Resectable colorectal liver metastases ≤3 cm (up to 10 CRLM, no extrahepatic disease) — Amsterdam UMC (VUmc) / Dutch Colorectal Cancer Group; funded by Medtronic-Covidien Investigator-Sponsored Research grant
Resectable colorectal liver metastases ≤3 cm (up to 10 CRLM, no extrahepatic disease)ASCO 2024 LBA3501 / Lancet Oncology 2025
[Slide 1]
SUMMARY
LLISION
Colorectol Liver Metostoses:
surgery vs thermal oblation
COLLISION stopped at halftime based on predefined stopping rules for
Showing benefit of the experimental arm (ablation) over standard-of-care (resection)
For patients with small-size colorectal liver metastases, thermal ablation compared to
standard-of-care surgical resection
Substantially reduced morbidity and mortality
treatment related mortality 2.1% (resection)
0.0% (ablation)
all-cause 90-day mortality 2.1% (resection)
0.7% (ablation)
AEs rate 56% (resection)
19% (ablation) and SAE rate 20% (resection)
7% (ablation)
Was at least as good as surgical resection in locally controlling CRLM
no difference in per-patient local control: HR 0.131 (95% CI 0.016-1.064; p = 0.057)
superior per-tumor local control: HR 0.092 (95% CI 0.011-0.735; p = 0.024)
Showed no difference in local & distant tumor progression-free survival
Did not compromise overall survival (OS)
2024
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---
[Slide 2]
RESULTS
LLISION
Colorectal Liver Metastoses
surgery vs thermal oblation
OVERALL SURVIVAL - - PRIMARY ENDPOINT
Overall survival (OS)
1.0
Conditional probability
to eventually prove non-
inferiority 91%!
0.8
Survival probability
0.6
0.4
HR 1.051 (95% CI 0.695-1.590; p = 0.813)
0.2
Resection
Ablation
0.0
0
12
24
36
48
60
72
Months from randomization
Number at risk (number of events)
Resection
Strata
148(0)
124 (10)
84 (26)
54 (35)
37 (42)
15 (43)
3(43)
Ablation
148 (0)
124 (10)
89 (27)
61 (37)
36 (42)
15 (47)
5(47)
0
12
24
36
48
60
72
Months from randomization
2024 ASCO
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[Slide 3]
RESULTS
Calilia
LLISION
Colorectol Liver Metostoses
surgery vs thermal obtation
SANKEY FLOWCHART
No resection plane recurrence
122
Resection. locally controlled
131
Resection
148
Resection plane recurrence resected
1
Resection plane recurrence
Resection plane recurrence ablated
21
6
Competing risk (R)
6
Subjects randomized
296
Not resected > PD
Crossover to ablation
No re-resection or ablation
Loss of local control (R)
5
1
15
7
Ablation
148
No ablation site recurrence
127
Ablation, locally controlled
140
Ablation site recurrence resected
3
Ablation site recurrence
Competing risk (A)
Ablation site recurrence ablated
4
18
13
Not ablated -> PD
3
No re-ablation or resection
Loss of local control (A)
2
1
Made at SankeyMATIC com
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[Slide 4]
LISION
Coloractol Liver Metostoses
surgery is thermal oblation
Patients with Resectable Colorectal Liver
Metastases (CRLM)
Limited
burden
ArmA:
No extrahepatic mets
Total number of CRLM â 10
Expert
≥1 resectable & ablatable CRLM â 3cm
panel
Interm.
