{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T22:20:12Z","timestamp":1794435612888,"version":"4.9.1"},"reference-count":34,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T00:00:00Z","timestamp":1732060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Background: The global incidence of secondary liver cancer is rising due to multiple risk factors, presenting significant challenges in public health. Similarly, colorectal cancer (CRC) remains a leading cause of cancer-related mortality with the development of frequent liver metastases. Surgical resection of CRC liver metastases is only suitable for a limited subset of patients, necessitating alternative nonsurgical treatments such as electrochemotherapy (ECT); Methods: This review adhered to the S.P.I.D.E.R. framework. Systematic searches of PubMed, Cochrane, and Scopus databases were conducted for studies published between 2003 and 2023, following PRISMA guidelines. Inclusion criteria were full-text clinical studies in English focusing on ECT-treated CRC liver metastases, excluding reviews, editorials, and non-clinical papers. The GRADE approach was utilized to assess evidence quality, considering study limitations, consistency, and other factors; Results: From 38 identified articles, 4 met the inclusion criteria, encompassing 78 patients and 128 treated lesions. The studies demonstrated variability in design and follow-up duration (3\u201311 months). Complete response (CR) rates ranged from 33.3% to 63.0%, while progression disease (PD) rates were high, ranging from 23.0% to 55.6%. Median overall survival (OS) spanned 11.3 to 29.0 months. No severe ECT-related complications were reported. Conclusions: ECT appears to be a safe and effective modality for the treatment of CRC liver metastases, especially for lesions unsuitable for other ablative techniques. Further prospective and randomized studies are essential to better define the role of ECT in managing CRC liver metastases and to compare its efficacy with other ablative methods.<\/jats:p>","DOI":"10.3390\/curroncol31110546","type":"journal-article","created":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T06:57:54Z","timestamp":1732172274000},"page":"7403-7413","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Electrochemotherapy in the Locoregional Treatment of Metastatic Colorectal Liver Metastases: A Systematic Review"],"prefix":"10.3390","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7568-7180","authenticated-orcid":false,"given":"Pierluigi","family":"Barbieri","sequence":"first","affiliation":[{"name":"Department of Diagnostic Imaging and Oncologic Radiotherapy\u2014Emergency and Interventional Radiology Unit, Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d\u2014IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9617-3413","authenticated-orcid":false,"given":"Alessandro","family":"Posa","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Oncologic Radiotherapy\u2014Emergency and Interventional Radiology Unit, Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d\u2014IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3507-7051","authenticated-orcid":false,"given":"Valentina","family":"Lancellotta","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Oncological Radiotherapy\u2014Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d\u2014IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Madoff","sequence":"additional","affiliation":[{"name":"Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3201-3198","authenticated-orcid":false,"given":"Alessandro","family":"Maresca","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Oncologic Radiotherapy\u2014Emergency and Interventional Radiology Unit, Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d\u2014IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5573-6352","authenticated-orcid":false,"given":"Patrizia","family":"Cornacchione","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Oncological Radiotherapy\u2014Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d\u2014IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2308-0982","authenticated-orcid":false,"given":"Luca","family":"Tagliaferri","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Oncological Radiotherapy\u2014Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d\u2014IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2791-481X","authenticated-orcid":false,"given":"Roberto","family":"Iezzi","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Imaging and Oncologic Radiotherapy\u2014Emergency and Interventional Radiology Unit, Fondazione Policlinico Universitario \u201cAgostino Gemelli\u201d\u2014IRCCS, 00168 Rome, Italy"},{"name":"Facolt\u00e0 di Medicina e Chirurgia, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,20]]},"reference":[{"key":"ref_1","unstructured":"Global Burden of Disease Cancer Collaboration, Fitzmaurice, C., Allen, C., Barber, R.M., Barregard, L., Bhutta, Z.A., Brenner, H., Dicker, D.J., Chimed-Orchir, O., and Dandona, R. (2017). Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A systematic analysis for the global burden of disease study. JAMA Oncol., 3, 524\u2013548. Erratum in JAMA Oncol. 2017, 3, 418."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1002\/hep.29498","article-title":"Projections of primary liver cancer to 2030 in 30 countries worldwide","volume":"67","author":"Valery","year":"2017","journal-title":"Hepatology"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Engstrand, J., Nilsson, H., Str\u00f6mberg, C., Jonas, E., and Freedman, J. (2018). Colorectal cancer liver metastases\u2014a population-based study on incidence, management and survival. BMC Cancer, 18.","DOI":"10.1186\/s12885-017-3925-x"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1186\/1471-2407-14-810","article-title":"Treatment of colorectal liver metastases in Germany: A ten-year population-based analysis of 5772 cases of primary colorectal adenocarcinoma","volume":"14","author":"Hackl","year":"2014","journal-title":"BMC Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"49","DOI":"10.21037\/hbsn.2019.06.08","article-title":"Role of thermal ablation in the management of colorectal liver metastasis","volume":"9","author":"Takahashi","year":"2020","journal-title":"HepatoBiliary Surg. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/02656736.2016.1209694","article-title":"Microwave ablation in primary and secondary liver tumours: Technical and clinical approaches","volume":"33","author":"Meloni","year":"2016","journal-title":"Int. J. Hyperth."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e990","DOI":"10.1634\/theoncologist.2018-0337","article-title":"Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update","volume":"24","author":"Izzo","year":"2019","journal-title":"Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.2214\/AJR.16.17582","article-title":"Percutaneous Image-Guided Cryoablation of Hepatic Tumors: Single-Center Experience With Intermediate to Long-Term Outcomes","volume":"209","author":"Glazer","year":"2017","journal-title":"Am. J. Roentgenol."},{"key":"ref_9","first-page":"190","article-title":"Stereotactic body radiation therapy for liver metastases","volume":"5","author":"Scorsetti","year":"2014","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Walter, F., Rottler, M., Nierer, L., Landry, G., Well, J., Rogowski, P., Mohnike, K., Seidensticker, M., Ricke, J., and Belka, C. (2021). Interstitial High-Dose-Rate Brachytherapy of Liver Metastases in Oligometastatic Patients. Cancers, 13.","DOI":"10.3390\/cancers13246250"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1148\/radiol.2021203089","article-title":"Irreversible Electroporation to Treat Unresectable Colorectal Liver Metastases (COLDFIRE-2): A Phase II, Two-Center, Single-Arm Clinical Trial","volume":"299","author":"Meijerink","year":"2021","journal-title":"Radiology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1097\/01.sla.0000250419.36053.33","article-title":"Electrochemotherapy","volume":"245","author":"Larkin","year":"2007","journal-title":"Ann. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1093\/annonc\/mdw235","article-title":"ESMO consensus guidelines for the management of patients with metastatic colorectal cancer","volume":"27","author":"Cervantes","year":"2016","journal-title":"Ann. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"323","DOI":"10.2214\/ajr.174.2.1740323","article-title":"Thermal Ablation Therapy for Focal Malignancy","volume":"174","author":"Goldberg","year":"2000","journal-title":"Am. J. Roentgenol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Granata, V., Fusco, R., D\u2019alessio, V., Simonetti, I., Grassi, F., Silvestro, L., Palaia, R., Belli, A., Patrone, R., and Piccirillo, M. (2023). Percutanous Electrochemotherapy (ECT) in Primary and Secondary Liver Malignancies: A Systematic Review. Diagnostics, 13.","DOI":"10.3390\/diagnostics13020209"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1016\/S0190-9622(97)70178-6","article-title":"Intralesional bleomycin-mediated electrochemotherapy in 20 patients with basal cell carcinoma","volume":"37","author":"Glass","year":"1997","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ejcsup.2006.08.002","article-title":"Electrochemotherapy\u2014An easy, highly effective and safe treatment of cutaneous and subcutaneous metastases: Results of ESOPE (European Standard Operating Procedures of Electrochemotherapy) study","volume":"4","author":"Marty","year":"2006","journal-title":"Eur. J. Cancer Suppl."