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Review
. 2025 May:136:102926.
doi: 10.1016/j.ctrv.2025.102926. Epub 2025 Mar 27.

EORTC consensus recommendations on the optimal management of colorectal cancer liver metastases

Affiliations
Review

EORTC consensus recommendations on the optimal management of colorectal cancer liver metastases

Giacomo Bregni et al. Cancer Treat Rev. 2025 May.

Abstract

Patients with colorectal cancer liver metastases have long represented a unique and thoroughly investigated population. Nevertheless, the optimal management of these is still controversial with a number of open questions which are only partially addressed by available studies and existing guidelines. The European Organisation for Research and Treatment of Cancer (EORTC) Gastrointestinal Tract Cancer Group (GITCG) sought to fill this knowledge gap and promoted the development of a European consensus on this subject. By using the Delphi methodology and leveraging a multidisciplinary team of 43 international experts, including gastrointestinal oncologists, hepatobiliary surgeons, interventional radiologists, radiation oncologists, radiologists, nuclear medicine physicians and pathologists from 12 European countries, 34 practical recommendations and two consensus statements were proposed. These cover varying aspects of the optimal management of colorectal cancer liver metastases such as baseline imaging, selection criteria for liver-directed therapies, treatment strategies, assessment of treatment response, follow-up, care delivery, clinical research and future perspectives. This roadmap document is intended to complement national and international guidelines, and to provide practical guidance for clinicians and multidisciplinary teams, ultimately promoting practice standardisation, optimal management and better patient outcomes across Europe. Also, it provides a unique opportunity to highlight grey areas and unmet needs, and to give a strategic direction to future research in the field by identifying topics where there is no consensus among experts.

