Treatments for colorectal liver metastases: A new focus on a familiar concept

Zampino, Maria Giulia; Magni, Elena; Ravenda, Paola Simona; Cella, Chiara Alessandra; Bonomo, Guido; Vigna, Paolo Della; Galdy, Salvatore; Spada, Francesca; Varano, Gianluca Maria; Mauri, Giovanni; Fazio, Nicola; Orsi, Franco

doi:10.1016/j.critrevonc.2016.11.005

Cited by 33 publications

(24 citation statements)

References 80 publications

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“…Colorectal cancer (CRC) is the fourth most common cancer in the UK. Liver metastases are common among patients with CRC; resection of the primary and metastatic tumours is favoured where possible, but the majority (70-80%) of patients are unsuitable for liver surgery [1]. Systemic chemotherapy is the standard treatment for unresectable metastatic disease, which may be combined with biological agents such as EGFR (epidermal growth factor receptor) inhibitors (cetuximab or panitumumab) or VEGF (vascular endothelial growth factor) inhibitors (bevacizumab).…”

Section: Introductionmentioning

confidence: 99%

Analysis of a National Programme for Selective Internal Radiation Therapy for Colorectal Cancer Liver Metastases

et al. 2019

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Patients with chemotherapy-refractory colorectal cancer liver metastases have limited therapeutic options. Selective internal radiation therapy (SIRT) delivers yttrium-90 microspheres as a minimally invasive procedure. This prospective, single arm, observational, service evaluation study was part of NHS England Commissioning through Evaluation. Patients eligible for treatment had histologically confirmed carcinoma with liver-only/liver-dominant metastases with clinical progression during or following oxaliplatin-based and irinotecan-based chemotherapy. All patients received SIRT plus standard of care. Primary outcome was overall survival; secondary outcomes included safety, progression-free survival (PFS) and liver-specific PFS (LPFS). Between December 2013 and March 2017, 399 patients were treated in 10 centres with median follow-up 14.3 months (95% CIs 9.2-19.4). Median overall survival was 7.6 months (95% CIs 6.9-8.3). Median PFS and LSPFS were 3.0 months (95% CIs 2.8-3.1) and 3.7 months (95% CIs 3.2-4.3), respectively. During the follow-up period, 143 patients experienced an adverse event and 8% of the events were grade =3. Survival estimates from this pragmatic study demonstrate clinical outcomes attainable in the NHS comparable to previously published data. This study demonstrates the value of a registry-based commissioning model to aid national commissioning decisions for highly specialist cancer treatments.

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Section: Introductionmentioning

confidence: 99%

Analysis of a National Programme for Selective Internal Radiation Therapy for Colorectal Cancer Liver Metastases

et al. 2019

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“…However, up to now, the most effective ablative technique and application methods have not been definitively established and still depend on institutional and local preferences along with operator expertise. 21 Patient selection generally occurs during dedicated multidisciplinary meetings involving surgeons, hepatologists, radiation therapists, oncologists, and radiologists. Preliminarily, patient's clinical history, performance status, and laboratory tests (blood count, serum creatinine, platelets, prothrombin time) must be taken into account to assess if they meet the requirements for percutaneous interventions.…”

Section: Indications Of Image-guided Thermal Ablation In Crlmsmentioning

confidence: 99%

Thermal Ablations for Colorectal Liver Metastases

et al. 2019

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Approximately 25% of colorectal cancers patients will develop hepatic metastases in the course of their disease. Surgical resection of hepatic metastases remains the first treatment choice for these patients, when feasible. However, only approximately 30% of metastatic lesions are resectable at the time of diagnosis. Thermal ablations have played an increasing role over the last few decades in the palliative and curative setting of colorectal liver metastases (CRLMs) in nonsurgical candidates with a liver-predominant disease. Several different techniques have been used to perform image-guided thermal ablations in the liver, including radiofrequency ablation, microwave ablation, cryoablation, and laser thermal ablation. We review the current ablation techniques, image-guidance modalities, indications, and debated topics of image-guided thermal ablation in CRLMs. Moreover, recent results from clinical trials are discussed along with future trends in liver thermal ablations.

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“…Multiple agents have been tested to be infused via hepatic artery, although Floxuridine (FUDR) is the most widely used drug, thanks to its short half-life and high first-pass metabolism rate which allow the intrametastatic drug concentrations to be increased without significant systemic side effects [88]. On that basis, HAI has been investigated as a treatment for heavily treated metastatic colorectal cancer with liver metastases, as well as in the perioperative liver resection setting [90,91]. In the following paragraphs, we will review the evidence for HAI in these different categories.…”

Section: Hepatic Artery Infusion Chemotherapymentioning

confidence: 99%

Local Treatment Options for Unresectable Liver Metastases in Colorectal Cancer

McGregor¹,

Rico²,

Townsend³

et al. 2018

Cancer Management and Therapy

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Despite the increase in effectiveness of systemic therapy, cure for colorectal cancer with liver metastases (CRLM) is rarely achieved without surgical resection, with less than 20% of patients initially suitable for surgery. Liver-directed therapies are continually being investigated in the hope of improving cure rates in patients with unresectable liver metastases. These modalities include selective internal radiation therapy (SIRT), radiofrequency ablation (RFA), transarterial chemoembolization (TACE) and hepatic artery infusion (HAI) chemotherapy. While there is evidence of activity for all these treatments, they are somewhat lacking in high level randomized, controlled trial evidence (RCT) with appropriate control arms relevant to current standard of care. This review examines the efficacy and safety of these treatments in unresectable CRLM.

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Treatments for colorectal liver metastases: A new focus on a familiar concept

Cited by 33 publications

References 80 publications

Analysis of a National Programme for Selective Internal Radiation Therapy for Colorectal Cancer Liver Metastases

Analysis of a National Programme for Selective Internal Radiation Therapy for Colorectal Cancer Liver Metastases

Thermal Ablations for Colorectal Liver Metastases

Local Treatment Options for Unresectable Liver Metastases in Colorectal Cancer

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