The Management of Colorectal Cancer Liver Metastases: The Interventional Radiology Viewpoint

Comparison of Stereotactic Body Radiation Therapy and Radiofrequency Ablation in the Treatment of Intrahepatic Metastases” by Jackson et al is a thought-provoking addition to the literature concerning treatment of colorectal cancer metastasis (CLM). The benefits of hepatic CLM resection are well established; however, most patients are not candidates for resection. Local tumor ablation is a safe and effective alternative treatment for select patients. Considerable research has evaluated percutaneous ablation as treatment of CLM, including retrospective reviews with long-term follow-up and prospective randomized trials showing prolongation of progression-free and patient survival compared with chemotherapy alone.1, 2, 3 The National Comprehensive Cancer Network guidelines recommend ablation for patients with CLMs with or without surgery as long as all tumors can be effectively treated. Conversely, the evidence for stereotactic body radiation therapy (SBRT) in the treatment of any size of CLM is sparse; the National Comprehensive Cancer Network recommends that SBRT not be used indiscriminately when other treatment options are available.