The role of interventional oncology in the treatment of colorectal cancer liver metastases

Abstract

Colorectal cancer is a leading cause of death both in Europe and worldwide. Unfortunately, 20-25% of patients with colorectal cancer already have metastases at the time of diagnosis, while 50-60% of the remainder will develop metastases later during the course of the disease. Although hepatic excision is the first-line treatment for patients with liver-limited colorectal metastases and is reported to prolong the survival of these patients, few patients are candidates. Locoregional therapy encompasses minimally invasive techniques practiced by interventional radiology. Most widely used locoregional therapies include ablative treatments (radiofrequency ablation, microwave ablation) and transcatheter intra-arterial therapies (transarterial chemoembolization, and radioembolization with yttrium-90).

Keywords: Colorectal cancer; intra-arterial therapies; thermal ablation; treatment.

Figure 1

Patient with a small metastatic lesion from colorectal cancer, measuring 1 cm in maximum diameter, treated with microwave ablation under computed tomographic (CT) guidance. (A) CT scan in arterial phase depicting a hypodense hypovascular lesion in segment VI (red arrow) (B) CT scan in portal venous phase depicting a hypodense lesion with rim enhancement in segment VI (red arrow). (C, D) CT scan during the procedure, note the tip of the microwave antenna within the lesion (red arrow). CT scan immediately post-ablation during arterial (E) and venous (F) phase, depicting the necrotic zone of ablation; note the presence of a peripheral rim of enhancement representing a hypervascular rim of inflammation immediate post ablation (red arrows)

Figure 2

Patient with oligometastatic disease from colorectal cancer treated with liver chemoembolization after failed second line chemotherapy. (A, B) Magnetic resonance (MRI) images after i.v. gadolinium administration depicting 3 hypervascular hepatic lesions in the right lobe (red arrows). (C) Selective hepatic angiogram, depicting the hypervascular lesions in the right liver lobe (red circles). (D) Final selective hepatic angiography after chemoembolization with drug-eluting beads and chemotherapy solution, revealing absence of the pathologic tumor blush (red circles). (E, F) MRI images after i.v. gadolinium administration 1 month after chemoembolization, depicting central necrosis of the lesions with residual minimal peripheral enhancement representing response to the treatment (red arrows)