TY - JOUR
T1 - Resectability and Ablatability Criteria for the Treatment of Liver Only Colorectal Metastases
T2 - Multidisciplinary Consensus Document from the COLLISION Trial Group
AU - Nieuwenhuizen, Sanne
AU - Puijk, Robbert S.
AU - van den Bemd, Bente
AU - Aldrighetti, Luca
AU - Arntz, Mark
AU - van den Boezem, Peter B.
AU - Bruynzeel, Anna M. E.
AU - Burgmans, Mark C.
AU - de Cobelli, Francesco
AU - Coolsen, Marielle M. E.
AU - Dejong, Cornelis H. C.
AU - Derks, Sarah
AU - Diederik, Arjen
AU - van Duijvendijk, Peter
AU - Eker, Hasan H.
AU - Engelsman, Anton F.
AU - Erdmann, Joris
AU - Futterer, Jurgen J.
AU - Geboers, Bart
AU - Groot, Gerie
AU - Haasbeek, Cornelis J. A.
AU - Janssen, Jan-Jaap
AU - de Jong, Koert P.
AU - Kater, G. Matthijs
AU - Kazemier, Geert
AU - Kruimer, Johan W. H.
AU - Leclercq, Wouter K. G.
AU - van der Leij, Christiaan
AU - Manusama, Eric R.
AU - Meier, Mark A. J.
AU - van der Meijs, Bram B.
AU - Melenhorst, Marleen C. A. M.
AU - Nielsen, Karin
AU - Nijkamp, Maarten W.
AU - Potters, Fons H.
AU - Prevoo, Warner
AU - Rietema, Floris J.
AU - Ruarus, Alette H.
AU - Ruiter, Simeon J. S.
AU - Schouten, Evelien A. C.
AU - Serafino, Gian Piero
AU - Sietses, Colin
AU - Swijnenburg, Rutger-Jan
AU - Timmer, Florentine E. F.
AU - Versteeg, Kathelijn S.
AU - Vink, Ted
AU - de Vries, Jan J. J.
AU - de Wilt, Johannes H. W.
AU - Zonderhuis, Barbara M.
AU - Scheffer, Hester J.
AU - van den Tol, Petrousjka M. P.
AU - Meijerink, Martijn R.
PY - 2020/7/3
Y1 - 2020/7/3
N2 - 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.
AB - 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.
KW - colorectal liver metastases
KW - thermal ablation
KW - microwave ablation
KW - radiofrequency ablation
KW - partial hepatectomy
KW - irreversible electroporation
KW - stereotactic body radiotherapy
KW - resectability criteria
KW - ablatability criteria
KW - consensus guideline
KW - STEREOTACTIC BODY RADIOTHERAPY
KW - HEPATIC RESECTION
KW - IRREVERSIBLE ELECTROPORATION
KW - RADIOFREQUENCY ABLATION
KW - MICROWAVE ABLATION
KW - NEOADJUVANT CHEMOTHERAPY
KW - SURGICAL RESECTION
KW - ELDERLY-PATIENTS
KW - PHASE-II
KW - CANCER
U2 - 10.3390/cancers12071779
DO - 10.3390/cancers12071779
M3 - Article
C2 - 32635230
SN - 2072-6694
VL - 12
SP - 1
EP - 17
JO - Cancers
JF - Cancers
IS - 7
M1 - 1779
ER -