Microwave ablation versus stereotactic body radiotherapy for oligometastatic colorectal liver metastases (LAVA-CRLM): a prospective, randomised, phase II trial
In brief
Stereotactic radiation caused moderate toxicity in 3%, versus 25% with ablation
In this two-center randomized phase II trial, 1-year freedom from local progression was similar with stereotactic body radiotherapy and microwave ablation (83% vs 78%), while moderate or worse treatment-related toxicity affected 3% and 25%, respectively. Severe toxicity occurred only after ablation, including one treatment-related death; the small trial did not establish equivalent tumor control.
- Journal
- The Lancet regional health. Europe (Q1)
- Published
- 1 December 2026
- Study design
- Phase 2 randomized trial (exploratory)
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Risumlund SL, Stick LB, Appelt A, Vogelius IR, Nyhuus B, Schultz NA, et al.
- PMID
- 42829779
- DOI
- 10.1016/j.lanepe.2026.101879
Why clinicians should know about it
- Picked for Radiation Oncology (paper of the day, 5 October 2026): Phase II RCT comparing MWA vs SBRT for liver mets
Abstract
BACKGROUND: Local therapies can achieve durable disease control in selected patients with oligometastatic colorectal liver metastases. Microwave ablation (MWA) is widely used, whereas stereotactic body radiotherapy (SBRT) is a non-invasive alternative with limited prospective comparative evidence. We aimed to compare freedom from local progression and safety of MWA versus SBRT. METHODS: LAVA-CRLM was a randomised, phase II trial conducted at two centres in Copenhagen, Denmark. Adults with one to three colorectal liver metastases, each ≤4.0 cm, deemed suitable for both MWA and SBRT with curative intent by a multidisciplinary team were randomly assigned (1:1) to MWA or SBRT. The primary endpoint was freedom from local progression in the modified intention-to-treat population. Toxicity was assessed in the safety population. The trial is registered with ClinicalTrials.gov (NCT03654131). FINDINGS: Between Jan 29, 2019, and Dec 3, 2024, 100 patients were randomly assigned; 92 were included in the modified intention-to-treat population. At a median follow-up of 34.9 months, 1-year freedom from local progression was 77.7% (95% CI 66.5-90.9) with MWA and 83.0% (72.3-95.4) with SBRT (hazard ratio 0.87, 95% CI 0.43-1.74; p = 0.70). Grade 2 or higher treatment-related toxicity occurred in 13 (25%) of 52 patients treated with MWA and one (3%) of 40 treated with SBRT. Grade 3 or higher toxicity occurred only with MWA (four [8%] patients), including one treatment-related death. INTERPRETATION: SBRT demonstrated a more favourable treatment-related safety profile, with no difference in freedom from local progression detected between SBRT and MWA in this phase II study. These findings support consideration of SBRT as a non-invasive local treatment option for selected patients with oligometastatic colorectal liver metastases. FUNDING: Danish Cancer Society.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.