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Table 2PICOTS (Population, Intervention, Comparator, Outcome, Timing, and Setting) for the Key Questions

PICOTSKQs 1 and 2KQs 3 and 4
PopulationPatients with unresectable liver metastases from primary CRC who are refractory to systemic chemotherapy but are candidates for local hepatic therapy.
  • Patients whose hepatic metastases are unresectable due to medical comorbidities, such as low hepatic reserve, cardiac insufficiency, or poor performance status
  • Patients whose hepatic metastases are unresectable because of certain characteristics of the metastases
  • Patients with no or minimal extrahepatic disease
Patients with unresectable liver metastases from primary CRC who receive systemic chemotherapy with local hepatic therapy.
  • Patients whose hepatic metastases are unresectable because of medical comorbidities, such as low hepatic reserve, cardiac insufficiency, or poor performance status
  • Patients whose hepatic metastases are unresectable because of certain characteristics of the metastases
  • Patients who have synchronous hepatic metastases
  • Patients whose hepatic metastases have recurred after resection
  • Patients with no extrahepatic disease
Intervention
  • Cryosurgical ablation
  • Radiofrequency ablation (RFA)
  • Microwave ablation (MWA)
  • Transarterial embolization (TAE)
  • Transarterial chemoembolization (TACE)
  • Hepatic arterial infusion (HAI)
  • Radioembolization or selective0internal radiation therapy (SIRT)
  • Drug-eluting beads (DEB)
  • External beam with 3D-CRT or IMRT
  • Stereotactic body radiation therapy (SBRT)
Same as KQs 1 and 2.
ComparatorAll the therapies listed above compared with the intervention in question for patients not eligible for systemic chemotherapy for CRCAll the therapies listed above compared with the intervention in question for patients receive systemic chemotherapy for CRC.
OutcomeKQ1:
Ultimate outcomes: Survival and quality of life
Intermediate outcomes: Time to progression, and local recurrence, length of stay

KQ2:
Adverse outcomes: biloma, hepatic abscess, hepatic hemorrhage, elevated alkaline phosphatase, elevated bilirubin, elevated transaminases, injury to adjacent organ(s), liver failure, rare adverse events, and steatohepatitis.
KQ3:
Ultimate outcomes: Same as KQs 1 and 2
Intermediate outcomes: Time to recurrence, and local recurrence, length of stay

KQ4:
Adverse outcomes: Same as KQs 1 and 2
TimingThe relevant periods occur at the time of treatment of CRC hepatic metastases through followup over months or years.Same as KQs 1 and 2.
SettingInpatient and outpatient.Same as KQs 1 and 2.

3D-CRT = three-dimensional conformal radiotherapy; CRC = colorectal cancer; IMRT = intensity-modulated radiation therapy; KQ = Key Question

From: Introduction

Cover of Local Hepatic Therapies for Metastases to the Liver From Unresectable Colorectal Cancer
Local Hepatic Therapies for Metastases to the Liver From Unresectable Colorectal Cancer [Internet].
Comparative Effectiveness Reviews, No. 93.
Belinson S, Chopra R, Yang Y, et al.

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