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.ejca.2020.06.020","article-title":"Electrochemotherapy in the treatment of cutaneous malignancy: Outcomes and subgroup analysis from the cumulative results from the pan-European International Network for Sharing Practice in Electrochemotherapy database for 2482 lesions in 987 patients (2008\u20132019)","volume":"138","author":"Clover","year":"2020","journal-title":"Eur. J. Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.ejca.2017.10.008","article-title":"European Research on Electrochemotherapy in Head and Neck Cancer (EURECA) project: Results from the treatment of mucosal cancers","volume":"87","author":"Plaschke","year":"2017","journal-title":"Eur. J. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.ejca.2016.05.001","article-title":"European Research on Electrochemotherapy in Head and Neck Cancer (EURECA) project: Results of the treatment of skin cancer","volume":"63","author":"Bertino","year":"2016","journal-title":"Eur. J. Cancer"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.diii.2019.01.001","article-title":"Multimodal image-guided electrochemotherapy of unresectable liver metastasis from renal cell cancer","volume":"100","author":"Cornelis","year":"2019","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1186\/1475-925X-14-S3-S5","article-title":"Electrochemotherapy of colorectal liver metastases\u2014an observational study of its effects on the electrocardiogram","volume":"14","author":"Mali","year":"2015","journal-title":"Biomed. Eng. Online"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s12938-020-00827-7","article-title":"Investigation of safety for electrochemotherapy and irreversible electroporation ablation therapies in patients with cardiac pacemakers","volume":"19","author":"Jarm","year":"2020","journal-title":"Biomed. Eng. Online"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Iezzi, R., Posa, A., Caputo, C.T., De Leoni, D., Sbaraglia, F., Rossi, M., Tortora, G., Tagliaferri, L., Valentini, V., and Colosimo, C. (2023). Safety and Feasibility of Analgosedation for Electrochemotherapy of Liver Lesions. Life, 13.","DOI":"10.3390\/life13030631"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1177\/1049732312452938","article-title":"Beyond PICO","volume":"22","author":"Cooke","year":"2012","journal-title":"Qual. Heal. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.ejca.2008.10.026","article-title":"New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1)","volume":"45","author":"Eisenhauer","year":"2009","journal-title":"Eur. J. Cancer"},{"key":"ref_27","first-page":"90","article-title":"CTCAE versi\u00f3n 5.0. Evaluaci\u00f3n de la gravedad de los eventos adversos dermatol\u00f3gicos de las terapias antineopl\u00e1sicas","volume":"112","author":"Santana","year":"2020","journal-title":"Actas Dermo-Sifiliogr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_29","first-page":"i2016","article-title":"GRADE Evidence to Decision (EtD) frameworks: A systematic and transparent approach to making well informed healthcare choices. 1: Introduction","volume":"353","author":"Moberg","year":"2016","journal-title":"BMJ"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1002\/jso.23625","article-title":"Intraoperative electrochemotherapy of colorectal liver metastases","volume":"110","author":"Edhemovic","year":"2014","journal-title":"J. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1016\/j.ejso.2020.04.037","article-title":"Intraoperative electrochemotherapy of colorectal liver metastases: A prospective phase II study","volume":"46","author":"Edhemovic","year":"2020","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ijsu.2017.06.033","article-title":"Safety and feasibility of electrochemotherapy in patients with unresectable colorectal liver metastases: A pilot study","volume":"44","author":"Coletti","year":"2017","journal-title":"Int. J. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"102","DOI":"10.2478\/raon-2022-0003","article-title":"Percutaneous electrochemotherapy in primary and secondary liver malignancies\u2014local tumor control and impact on overall survival","volume":"56","author":"Spallek","year":"2022","journal-title":"Radiol. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s12913-020-4930-3","article-title":"The impact of tumor board on cancer care: Evidence from an umbrella review","volume":"20","author":"Specchia","year":"2020","journal-title":"BMC Heal. Serv. Res."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/31\/11\/546\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:36:06Z","timestamp":1760114166000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/31\/11\/546"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,20]]},"references-count":34,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["curroncol31110546"],"URL":"https:\/\/doi.org\/10.3390\/curroncol31110546","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,20]]}}}