijkstra M, Puijk RS, Timmer FEF, Nota IM, Opperman J, van den Bemd B, Geboers B, Ruarus AH, Schouten EAC, de Vries JJJ, Scheffer HJ, van Geel AM, van Waesberghe JHTM, Swijnenburg R-J, Versteeg KS, Lissenberg-Witte BI, van den Tol MP, Haasbeek CJA, Meijerink MR. Thermal Ablation versus Stereotactic Ablative Body Radiotherapy to Treat Unresectable Colorectal Liver Metastases: A Comparative Analysis from the Prospective Amsterdam CORE Registry. Cancers. 2021; 13(17):4303. https://doi.org/10.3390/cancers13174303

Chicago/Turabian Style

Nieuwenhuizen, Sanne, Madelon Dijkstra, Robbert S. Puijk, Florentine E.F. Timmer, Irene M. Nota, Jip Opperman, Bente van den Bemd, Bart Geboers, Alette H. Ruarus, Evelien A.C. Schouten, Jan J.J. de Vries, Hester J. Scheffer, Anne M. van Geel, Jan H.T.M. van Waesberghe, Rutger-Jan Swijnenburg, Kathelijn S. Versteeg, Birgit I. Lissenberg-Witte, M. P. van den Tol, Cornelis J.A. Haasbeek, and Martijn R. Meijerink 2021. "Thermal Ablation versus Stereotactic Ablative Body Radiotherapy to Treat Unresectable Colorectal Liver Metastases: A Comparative Analysis from the Prospective Amsterdam CORE Registry" Cancers 13, no. 17: 4303. https://doi.org/10.3390/cancers13174303

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