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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


Surgical resection is the treatment of choice for patients with isolated colorectal cancer (CRC) 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 (see "Management of potentially resectable colorectal cancer liver metastases"). 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).

Local or regional treatment approaches may be considered after the cancer has progressed on systemic therapies but remains isolated to the liver or as a means of delaying the need for systemic chemotherapy in patients who have liver-isolated metastatic disease. Whether this rationale is valid or not is unclear. Although these methods (particularly radiofrequency ablation, RFA) can provide local control in a high number of patients, whether there are any long-term survivors (ie, cures) remains uncertain. Moreover, it is unclear whether the sequential use of regional treatments followed by systemic chemotherapy at the time of progression provides better long-term benefit in terms of duration of symptom control or survival than systemic chemotherapy alone.

This topic review will focus on nonsurgical methods for local tumor ablation, regional chemotherapy into the hepatic artery, and radiotherapy. Resection and the use of pre-resection (induction) chemotherapy, as well as systemic treatment strategies for metastatic CRC, are addressed elsewhere. (See "Management of potentially resectable colorectal cancer liver metastases" and "Systemic chemotherapy for metastatic colorectal cancer: General principles" and "Systemic chemotherapy for nonoperable metastatic colorectal cancer: Treatment recommendations".)


Depending on the clinical picture, biopsy may be indicated to confirm the diagnosis of metastatic disease. However, whether all patients need biopsy confirmation of suspected metastatic disease is debated. Many oncologists feel it is important to provide tissue documentation of the first site of noncurable disease, while others consider that biopsy is not necessary in a patient with a history of CRC in the preceding five years who has a new elevation of carcinoembryonic antigen (CEA) and new unresectable liver lesions on imaging that are clinically suspicious.

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Literature review current through: Nov 2017. | This topic last updated: Nov 03, 2017.
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