Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, the interventional oncology sans frontiSres meeting 2013

Previous attempts at meta-analysis and systematic review have not provided clear recommendations for the clinical application of thermal ablation in metastatic colorectal cancer. Many authors believe that the probability of gathering randomised controlled trial (RCT) data is low. Our aim is to provide a consensus document making recommendations on the appropriate application of thermal ablation in patients with colorectal liver metastases. This consensus paper was discussed by an expert panel at The Interventional Oncology Sans FrontiSres 2013. A literature review was presented. Tumour characteristics, ablation technique and different clinical applications were considered and the level of consensus was documented. Specific recommendations are made with regard to metastasis size, number, and location and ablation technique. Mean 31 % 5-year survival post-ablation in selected patients has resulted in acceptance of this therapy for those with technically inoperable but limited liver disease and those with limited liver reserve or co-morbidities that render them inoperable. In the absence of RCT data, it is our aim that this consensus document will facilitate judicious selection of the patients most likely to benefit from thermal ablation and provide a unified interventional oncological perspective for the use of this technology. aEuro cent Best results require due consideration of tumour size, number, volume and location. aEuro cent Ablation technology, imaging guidance and intra-procedural imaging assessment must be optimised. aEuro cent Accepted applications include inoperable disease due to tumour distribution or inadequate liver reserve. aEuro cent Other current indications include concurrent co-morbidity, patient choice and the test-of-time approach. aEuro cent Future applications may include resectable disease, e.g. for small solitary tumours.