Regional hepatic therapies: an important component in the management of colorectal cancer liver metastases

Abstract

The treatment of colorectal cancer liver metastases (CRLM) has evolved significantly in the last 15 years. Currently, complete surgical resection remains the only potentially curative option; unfortunately, approximately 80% of patients with CRLM are not candidates for complete tumor resection. For patients with unresectable CRLM the available treatment options were historically limited; however, the development of regional hepatic therapies (RHT) and improvement of systemic chemotherapeutic regimens have emerged as viable options to improve overall survival and quality of life for this group of patients. The selection, sequence and integration of interventions into a multi-modal approach is a complex and evolving discipline. In this article, the currently available RHT modalities for CRLM are presented as a guide to the options for clinical treatment decisions.

Keywords: Colorectal; liver metastases; tumor ablation.

Figure 1

Initial management of patients with CRLM. CRLM, colorectal liver metastasis; RHT, regional hepatic therapies; PVE, portal vein embolization; IOUS, intra-operative ultra sound; FLR, future liver remnant

Figure 2

Regional hepatic therapy types. RFA, radiofrequency ablation; MWA, microwave ablation; IRE, irreversible electroporation; SIRT, selective internal radiation therapy; TACE, trans-arterial chemo-embolization; DEBS, drug eluding beads; IMRT, intensity modulated radiation therapy; IGRT, image guided radiation therapy