Keywords: Colorectal cancer; Delphi survey; EORTC; European consensus; Expert consensus; Liver metastases.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Reto Bale. Consulting fees from Interventional Systems. Stock or stock options from VSOPs Interventional Systems. Irene Bergellini. Consulting fees from Boston Scientific, Sirtex, Terumo Europe. Honoraria from Boston Scientific, Sirtex, Terumo Europe. Participation on a Data Safety Monitoring Board for AstraZeneca. Lennart Blomqvist. Royalty as Editor of Nordic Textbook of Radiology version 2. Co-founder and share holder of Collective Minds Radiology. Chiara Cremolini. Honoraria from Amgen, Merck, MSD, Pierre Fabre, Servier, Takeda. Payment for expert testimony for Bayer. Participation on a Data Safety Monitoring Board or Advisory Board for Lilly, Nordic Pharma, Roche, Rottapharm, Servier, Takeda. Timm Denecke: Honoraria from Bayer. Research grants from Bayer. Anthony Dohan. Honoraria from Terumo. Participation on a Data Safety Monitoring Board or Advisory Board for Terumo, Varian Medical. Elena Elez. Research grants from Abbvie Deutschland Gmbh & Co KG, Amgen Inc., Array Biopharma Inc, Astra Zeneca Pharmaceuticals LP, Bayer Pharma AG, BeiGene, Bioncotech, Therapeutics, S.L., Biontech Rna Pharmacuticals GMBH, Biontech Small Molecules GMBH, Boehringer Ingelheim, Boehringer Ingelheim de España S.A., Bristol-Myers Squibb International Corporation, Celgene International SARL, Daiichi Sankyo, Inc, Debiopharm International SA, Genentech Inc, Gercor, HalioDX SAS, Hoffmann-La Roche Ltd, Hutchinson Medipharma Limited, Hutchison MediPharma, International, Iovance Biotherapeutics, Inc., Janssen Research & Development, Janssen-Cilag SA, MedImmune, Menarini, Menarini Ricerche SPA, Merck Health KGAA, Merck, Sharp & Dohme de España S.A., Merus NV, Mirati, Nouscom SRL., Novartis Farmacéutica SA, Pfizer, PharmaMar SA, Pledpharma AB, Redx Pharma PLC, Sanofi Aventis Recherche & Développement, Scandion Oncology, Seattle Genetics Inc., Servier, Sotio A.S., Taiho Pharma USA Inc, Wntresearch AB. Consulting fees from Agenus, Amgen, Bayer, BMS, Boehringer Ingelheim, Cure Teq AG, GlaxoSmithKline, Hoffman La – Roche, Janssen, Lilly, Medscape, Merck Serono, MSD, Novartis, Organon, Pfizer, Pierre Fabre, Repare Therapeutics Inc., RIN Institute Inc., Sanofi, Seagen International, GmbH, Servier, Takeda. Honoraria from Agenus, Amgen, Bayer, BMS, Boehringer Ingelheim, Cure Teq AG, GlaxoSmithKline, Hoffman La – Roche, Janssen, Lilly, Medscape, Merck Serono, MSD, Novartis, Organon, Pfizer, Pierre Fabre, Repare Therapeutics Inc., RIN Institute Inc., Sanofi, Seagen International, GmbH, Servier, Takeda. Travel grants from Agenus, Amgen, Bayer, BMS, Boehringer Ingelheim, Cure Teq AG, GlaxoSmithKline, Hoffman La – Roche, Janssen, Lilly, Medscape, Merck Serono, MSD, Novartis, Organon, Pfizer, Pierre Fabre, Repare Therapeutics Inc., RIN Institute Inc., Sanofi, Seagen International, GmbH, Servier, Takeda. Participation on a Data Safety Monitoring Board or Advisory Board for Agenus, Amgen, Bayer, BMS, Boehringer Ingelheim, Cure Teq AG, GlaxoSmithKline, Hoffman La – Roche, Janssen, Lilly, Medscape, Merck Serono, MSD, Novartis, Organon, Pfizer, Pierre Fabre, Repare Therapeutics Inc., RIN Institute Inc., Sanofi, Seagen International, GmbH, Servier, Takeda. Leadership roles for the European Society of Medical Oncology (ESMO), the American Society of Clinical Oncology (ASCO), and the Sociedad Española de Oncología Médica (SEOM). Roger Feakins. Consulting fees from Abbvie, DeciBio, Alimentiv plc. Honoraria from Janssen. Leadership roles for the European Society of Pathology (ESP), and the British Society of Gastroenterology (BSG). Matthias Guckenberger. Research grants from Varian/Siemens Healthineers, ViewRay. Consulting fees for Astra Zeneca. Leadership role for the European Society for Radiotherapy and Oncology (ESTRO). Marianne G Guren. Research grants from the Norwegian Cancer Society, Health Region South-Est. Participation on a Data Safety Monitoring Board or Advisory Board for academic trials. Leadership role for the Norwegian Colorectal Cancer Group. Institutional payment for participation in pharma-sponsored clinical trials. Thibaud Koessler. Consulting