Colorectal Cancer Metastatic, Liver Metastasis Colon Cancer
Conditions
Brief summary
Multiple articles report that thermal ablation is a safe and effective treatment for unresectable colorectal liver metastases (CRLM) ≤3cm. However efficacy of thermal ablation decreases with increasing lesion size. Guidelines state that thermal ablation is the preferred option for unresectable CRLM ≤3cm and stereotactic body radiotherapy (SBRT) when thermal ablation is not possible. It remains uncertain what local treatment method should be recommended for unresectable CRLM of 3-5cm.
Detailed description
Objective: The primary objective of this study is to compare efficacy of MWA to the efficacy of SBRT with regards to the primary endpoint (local tumour progression free survival at 1 year \[1-year LTPFS\]) in patients with unresectable CRLM (3 - 5 cm) that are unsuitable for surgery due to either comorbidities, a history of extensive abdominal surgery, a poor performance status or due to a certain unfavourable anatomical location of the tumour. Study design: COLLISION XL is a prospective multi-centre phase-II randomized controlled trial. Study population: 68 patients with 1-3 unresectable lesions of 3 - 5cm, unsuitable for (further) chemotherapy regimens, suitable for both MWA and SBRT and no or limited extrahepatic disease (1 extrahepatic lesion is allowed, not including positive para-aortal lymph nodes, celiac lymph nodes, adrenal metastases, pleural carcinomatosis or peritoneal carcinomatosis) are considered eligible. Supplementary resections for resectable lesions and thermal ablations for unresectable CRLM ≤3cm are allowed. A maximum number of 10 CRLM are allowed for patients with no extrahepatic disease and a maximum number of 5 lesions are allowed for patients with limited extrahepatic disease. Intervention: SBRT or MWA. The panel, consisting of at least two interventional radiologists, two hepatobiliary surgeons and two radiation oncologists, will appoint lesions of 3-5cm that are unresectable and suitable for both MWA and SBRT, as target lesions. All lesions that are not suitable for ablation should be resectable and all unresectable lesions \<3cm should be suitable for thermal ablation. Main study parameters/endpoints: Primary endpoint is local tumour progression free survival (LTPFS) at 1 year from randomization. Secondary endpoints are local tumour progression free survival time, OS, disease-free survival (DFS), time to progression (TTP), procedural morbidity/toxicity and mortality, assessment of pain and quality of life (QoL) and cost-effectiveness ratio (ICER).
Interventions
DEVICEStereotactic Body Radiotherapy
Patients will undergo Stereotactic Body Radiotherapy (SBRT)
DEVICEMicrowave Ablation
Patients will undergo Microwave Ablation (MWA)
Sponsors
Amsterdam UMC, location VUmc
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Stereotactic Body Radiotherapy vs. Microwave Ablation
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 1-3 unresectable CRLM size 3-5 cm eligible for both MWA and SBRT (target lesions); * Additional CRLM are allowed if considered either resectable or ablatable and \<3cm * No or limited extrahepatic disease (1 extrahepatic lesion is allowed, not including positive para-aortal lymph nodes, celiac lymph nodes, adrenal metastases, pleural carcinomatosis or peritoneal carcinomatosis); * For subjects with liver only disease the maximum number of CRLM is 10; for subjects with limited extrahepatic disease the maximum number of CRLM is 5; * Prior focal liver treatment is allowed * Subjects without prior focal liver treatment should be either unsuitable for 1st line chemotherapy or have progressed under/after 1st-line chemotherapy; * Subjects with recurrent (either local or distant-hepatic) CRLM after previous focal treatment should be unsuitable for (further) systemic therapy (further downsizing or conversion to resectable disease improbable).
Exclusion criteria
* Compromised liver function (e.g. signs of portal hypertension, INR \> 1,5 without use of anticoagulants, ascites); * Pregnant or breast-feeding subjects; * Immunotherapy ≤ 6 weeks prior to the procedure; * Chemotherapy ≤ 6 weeks prior to the procedure; * Severe allergy to contrast media not controlled with premedication.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| One-year local tumor progression-free survival | 1 year | One-year local tumor progression-free survival |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Timo-to-local tumor progression | 5 years | Timo-to-local tumor progression |
| Overall survival (OS) | 5 years | Overall survival (OS) |
| Disease-Free Survival (DFS) | 5 years | Disease-Free Survival (DFS) |
| Mortality | 5 years | Mortality |
Countries
Netherlands
Contacts
Primary ContactS. van der Lei, MD
Backup ContactM.R. Meijerink, MD, PhD
Outcome results
None listed