Thermal ablation of small-size colorectal liver metastases is non-inferior to resection

For patients with small-size colorectal liver metastases, thermal ablation compared with standard-of-care surgical resection offers substantially reduced mortality and morbidity without compromising OS, demonstrated the phase 3 COLLISION trial.

Radical (laparoscopic) resection is the standard local treatment for small-size colorectal liver metastases (CRLM). Ablation techniques can be used alone or in combination with resection. However, growing evidence suggests that thermal ablation is associated with a superior safety profile, lower costs, and shorter hospital stay while rivalling surgical resection in terms of local control and overall survival [1,2].

The phase 3 COLLISION trial (NCT03088150) aimed to prospectively explore the potential non-inferiority of thermal ablation compared with surgical resection in patients with small-size (≤3 cm) resectable CRLM and no extrahepatic disease. Prof. Martijn Meijerink (Amsterdam UMC, the Netherlands) presented the final findings [3].

The 296 participants (median number CRLM=2, mean size CRLM=14 mm) were 1:1 randomised to undergo resection (64% [robot] laparoscopy) or thermal ablation (83% percutaneously). The median overall survival did not differ between both arms (HR 1.051; 95% CI 0.695–1.590; P=0.0813), nor did distant progression-free survival (HR 1.030; 95% CI 0.776–1.368; P=0.836).

However, both treatment-related mortality (0.0% vs 2.1%) and adverse event rates (no complications in 81% vs 54%) favoured ablation over resection. In addition, the length of hospital stay was significantly shorter in the ablation arm (P<0.001).

The trial was stopped at half-time for having met predefined stopping rules. “In conclusion, transitioning from surgical resection to thermal ablation as standard-of-care for patients with small-size CRLM would reduce complications, shorten hospital stay, and improve local control, without compromising disease-free and overall survival,” said Prof. Meijerink.

1. Meijerink MR, et al. Cardiovasc Intervent Radiol. 2018;41:1189-1204.
2. Puijk RS, et al. Cardiovasc Intervent Radiol. 2022;45:1074-1089.
3. Meijerink MR, et al. Surgery versus thermal ablation for small-size colorectal liver metastases (COLLISION): An international, multicenter, phase III randomized controlled trial. Abstract LBA3501, ASCO Annual Meeting 2024, 31 May–4 June, Chicago, IL, USA.

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Posted on 18 July 202418 July 2024