Hepatic metastases management: A comparative review of surgical resection, thermal ablation, and stereotactic body radiation therapy.

Fiche publication

Date publication

août 2025

Journal

European journal of cancer (Oxford, England : 1990)

Auteurs

Membres identifiés du Cancéropôle Est :
Pr BOUCHE Olivier

Tous les auteurs :
Torielli P, McGale J, Liao MJ, Rhaiem R, Bouche O, Botsen D, Gerin O, Lamane A, Lawrence Y, Madelis G, Rozenblum L, Sajan A, Tordjman M, Dercle L, Beddok A

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/40818316

Résumé

Hepatic metastases contribute significantly to cancer-related mortality across multiple primary malignancies, including colorectal, melanoma, breast, and lung cancers. While surgical resection has long been considered the gold standard, evolving strategies have expanded local treatment options. This narrative review critically compares three established modalities-surgical resection, thermoablation using radiofrequency (RFA) or microwave ablation (MA), and stereotactic body radiation therapy (SBRT)-through the lens of efficacy, limitations, and clinical applicability. Surgical resection remains associated with the highest 5-year overall survival (OS) rates, ranging from 25 % to 47 % in colorectal liver metastases and up to 65 % in selected breast cancer cases, but is limited by strict eligibility criteria and high complication rates. Thermoablation, a minimally invasive option particularly effective for lesions < 3 cm, achieves 5-year OS rates of 30-46 % and local control (LC) rates up to 71 %, though efficacy is reduced near large vessels or subcapsular regions. SBRT, a non-invasive and image-guided modality, enables the delivery of ablative doses in a few sessions. It achieves up to 94 % LC at 2 years for tumors < 3 cm, and remains effective for larger lesions when other modalities are contraindicated. Grade ≥ 3 toxicity is rare (<10 %) with modern techniques. In selected cases, combining local modalities, such as surgery with intraoperative ablation, can improve LC in bilobar or borderline-resectable disease. Overall, these three approaches should be viewed as complementary tools within a multidisciplinary framework, allowing tailored treatment strategies for patients with hepatic metastases.