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Nonsurgical local treatment strategies for colorectal cancer liver metastases

Alan P Venook, MD
Section Editor
Kenneth K Tanabe, MD
Deputy Editor
Diane MF Savarese, MD


Approximately 134,490 Americans are diagnosed with colon or rectal cancer annually, and 49,190 die from this disease, most with metastatic tumors [1]. Global, country-specific incidence and mortality rates are available from the World Health Organization (WHO) GLOBOCAN database.

Hepatic metastatic disease from colorectal cancer (CRC) is a significant clinical problem. The liver is the dominant metastatic site for such patients, and although two-thirds of affected patients have extrahepatic spread, some have disease that is isolated to the liver. For such patients, regional treatment approaches may be considered as an alternative to systemic chemotherapy. (See "Systemic chemotherapy for metastatic colorectal cancer: Completed clinical trials".)

Surgical resection is the treatment of choice for patients with isolated liver metastases when feasible. For patients with four or fewer isolated hepatic lesions, five-year relapse-free survival rates after resection range from 24 to 58 percent, averaging 30 percent (table 1). Many of these patients are potentially cured.

The actual percent of patients with isolated hepatic metastases who are amenable to potentially curative resection is a moving target because of evolving technologies that have expanded the pool of patients who can be considered for surgical intervention. However, the majority are not surgical candidates because of tumor size, location, multifocality, or inadequate hepatic reserve.

There are several nonsurgical treatment options for patients with liver-isolated CRC metastases who are not candidates for potentially curative resection. These include systemic chemotherapy, regional chemotherapy via the hepatic artery, selective internal radiation using yttrium-labeled glass or resin microspheres, and regional tumor ablation (hyperthermic or radiofrequency coagulation, intratumoral injection of ethanol or acetic acid, and cryotherapy).


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