Review of Intra-Arterial Therapies for Colorectal Cancer Liver Metastasis

Abstract

The liver is frequently the most common site of metastasis in patients with colorectal cancer, occurring in more than 50% of patients. While surgical resection remains the only potential curative option, it is only eligible in 15–20% of patients at presentation. In the past two decades, major advances in modern chemotherapy and personalized biological agents have improved overall survival in patients with unresectable liver metastasis. For patients with dominant liver metastatic disease or limited extrahepatic disease, liver-directed intra-arterial therapies such as hepatic arterial chemotherapy infusion, chemoembolization and radioembolization are treatment strategies which are increasingly being considered to improve local tumor response and to reduce systemic side effects. Currently, these therapies are mostly used in the salvage setting in patients with chemo-refractory disease. However, their use in the first-line setting in conjunction with systemic chemotherapy as well as to a lesser degree, in a neoadjuvant setting, for downstaging to resection have also been investigated. Furthermore, some clinicians have considered these therapies as a temporizing tool for local disease control in patients undergoing a chemotherapy ‘holiday’ or acting as a bridge in patients between different lines of systemic treatment. This review aims to provide an update on the current evidence regarding liver-directed intra-arterial treatment strategies and to discuss potential trends for the future.

Management of Patients with Synchronous Liver Colorectal Cancer Metastasis

“…In addition, there is an experience of using intra-arterial chemotherapy in conjunction with systemic chemotherapy and as a neoadjuvant treatment. 65 According to the NCCN and ESMO recommendations, intra-arterial chemotherapy plays a role in the treatment of chemoresistant patients with predominant liver damage. 66,67 The blood supply of hepatic metastases mainly from the hepatic artery against the background of the peculiarities to the liver (portal vein: 70%, hepatic artery: 30%) makes intra-arterial chemotherapy an attractive treatment method that minimizes systemic and hepatic toxicity.…”

“…68 Fluorodeoxyuridine, oxaliplatin, and irinotecan are used among chemotherapy drugs for intra-arterial administration. 65 Before starting therapy, CT angiography is performed to determine the arterial blood supply to the liver. Sometimes ligation or embolization of the gastroduodenal artery and the right gastric artery is required to avoid toxic damage to the distal stomach and duodenum.…”

“…Mitomycin and cisplatin in combination with lipiodol are used for TACE. 65 By vascular access through the common femoral or radial artery, a catheter is passed through the abdominal trunk into the common hepatic artery. It is mandatory to conduct the next stage of angiography to determine the anatomy of the hepatic artery and identify the arteries whose embolization should be avoided (right gastric, gastroduodenal).…”

“…68 Fluorodeoxyuridine, oxaliplatin, and irinotecan are used among chemotherapy drugs for intra-arterial administration. 65…”

Prognostic Factors for Effectiveness Outcomes After Transarterial Radioembolization in Metastatic Colorectal Cancer: Results From the Multicentre Observational Study CIRT

“…Most of the data supporting the use of TARE has been published for hepatocellular carcinoma (HCC) patients and the procedure has been included in the standard "tool-box" of unresectable HCC (9)(10)(11). In mCRC, the current clinical landscape in systemic treatments, locoregional approaches and surgery remains complex and further evidence on how to implement TARE is warranted (12).…”