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{"title":"Mathematical 3D Liver Model for Surgical versus Ablative Therapy Treatment Planning for Colorectal Liver Metastases: Recommendations from the COLLISION and COLDFIRE Trial Expert Panels.","authors":"Bente A T van den Bemd, Robbert S Puijk, Han Keijzers, Petrousjka M van den Tol, Martijn R Meijerink","doi":"10.1148/rycan.240068","DOIUrl":null,"url":null,"abstract":"<p><p>Purpose To further define anatomic criteria for resection and ablation using an expert panel-based three-dimensional liver model to objectively predict local treatment recommendations for colorectal liver metastases (CRLM). Materials and Methods This study analyzed data from participants with small CRLM (≤3 cm) considered suitable for resection, thermal ablation, or irreversible electroporation (IRE), according to a multidisciplinary expert panel, who were included in two prospective multicenter trials (COLLISION [NCT03088150] and COLDFIRE-2 [NCT02082782]) between August 2017 and June 2022. Ten randomly selected participants were used to standardize the model's Couinaud segments. CRLM coordinates were measured and plotted in the model as color-coded lesions according to the treatment recommendations. Statistical validation was achieved through leave-one-out cross-validation. Results A total of 611 CRLM in 202 participants (mean age, 63 [range, 29-87] years; 138 male and 64 female) were included. Superficially located CRLM were considered suitable for resection, whereas more deep-seated CRLM were preferably ablated, with the transition zone at a subsurface depth of 3 cm. Ninety-three percent (25 of 27) of perihilar CRLM treated with IRE were at least partially located within 1 cm from the portal triad. Use of the model correctly predicted the preferred treatment in 313 of 424 CRLM (73.8%). Conclusion The results suggest that CRLM can be defined as superficial (preferably resected) and deep-seated (preferably ablated) if the tumor center is within versus beyond 3 cm from the liver surface, respectively, and as perihilar if the tumor margins extend to within 1 cm from the portal triad. <b>Keywords:</b> Ablation Techniques, CT, MRI, Liver, Abdomen/GI, Metastases, Oncology <i>Supplemental material is available for this article.</i> © RSNA, 2024.</p>","PeriodicalId":20786,"journal":{"name":"Radiology. Imaging cancer","volume":"6 6","pages":"e240068"},"PeriodicalIF":5.6000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiology. Imaging cancer","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1148/rycan.240068","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
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Abstract
Purpose To further define anatomic criteria for resection and ablation using an expert panel-based three-dimensional liver model to objectively predict local treatment recommendations for colorectal liver metastases (CRLM). Materials and Methods This study analyzed data from participants with small CRLM (≤3 cm) considered suitable for resection, thermal ablation, or irreversible electroporation (IRE), according to a multidisciplinary expert panel, who were included in two prospective multicenter trials (COLLISION [NCT03088150] and COLDFIRE-2 [NCT02082782]) between August 2017 and June 2022. Ten randomly selected participants were used to standardize the model's Couinaud segments. CRLM coordinates were measured and plotted in the model as color-coded lesions according to the treatment recommendations. Statistical validation was achieved through leave-one-out cross-validation. Results A total of 611 CRLM in 202 participants (mean age, 63 [range, 29-87] years; 138 male and 64 female) were included. Superficially located CRLM were considered suitable for resection, whereas more deep-seated CRLM were preferably ablated, with the transition zone at a subsurface depth of 3 cm. Ninety-three percent (25 of 27) of perihilar CRLM treated with IRE were at least partially located within 1 cm from the portal triad. Use of the model correctly predicted the preferred treatment in 313 of 424 CRLM (73.8%). Conclusion The results suggest that CRLM can be defined as superficial (preferably resected) and deep-seated (preferably ablated) if the tumor center is within versus beyond 3 cm from the liver surface, respectively, and as perihilar if the tumor margins extend to within 1 cm from the portal triad. Keywords: Ablation Techniques, CT, MRI, Liver, Abdomen/GI, Metastases, Oncology Supplemental material is available for this article. © RSNA, 2024.
用于结直肠肝转移手术与烧蚀疗法治疗规划的三维肝脏数学模型:COLLISION 和 COLDFIRE 试验专家组的建议。
目的 使用基于专家小组的三维肝脏模型进一步确定切除和消融的解剖学标准,以客观预测结直肠肝转移瘤(CRLM)的局部治疗建议。材料与方法 本研究分析了2017年8月至2022年6月期间被纳入两项前瞻性多中心试验(COLLISION [NCT03088150] 和 COLDFIRE-2 [NCT02082782])、根据多学科专家小组意见被认为适合切除、热消融或不可逆电穿孔(IRE)的小CRLM(≤3 cm)参与者的数据。随机抽取的 10 名参与者用于标准化模型的 Couinaud 区段。根据治疗建议,测量 CRLM 坐标并在模型中绘制为彩色编码病灶。统计验证是通过留空交叉验证实现的。结果 共纳入了 202 名参与者(平均年龄 63 [范围 29-87] 岁;男性 138 名,女性 64 名)的 611 个 CRLM。位置较浅的 CRLM 适合切除,而位置较深的 CRLM 则最好消融,过渡区的深度为表皮下 3 厘米。93%(27 例中的 25 例)接受 IRE 治疗的肝周 CRLM 至少部分位于距离肝门三联征 1 厘米的范围内。该模型正确预测了 424 例 CRLM 中 313 例(73.8%)的首选治疗方法。结论 研究结果表明,如果肿瘤中心距离肝脏表面3厘米以内或3厘米以外,CRLM可分别定义为浅表型(最好切除)和深部型(最好消融);如果肿瘤边缘延伸至距离肝门三角区1厘米以内,则可定义为近端型。关键词消融技术 CT MRI 肝脏 腹部/消化道 转移 肿瘤学 本文有补充材料。© RSNA, 2024.
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