Comparative analysis of treatment of patients with metastatic colorectal cancer using local destruction methods

Introduction. Approximately 90 % of liver tumors are metastatic, predominantly from colorectal cancer (CRC). Only 10–25 % of such metastases are resectable. The median survival is less than a year without treatment and even with chemotherapy it does not exceed 18 months. The aim of the study to improve the effectiveness of treatment for patients with colorectal cancer liver metastases using minimally invasive local destruction methods. Materials and methods of research. The study included 257 patients with CRC liver metastases (2002–2024). All patients underwent ultrasound, contrast-enhanced MRI/CT, PET-CT, and 3D modeling (MYRIAN XP-Liver) for treatment planning. All patients received combined therapy: chemotherapy according to FOLFOX/XELOX/FOLFIRI regimens ± targeted therapy. Transarterial chemoembolization (TACE): 34 patients (to shrink tumors >4 cm). Radiofrequency ablation (RFA): 121 patients (tumors 1–5 cm). Microwave ablation (MWA): 57 patients (tumors 1–3,5 cm). Laser ablation (LA): 45 patients (tumors 1–3,3 cm). Treatment results. Survival in the RFA group: 1 year – 73,5 %, 2 years – 53,3 %, 3 years – 32,1 %. MWA: 1 year – 78,5 %, 2 years – 63,3 %, 3 years – 58,3 %. LA: 1 year – 88 %, 2 years – 71 %, 3 years – 43,5 %. Median relapse-free survival is 8,5 months. The 1-year survival rate in the subgroup of 12 patients was 84 %. Mortality was 0,6 % (2 cases in the RFA group). The average hospital stay was 7 days. Conclusion. The use of minimally invasive thermodestruction methods (RFA, MWA, LA) within a multidisciplinary approach significantly expands treatment indications for non-resectable patients (with severe comorbidities, bilobar involvement, low functional liver reserve). This increases overall resectability to 35–40 %, reduces surgical risks and the number of complications, shortens hospitalization times, and improves survival rates.