Editorial Note :At the 2024 ASCO Annual Meeting, a groundbreaking study led by Dr. Martijn Ruben Meijerink from Amsterdam University Medical Center focused on thermal ablation versus surgery for small colorectal liver metastases. This study has the potential to change clinical practice. Dr. Shaalan Beg from the Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center recently shared his insights on this noteworthy research in ASCO Daily News. This article presents the study’s key findings and its implications in the medical field.

• Dr. Shaalan Beg: I commend the researchers for their dedication to exploring treatment outcomes in colorectal cancer patients with isolated liver metastases. This type of clinical trial is challenging to design, given the multidisciplinary nature of interventions and the varied preferences of patients and healthcare providers. The study included patients with resectable colorectal cancer liver metastases, limited to those without extrahepatic metastases and with no more than ten lesions, each less than 3 cm in diameter. After evaluation by an expert panel, patients were randomized to either a surgical resection group or an ablation group. Treatment modality—laparoscopic, open, or percutaneous—was chosen based on individual patient biology and anatomy.
• The trial met predefined interim stopping rules, with results showing that the ablation group outperformed the standard treatment group in various aspects. While overall survival (OS) and local progression-free survival did not differ significantly between the groups, differences were observed in morbidity and mortality. Postoperative mortality within 90 days was 2.1% for the surgery group versus 0.7% for the ablation group. The adverse event rate was 56% in the surgery group and only 19% in the ablation group. Thus, thermal ablation was associated with lower morbidity, mortality, and fewer adverse events than surgical resection, without compromising local control or OS.
• For clinical practice in the U.S., this study provides valuable data for managing small, surgically treatable or ablatable lesions. Previously, decisions about whether a patient should undergo surgery or ablation were often influenced by non-biological factors, such as physician experience, institutional practices, and specialist expertise. This study demonstrates that thermal ablation is a highly effective option for small lesions, offering good local control. It is especially notable that these findings are based on patients with liver-only metastases. I believe this data will strongly support tumor board discussions and provide solid evidence for the use of ablation in treating such lesions.

References: [1]https://dailynews.ascopubs.org/do/podcast-esopec-and-other-key-gi-studies-asco24 [2] https://meetings.asco.org/2024-asco-annual meeting/15828?presentation=234189%23234189