| Literature DB >> 32635230 |
Sanne Nieuwenhuizen1, Robbert S Puijk1, Bente van den Bemd1, Luca Aldrighetti2, Mark Arntz3, Peter B van den Boezem4, Anna M E Bruynzeel5, Mark C Burgmans6, Francesco de Cobelli7, Marielle M E Coolsen8, Cornelis H C Dejong8, Sarah Derks9, Arjen Diederik10, Peter van Duijvendijk11, Hasan H Eker12, Anton F Engelsman13, Joris I Erdmann13, Jurgen J Fütterer3, Bart Geboers1, Gerie Groot10, Cornelis J A Haasbeek5, Jan-Jaap Janssen3, Koert P de Jong14, G Matthijs Kater15, Geert Kazemier13, Johan W H Kruimer16, Wouter K G Leclercq17, Christiaan van der Leij18, Eric R Manusama12, Mark A J Meier19, Bram B van der Meijs1, Marleen C A M Melenhorst1, Karin Nielsen13, Maarten W Nijkamp14, Fons H Potters19, Warner Prevoo20, Floris J Rietema21, Alette H Ruarus1, Simeon J S Ruiter14, Evelien A C Schouten1, Gian Piero Serafino22, Colin Sietses23, Rutger-Jan Swijnenburg13, Florentine E F Timmer1, Kathelijn S Versteeg24, Ted Vink25, Jan J J de Vries1, Johannes H W de Wilt4, Barbara M Zonderhuis13, Hester J Scheffer1, Petrousjka M P van den Tol13, Martijn R Meijerink1.
Abstract
The guidelines for metastatic colorectal cancer crudely state that the best local treatment should be selected from a 'toolbox' of techniques according to patient- and treatment-related factors. We created an interdisciplinary, consensus-based algorithm with specific resectability and ablatability criteria for the treatment of colorectal liver metastases (CRLM). To pursue consensus, members of the multidisciplinary COLLISION and COLDFIRE trial expert panel employed the RAND appropriateness method (RAM). Statements regarding patient, disease, tumor and treatment characteristics were categorized as appropriate, equipoise or inappropriate. Patients with ECOG≤2, ASA≤3 and Charlson comorbidity index ≤8 should be considered fit for curative-intent local therapy. When easily resectable and/or ablatable (stage IVa), (neo)adjuvant systemic therapy is not indicated. When requiring major hepatectomy (stage IVb), neo-adjuvant systemic therapy is appropriate for early metachronous disease and to reduce procedural risk. To downstage patients (stage IVc), downsizing induction systemic therapy and/or future remnant augmentation is advised. Disease can only be deemed permanently unsuitable for local therapy if downstaging failed (stage IVd). Liver resection remains the gold standard. Thermal ablation is reserved for unresectable CRLM, deep-seated resectable CRLM and can be considered when patients are in poor health. Irreversible electroporation and stereotactic body radiotherapy can be considered for unresectable perihilar and perivascular CRLM 0-5cm. This consensus document provides per-patient and per-tumor resectability and ablatability criteria for the treatment of CRLM. These criteria are intended to aid tumor board discussions, improve consistency when designing prospective trials and advance intersociety communications. Areas where consensus is lacking warrant future comparative studies.Entities:
Keywords: ablatability criteria; colorectal liver metastases; consensus guideline; irreversible electroporation; microwave ablation; partial hepatectomy; radiofrequency ablation; resectability criteria; stereotactic body radiotherapy; thermal ablation
Year: 2020 PMID： 32635230 DOI： 10.3390/cancers12071779
Source DB: PubMed Journal: Cancers (Basel) ISSN： 2072-6694 Impact factor: 6.639