Locoregional Therapies for Colorectal Cancer Liver Metastases: Options Beyond Resection

Abstract

Colorectal cancer was the third most common malignancy worldwide in 2018, and most patients present with or develop distant metastases. Colorectal liver metastases are most commonly observed because of the vascular drainage of the colon and superior rectum. Current guidelines recommend surgical resection as first-line treatment; however, 80% to 90% of patients with colorectal liver metastases are ineligible for primary resection. For patients with unresectable disease, a multidisciplinary treatment approach is favored, incorporating systemic therapy and a toolbox of local ablative therapies. These treatments either aim at cytoreduction to enable a conversion to surgical resectability or control of disease progression and spread. Each of these treatments carries unique outcomes and risk profiles, thereby contributing to an individualized treatment strategy for patients with colorectal liver metastases. This review summarizes evidence on hepatic artery infusion, stereotactic body radiation therapy, thermal ablation, transarterial chemoembolization with drug-eluding beads, and transarterial radioembolization for treatment of colorectal liver metastases. Results of large-scale prospective and retrospective studies and international guidelines are discussed to provide detailed background on the current and prospective use of local ablative techniques in management of colorectal liver metastases.

Radioembolization With Chemotherapy for Colorectal Liver Metastases: A Randomized, Open-Label, International, Multicenter, Phase III Trial

“…Nonsurgical locoregional approaches for colorectal liver metastases (CLM) may offer clinically meaningful benefit beyond systemic therapy alone. 2…”

“…An estimated 60% of patients diagnosed with colorectal cancer (CRC) eventually will demonstrate liver disease as a predominant site of spread. 1,2 Consequently, much of the morbidity and mortality in these patients results from unresectability and progression of liver metastases. Nonsurgical locoregional approaches for colorectal liver metastases (CLM) may offer clinically meaningful benefit beyond systemic therapy alone.…”

“…Nonsurgical locoregional approaches for colorectal liver metastases (CLM) may offer clinically meaningful benefit beyond systemic therapy alone. 2 Transarterial radioembolization with Yttrium-90 glass microspheres (TARE) is an arterially based microembolic radiotherapy that delivers micron-sized beta-emitting particles through the hepatic tumor-feeding arteries. 3 By administering radiotherapy using a selective internal approach, radiation delivery to the tumor is optimized and nontarget parenchymal exposure is minimized.…”

Simultaneous Approach of Colo-Rectal and Hepatic Lesions in Colo-Rectal Cancers With Liver Metastasis – A Single Oncological Center Overview

“…This objective regarding the control of liver metastases is not easy to achieve, if we consider that 80% to 90% of patients with colorectal liver metastases are ineligible for primary resection [43]. For these patients, a correct evaluation in the tumor board and the choice of the optimal sequence of multidisciplinary treatment, combining systemic therapy and ablative techniques, with a double aim: either obtaining the conversion to surgical respectability, or at least controlling the progression and spread of the cancer [43] is necessary. Another solution considered recently, for patients with colorectal cancer and unresectable liver metastases, is regional systemic therapy, delivering chemotherapy via the hepatic artery.…”

Current Surgical Management Strategies for Colorectal Cancer Liver Metastases

“…For select patients with resectable CRLM, however, a surgery-first approach may be advantageous [ 17 ], and we have recently seen the benefit of perioperative chemotherapy come into question [ 18 , 19 ]. Additionally, there are numerous locoregional therapies for which all patients with CRLM, including those with extrahepatic disease, should be considered [ 20 , 21 ].…”