Resectability and ablatability criteria for the treatment of liver only colorectal metastases: Multidisciplinary consensus document from the COLLISION trial group

Sanne Nieuwenhuizen, Robbert S. Puijk, Bente van den Bemd, Luca Aldrighetti, Mark Arntz, Peter B. van den Boezem, Anna M.E. Bruynzeel, Mark C. Burgmans, Francesco de Cobelli, Marielle M.E. Coolsen, Cornelis H.C. Dejong, Sarah Derks, Arjen Diederik, Peter van Duijvendijk, Hasan H. Eker, Anton F. Engelsman, Joris I. Erdmann, Jurgen J. Fütterer, Bart Geboers, Gerie GrootCornelis J.A. Haasbeek, Jan Jaap Janssen, Koert P. de Jong, G. Matthijs Kater, Geert Kazemier, Johan W.H. Kruimer, Wouter K.G. Leclercq, Christiaan van der Leij, Eric R. Manusama, Mark A.J. Meier, Bram B. van der Meijs, Marleen C.A.M. Melenhorst, Karin Nielsen, Maarten W. Nijkamp, Fons H. Potters, Warner Prevoo, Floris J. Rietema, Alette H. Ruarus, Simeon J.S. Ruiter, Evelien A.C. Schouten, Gian Piero Serafino, Colin Sietses, Rutger Jan Swijnenburg, Florentine E.F. Timmer, Kathelijn S. Versteeg, Ted Vink, Jan J.J. de Vries, Johannes H.W. de Wilt, Barbara M. Zonderhuis, Hester J. Scheffer, Petrousjka M.P. van den Tol, Martijn R. Meijerink*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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.

Original languageEnglish
Article number1779
Pages (from-to)1-17
Number of pages17
JournalCancers
Volume12
Issue number7
DOIs
Publication statusPublished - Jul 2020

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