burden
Additional ablations for unresectable
CRLM allowed
IOUS
M O O D A T N A N Z R I I
Resection
Additional resection(s) >3cm allowed
Arm B:
W O O U P F L L
DEATH
Ablation
High
burden
n = 599
Phase III international multicenter randomized controlled trial to prove / disprove hypothesis of non-inferiority of thermal ablation
compared to surgical resection for small-size colorectal liver metastases (CRLM)
Approach (percutaneous, laparoscopic or open) according to local expertise
If limited disease burden (max 3 CRLM s 3cm) consider percutaneous / laparoscopic approach
If intermediate or high disease burden randomize after eligibility check (after IOUS) during OR (single-blind)
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[Slide 1]
SUMMARY
C
LLISION
Colorectol Liver Metestoses
surgery vs thermal oblation
COLLISION stopped at halftime based on predefined stopping rules for
Showing benefit of the experimental arm (ablation) over standard-of-care (resection)
For patients with small-size colorectal liver metastases, thermal ablation compared to
standard-of-care surgical resection
Substantially reduced morbidity and mortality
treatment related mortality 2.1% (resection) 0.0% (ablation)
all-cause 90-day mortality 2.1% (resection) - 0.7% (ablation)
AEs rate 56% (resection) -> 19% (ablation) and SAE rate 20% (resection) 7% (ablation)
Was at least as good as surgical resection in locally controlling CRLM
no difference in per-patient local control: HR 0.131 (95% CI 0.016-1.064; p = 0.057)
superior per-tumor local control: HR 0.092 (95% CI 0.011-0.735; p = 0.024)
Showed no difference in local & distant tumor progression-free survival
Did not compromise overall survival (OS)
2024 ASCO
PRESENTED BY:
#ASCO24
ASCO
AMERICAN SOCIETY OF
CLINICAL ONCOLOGY
ANNUAL MEETING
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KNOWLEDGE CONQUERS CANCER
---
[Slide 2]
C
LLISION
Colorectol Liver Metostoses
surgery is thermol oblation
R
Patients with Resectable Colorectal Liver
Limited
burden
A
Metastases (CRLM)
N
Arm A:
D
Resection
No extrahepatic mets
O
Total number of CRLM ≤ 10
Expert
M
≥1 resectable & ablatable CRLM S 3cm
panel
Interm.
burden
I
Additional resection(s) >3cm allowed
Additional ablations for unresectable
IOUS
A
W O O U P L L F
DEATH
Z
Arm B:
CRLM allowed
T
Ablation
High
burden
I
O
n = 599
N
Phase III international multicenter randomized controlled trial to prove / disprove hypothesis of non-inferiority of thermal ablation
compared to surgical resection for small-size colorectal liver metastases (CRLM)
Approach (percutaneous, laparoscopic or open) according to local expertise
If limited disease burden (max 3 CRLM < 3cm) consider percutaneous / laparoscopic approach
If intermediate or high disease burden randomize after eligibility check (after IOUS) during OR (single-blind)
2024 ASCO
#ASCO24
ASCO
AMERICAN SOCIETY OF
PRESENTED BY:
CLINICAL ONCOLOGY
ANNUAL MEETING
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KNOWLEDGE CONQUERS CANCER
---
[Slide 3]
RESULTS
C
LLISION
Colorectal Liver Metastoses:
surgery is thermal oblation
DISTANT PROGRESSION-FREE SURVIVAL
Distant progression-free survival (DPFS)
1.0
0.8
Survival probability
0.6
HR 1.030 (95% CI 0.776-1.368; p = 0.836)
0.4
0.2
Resection
Ablation
0.0
0
12
24
36
48
60
72
Months from randomization
Number at risk (number of events)
section
148(0)
51 (81)
34(88)
21 (90)
14 (91)
5(93)
1 (93)
Ablation
148 (0)
57 (74)
32(91)
15(98)
9(99)
4 (99)
2(99)
0
12
24
36
48
60
72
Months from randomization
2024 ASCO
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AMERICAN SOCIETY OF
PRESENTED BY:
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ANNUAL MEETING
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---
[Slide 4]
RESULTS
LLISION
Colorectol Liver Metostoses
surgery vs thermal obtation
LOCAL CONTROL (TARGET CRLMs) INCLUDING REPEAT TREATMENTS'
Local tumor control (LC)
1.0
0.8
Survival probability
0.6
0.4
Resection (per patient)
Ablation (per patient)
HR 0.131 (95% CI 0.016-1.064; p = 0.057)
0.2
Resection (per tumor)
HR 0.092 (95% CI 0.011-0.735; p = 0.024)
Ablation (per tumor)
0.0
0
12
24
36
48
60
72
Months from randomization
Number at risk (number of events)
Resection (per patient)
148 (0)
109(5)
74 (5)
47 (7)
31 (7)
13(7)
3(7)
E
Ablation (per patient)
148(0)
121(0)
83 (1)
56(1)
33 (1)
14(1)
5(1)
Resection (per tumor)
304(0)
220(6)
125(6)
70(8)
45(8)
16(8)
5(8)
Ablation (per tumor)
349(0)
295(0)
208(1)
129(1)
74(1)
40(1)
16(1)
0
12
24
36
48
60
72
Months from randomization
2024 ASCO
#ASCO24
PRESENTED BY:
ASCO
AMERICAN SOCIETY OF
CLINICAL ONCOLOGY
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Presentation is property of the author and ASCO Permission required for reuse contact permissions@asco.org
KNOWLEDGE CONQUERS CANCER
---
[Slide 5]
SUMMARY
C
LLISION
Colorectal Liver Metostoses
surgery is thermal obtation
COLLISION stopped at halftime based on predefined stopping rules for
Showing benefit of the experimental arm (ablation) over standard-of-care (resection)
For patients with small-size colorectal liver metastases, thermal ablation compared to
standard-of-care surgical resection
Substantially reduced morbidity and mortality
treatment related mortality 2.1% (resection)
0.0% (ablation)
all-cause 90-day mortality 2.1% (resection)
0.7% (ablation)
AEs rate 56% (resection) 19% (ablation) and SAE rate 20% (resection) 7% (ablation)
Was at least as good as surgical resection in locally controlling CRLM
no difference in per-patient local control: HR 0.131 (95% CI 0.016-1.064; p = 0.057)
superior per-tumor local control: HR 0.092 (95% CI 0.011-0.735; p = 0.024)
Showed no difference in local & distant tumor progression-free survival
Did not compromise overall survival (OS)
2024 ASCO
#ASCO24
ASCO
AMERICAN SOCIETY OF
PRESENTED BY:
CLINICAL ONCOLOGY
ANNUAL MEETING
Presentation is property of the author and ASCO Permission required for reuse: contact permissions@asco.org
KNOWLEDGE CONQUERS CANCER
[Slide 1]
C
LLISION
Coloraction Materials
R
Patients with Resectable Colorectal Liver
Limited
burden
A
Metastases (CRLM)
N
ArmA:
D
Resection
No extrahepatic mets
O
Total number of CRLM < 10
Expert
M
>1 resectable & ablatable CRLM ≤ 3cm
panel
Interm.
burden
I
Additional resection(s) >3cm allowed
Additional ablations for unresectable
IOUS
A
ArmB:
FOLLOW W UP O O L L F
DEATH
Z
CRLM allowed
T
Ablation
High
burden
I
O
n 599
N
Phase III international multicenter randomized controlled trial to prove / disprove hypothesis of non-inferiority of thermal ablation
compared to surgical resection for small-size colorectal liver metastases (CRLM)
Approach (percutaneous, laparoscopic or open) according no-local expertise
' limited disease burden (max 3 CRLM $ 3cm) consider percutaneous laparoscopic approach
If intermediate or high disease burden randomize after eligibility check (after IOUS) during OR (single-blind)
2024 ASCO
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PRESENTED BY or
ASCO
-
- -
ANNUAL MEETING
- - - - - 4000 Permission - -
KNOWLEDGE CONQUERS CANCER
2024 ASC
ANNUAL MEETIN
---
[Slide 2]
RESULTS
C
LLISION
Coloracter
OVERALL SURVIVAL - PRIMARY ENDPOINT
Overall survival (OS)
1.0
Conditional probability
to eventually prove non-
inferiority 91%!
