Ablation vs Resection of Colorectal Cancer Liver Metastases

N/AActive Not RecruitingNCT05129787

Oslo University Hospital230 enrolled

Overview

230 patients with colorectal cancer liver metastases will be randomly assigned to resection or thermal ablation.

Rationale: The use of thermal ablation of liver tumors is rapidly increasing. This is despite a lack of high-level evidence of the oncologic efficacy of ablation. Ablation is most often used in cases where resection is not possible, but as the technique has improved it is increasingly used as a substitute for resection. A majority of studies on ablation are hampered by selection bias. Selection bias can only be overcome in a randomized controlled trial. Primary objective: To compare rates of local tumor progression within 12 months in patients randomly assigned to thermal ablation or surgical resection of colorectal liver metastases. Secondary objectives: * To establish a pipeline for immediate three-dimensional verification of the ablated zone following thermal ablation of liver metastases. * To compare health related quality of life in patients randomly assigned to thermal ablation or surgical resection of colorectal liver metastases. * To perform a cost-effectiveness analysis (Cost per quality adjusted life year) of thermal ablation and resection of colorectal liver metastases. * To compare disease-free and overall survival in in patients randomly assigned to thermal ablation or surgical resection of colorectal liver metastases. * To evaluate the hemodynamic response to thermal ablation and laparoscopic resection of liver tumors. Study design: A randomized, controlled, multicenter, double-blinded non-inferiority trial. Study population: Two groups of 115 patients (230 in total) with colorectal liver metastasis eligible for radical treatment using EITHER resection OR ablation (not a combination). Intervention: Ablation of colorectal liver metastases Control: Resection of colorectal liver metastases Main study parameters/endpoints: The primary endpoint of the study is local recurrence of cancer at 12 months. Secondary endpoints include overall survival, disease free survival, health related quality of life, postoperative pain, complications, hospital stay and cost-effectiveness.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

230

Conditions

Colorectal Cancer Metastatic

Interventions

Surgical resectionPROCEDURE

Resection of metastasis

Thermal ablationPROCEDURE

Ablation of metastasis

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Histologically verified colorectal cancer * Colorectal liver metastases (proven or suspected) eligible for radical treatment using EITHER resection OR ablation (not a combination), as decided by the liver MDT meeting at the study center * The patient is fit to undergo both resection and ablation of all liver metastases * Size of largest lesion up to and including 30 mm * In case of solitary metastasis, resection plan includes resection of ≤ 2 anatomical segments. * In case of multiple metastases in one continuous resection, resection plan can include ≤ 4 anatomical segments (including hemihepatectomy) * ≤ 5 tumors to be treated in one procedure * Primary tumor either resected (primary first) or with a plan for curative treatment (liver first). Exclusion Criteria: • More than 3 lung metastases where 1 is \>10mm, or 1 lung metastasis \>15 mm (OR: unresectable lung metastases as decided by the lung MDT meeting) * Presence of extrahepatic, extrapulmonary metastases. * Surgical indication for removal of enlarged lymph nodes in the hepatic hilum. (Enlarged lymph nodes without indication of removal are not considered an exclusion criterium) * Tumor closer than 10 mm to right/left main bile duct * Suspected tumor infiltration to adjacent organs * Progression (as of RECIST \[18\]) on 2nd line chemotherapy * Previous inclusion in this trial * Not eligible for workup according to study criteria * Contraindication to contrast enhanced CT scan * Manifest liver cirrhosis * Pregnancy * ECOG performance status ≥3 * Simultaneous resection of primary tumor or any other concomitant surgical procedure * Any other reason why, in the investigator's opinion, the patient should not be included.

Locations (1)

Oslo University Hospital, Department of Gastrointestinal surgery, The National Hospital

Oslo, Norway

Outcomes

Primary Outcomes

Local tumor progression

Local tumor progression at site of treatment

Time frame: 12 months

Secondary Outcomes

Overall survival

Overall survival following treatment

Time frame: 60 months

Overall survival (secondary analysis)

A secondary analysis will be performed on a oncologically more homogenous group of patients that fulfil the following requirements: a) no previous surgical procedure on the liver, b) no extrahepatic metastases, and c) that had their primary tumor resected

Time frame: 60 months

Disease free survival

DFS

Time frame: 60 months

Postoperative complications

Morbidity

Time frame: 30 days

Health related quality of life

HRQoL is measured using SF-36

Time frame: 12 months

Cost-Effectiveness

An analysis of cost will be performed to assess cost-effectiveness

Time frame: 12 months

Hemodynamic response

The hemodynamic response to the two interventions will be recorded and compared

Time frame: 7 days

Ventilation methods

The intraoperative movement of the liver will be measured using different ventilation methods (one lung ventilation, jet ventilation, gentle double lung ventilation). The movement of the liver during the different ventilation methods will be assessed in cm.

Data from ClinicalTrials.gov

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