fees from AstraZeneca, Bayer, BMS, Boehringer Ingelheim, GSK, Lilly, Merck, MSD, Novartis, Pierre-Fabre, Roche, Takeda, Vifor. Honoraria from AstraZeneca, Bayer, BMS, Boehringer Ingelheim, GSK, Lilly, Merck, MSD, Novartis, Pierre-Fabre, Roche, Takeda, Vifor. Payment for expert testimony from Astra Zeneca. Travel grants from Lilly, Ipsen, Sanofi, Pierre-Fabre, AstraZeneca, Daiichi Sankyo. Participation on a Data Safety Monitoring Board or Advisory Board for Boehringer Ingelheim. Wolfgang G Kunz. Honoraria from BMS, Boehringer Ingelheim, mintMedical, Need Inc. Martijn Intven. Honoraria from Elekta. Leadership roles for the Dutch Society of Radiotherapy and Oncology. Florian Lordick. Research grants from Astra Zeneca, BMS, Gilead. Consulting fees from Amgen, Astellas, Bayer, Beigene, Biontech, BMS, Eli Lilly, MSD, PAGE, Roche, Servier. Honoraria from Astellas, Astra Zeneca, BMS, Daiichi Sankyo, Eli Lilly, Medscape, MedUpdate, Merck, MSD, Roche, Servier, StreamedUp!. Travel grants from Daiichi Sankyo. Participation on a Data Safety Monitoring Board or Advisory Board for Biontech. Leadership roles for the European Society of Medical Oncology (ESMO), the International Gastric Cancer Association (IGCA), and the International Cancer Foundation. Wim JG Oyen. Honoraria from Novartis. Participation on a Data Safety Monitoring Board or Advisory Board for Bayer. Franco Orsi. Honoraria from Medtronic. Alexis Ricoeur: Honoraria from Astra Zeneca. Travel grants from Abbott, Boston Scientific, Terumo. Maxime Ronot. Honoraria from Angiodynamics, AstraZeneca, General Electrics, Guerbet, Servier, Sirtex, Terumo. Jenny Seligmann. Research grants from Amgen, GSK, Merck Serono. Consulting fees for Astra Zeneca, BMS, Merck Serono, Sanofi, Servier, Takeda. Honoraria from GSK, Elevation Oncology, GI Connect, Merck Serono, Servier, Takeda. Travel grants from Takeda. Participation on a Data Safety Monitoring Board or Advisory Board for GSK. Stefan Stättner. Honoraria from Astra Zeneca, BMS, Incyte, Mölnlycke, Roche, Takeda. Advisory board for Astra Zeneca. Educational grants from ITM Pharma. Julien Taieb. Consulting fees from Amgen, Astelllas, Astra Zeneca, BMS, Boehringer, Merck KGaA, MSD, Novartis, ONO pharmaceuticals, Pierre Fabre, Roche Genentech, Sanofi, Servier and Takeda. Honoraria from Amgen, Astelllas, Astra Zeneca, BMS, Boehringer, Merck KGaA, MSD, Novartis, ONO pharmaceuticals, Pierre Fabre, Roche Genentech, Sanofi, Servier and Takeda. Nick West: Research grants from Yorkshire Cancer Research, Cancer Research UK, National Institute for Health and Care Research, Pierre Fabre, GSK. Consulting fees from Amgen, Astellas, BMS, GSK, Pfizer. Markus Moehler. Research grants from Amgen, Astra Zeneca, Leap Therapeutics, Merck Serono, MSD, Taiho Pharmaceutical. Honoraria from Amgen, Astellas Pharma, Astra Zeneca/MedImmune, Bayer Schering Pharma, BMS, Daiichi Sankyo Europe GmbH, Idience, Merck Serono, MSD Oncology, Pierre Fabre, Roche/Genentech, Sanofi, Servier, Transcenta, Triptych Health Partners. Travel grants from Amgen, Astra-Zeneca, BeiGene, BMS, Daiichi Sankyo Europe GmbH, Takeda. Participation on a Data Safety Monitoring Board or Advisory Board for Amgen, Astra Zeneca, Bayer, BeiGene, BMS, Daiichi Sankyo Europe GmbH, Lilly, Merck Serono, MSD, Nordic Group, Servier, Taiho Pharmaceutical, Takeda. Leadership roles for the European Organisation for Research and Treatment of Cancer (EORTC), Arbeitsgemeinschaft Internistische Onkologie (AIO), and Johannes Gutenberg Universität (JGU) Mainz. Francesco Sclafani. Honoraria from Amgen, Merck, Servier. Participation on a Data Safety Monitoring Board or Advisory Board for AMAL Therapeutics, Bayer, BMS, Dragonfly Therapeutics, GSK, Nordic Pharma, Roche. Research grants from Amgen, Association Jules Bordet, Astellas, Astra Zeneca, Bayer, Belgian Health Care Knowledge Centre (KCE), BMS, Fondation Contre le Cancer, Horizon Europe, Merck, MSD, Pierre Fabre, Roche, Sanofi, Televie/FNRS. Travel grants from Amgen, Bayer, Lilly, Merck, Roche, Servier. Leadership roles for the European Organisation for Research and Treatment of Cancer (EORTC), All the other authors do not have any conflict of interest.

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