0.8
Survival probability
0.6
0.4
HR 1.051 (95% CI 0.695-1.590; P = 0.813)
0.2
Resection
Ablation
0.0
0
12
24
36
48
50
72
Months from randomization
Number at risk (number of events)
Strata
Resection
148(0)
124(10)
84(26)
54(35)
37(42)
15(43)
3(43)
Ablation
148(0)
124(10)
09(27)
61(37)
36(42)
15(47)
5(47)
0
12
24
36
48
50
72
Months from randomization
2024 ASCO
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ASCO
AMERICAN SOCIETY OF
CUNICAL ONCOLOGY
ANNUAL MEETING
property
of the
author
and
ASCO
Permission
required tor
-
KNOWLEDGE CONQUERS CANCER
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[Slide 3]
RESULTS
C:
LLISION
Coloractor
- -
DISTANT PROGRESSION-FREE SURVIVAL
Distant progression-free survival (DPFS)
1.0
0.8
Survival probability
0.6
HR 1.030 (95% CI 0.776-1.368; p I 0.836)
0.4
0.2
Resection
Ablation
0.0
0
12
24
36
48
50
72
Months from randomization
Number at risk (number of events)
section
148(0)
51 (81)
34(88)
21(90)
14(91)
5(93)
1(93)
Ablation
148(0)
57 (74)
32(91)
15(96)
9(99)
4(99)
2(99)
0
12
24
36
48
50
72
Months from randomization
2024 ASCO
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ASCO
AMERICAN SOCIETY OF
- INCOLOGY
ANNUAL MEETING
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[Slide 4]
RESULTS
C
LLISION
Coloractor Liver
ADVERSE EVENTS (CTCAE v5.0)
Resection
Ablation
Crede #
credit
-
1/7
12%
Grade L/2
No complication
IN
p 0.001
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COLLISION is the first Phase 3 non-inferiority RCT directly comparing thermal ablation vs. surgical resection in resectable small CRLM. Ablation was NON-INFERIOR on OS while offering lower procedural mortality (0% vs. 2.1%), lower AE burden, shorter hospital stay, and — unexpectedly — BETTER local control (HR 0.184). Stopped early at halftime for meeting stopping rules. Challenges the long-held assumption that resection is the default for small CRLM when both modalities are feasible. COLLISION XL (3-5cm CRLM, thermal ablation vs. SBRT) and COLLISION RELAPSE are ongoing.
Median: not reached (thermal ablation (RFA/MWA)) vs. not reached (surgical resection). HR 1.042 (95% CI 0.689-1.576), P=0.846 Phase 3 non-inferiority trial enrolled 341 patients (299 randomized: 147 ablation, 148 resection; 4 excluded post-randomization). At median follow-up 28.8 months, no OS difference: HR 1.042 (95% CI 0.689-1.576, P=0.846) — conditional probability >90% to prove non-inferiority. Trial stopped early (halftime) for meeting predefined halting criteria / early benefit. Published Lancet Oncology 2025;26(2):187-199.
✓ Non-inferior OS (HR 1.042); better safety + local control with ablation
HR 1.042 (95% CI 0.689-1.576), P=0.846 Primary OS met non-inferiority (see above). Local control FAVORED thermal ablation: HR 0.184 (95% CI 0.040-0.838, P=0.029). No differences in local PFS (HR 0.833, P=0.528) or distant PFS (HR 0.982, P=0.898). Practice-changing finding: local control comparable/better with ablation.
Strong safety and logistics advantage for thermal ablation: Procedure-related mortality 0% (0/147 ablation) vs. 2.1% (3/148 resection). Serious adverse events 7.4% vs. 19.9%. Total AEs significantly favored ablation (P<0.001). Hospital stay: median 1 day (range 1-44) ablation vs. 4 days (1-36) surgery, P<0.001. Bleeding requiring intervention: 1% vs. 5.5%. Infections requiring treatment: 4% vs. 7.5%.
✓ 0% vs. 2.1% procedure mortality; 1-day vs. 4-day hospital stay
✅ Practice-changing: thermal ablation is non-inferior to surgery for CRLM ≤3 cm with better safety, shorter stay, and improved local control. COLLISION is the first Phase 3 non-inferiority RCT directly comparing thermal ablation vs. surgical resection in resectable small CRLM. Ablation was NON-INFERIOR on OS while offering lower procedural mortality (0% vs. 2.1%), lower AE burden, shorter hospital stay, and — unexpectedly — BETTER local control (HR 0.184). Stopped early at halftime for meeting stopping rules. Challenges the long-held assumption that resection is the default for small CRLM when both modalities are feasible. COLLISION XL (3-5cm CRLM, thermal ablation vs. SBRT) and COLLISION RELAPSE are ongoing.
