Skip to main content
SpringerLink
Log in

Liver-Directed Treatments for Metastatic Colorectal Cancer

  • Lower Gastrointestinal Cancers (AB Benson, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

When possible, surgical resection remains the “gold standard” for the treatment of hepatic colorectal metastases. Liver resection should be considered when complete removal of all macroscopic disease can be achieved safely. For those patients with unresectable metastases, or when a patient may not be a candidate for liver resection, many choices are available to the clinician in an attempt to achieve locoregional control, including tumor ablation, intra-arterial therapies, and radiation therapy. Whereas with surgical resection, durable local control can be considered potentially curable, other liver-directed approaches currently are mostly palliative. Ongoing trials are being undertaken to evaluate the role of such cytoreductive therapies. During the initial evaluation of any patient who might be a candidate for liver-directed therapy, particularly when the intent may be curative, complete assessment with high-quality imaging should be done before any therapy to determine the full extent of disease. Most importantly, the establishment of a multidisciplinary team upon initial diagnosis can optimize the choice and sequencing of the various systemic and locoregional choices available to the colorectal cancer patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Tournigand C, Andre T, Achille E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol. 2004;22:229–37.

    Article  CAS  PubMed  Google Scholar 

  2. Pawlik TM, Scoggins CR, Zorzi D, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg. 2005;241:715–22.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Abdalla EK, Vauthey J-N, Ellis LM, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004;239:818–25.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Pawlik TM, Abdalla EK, Ellis LM, Vauthey JN, Curley SA. Debunking dogma: surgery for four or more colorectal liver metastases is justified. J Gastrointest Surg. 2006;10:240–8.

    Article  PubMed  Google Scholar 

  5. Nordlinger B, Van Cutsem E, Rougier P, et al. Does chemotherapy prior to liver resection increase the potential for cure in patients with metastatic colorectal cancer? A report from the European Colorectal Metastases Treatment Group. Eur J Cancer. 2007;43:2037–45.

    Article  CAS  PubMed  Google Scholar 

  6. Folprecht G, Gruenberger T, et al. Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial. Lancet Oncol. 2010;11(1):38–47.

    Article  CAS  PubMed  Google Scholar 

  7. Pamecha V, Glantzounis G, et al. Long-term survival and disease recurrence following portal vein embolisation prior to major hepatectomy for colorectal metastases. Ann Surg Oncol. 2009;16(5):1202–7.

    Article  PubMed  Google Scholar 

  8. de Jong MC, van Vledder MG, et al. Therapeutic efficacy of combined intraoperative ablation and resection for colorectal liver metastases: an international, multi-institutional analysis. J Gastrointest Surg. 2011;15(2):336–44.

    Article  PubMed  Google Scholar 

  9. Wicherts DA, Miller R, et al. Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases. Ann Surg. 2008;248(6):994–1005.

    Article  PubMed  Google Scholar 

  10. Pawlik TM, Poon RT, Abdalla EK, et al. Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma. Arch Surg. 2005;140:450–7.

    Article  PubMed  Google Scholar 

  11. Fernandez FG, Drebin JA, Linehan DC, Dehdashti F, Siegel BA, Strasberg SM. Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg. 2004;240:438–47.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg. 2002;235:759–66.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309–18.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Scheele J, Stang R, Altendorf-Hofmann A, Paul M. Resection of colorectal liver metastases. World J Surg. 1995;19:59–71.

    Article  CAS  PubMed  Google Scholar 

  15. Pawlik TM, Schulick RD, Choti MA. Expanding criteria for resectability of colorectal liver metastases. Oncologist. 2008;13:51–64.

    Article  PubMed  Google Scholar 

  16. Charnsangavej C, Clary B, Fong Y, Grothey A, Pawlik TM, Choti MA. Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol. 2006;13:1261–8.

    Article  PubMed  Google Scholar 

  17. Arita J, Ono Y, Takahashi M, Inoue Y, Takahashi Y, Saiura A. Usefulness of contrast-enhanced intraoperative ultrasound in identifying disappearing liver metastases from colorectal carcinoma after chemotherapy. Ann Surg Oncol. 2014.

  18. Zech CJ, Korpraphong P, Huppertz A, Denecke T, Kim MJ, Tanomkiat W, et al. Randomized multicentre trial of gadoxetic acid-enhanced MRI versus conventional MRI or CT in the staging of colorectal cancer liver metastases. Br J Surg. 2014. Randomized trial comparing MRI to CT for evaluation of CRLM. The study reports on the value of MRI for preoperative staging of potentially resectable patients.

  19. Joyce DL, Wahl RL, et al. Preoperative positron emission tomography to evaluate potentially resectable hepatic colorectal metastases. Arch Surg. 2006;141(12):1220–6. discussion 1227.

    Article  PubMed  Google Scholar 

  20. Jaeck D, Oussoultzoglou E, et al. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg. 2004;240(6):1037–49.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Tsai S, Marques HP, de Jong MC, Mira P, Ribeiro V, Choti MA, et al. Two-stage strategy for patients with extensive bilateral colorectal liver metastases. HPB (Oxford). 2010;12(4):262–9.

    Article  Google Scholar 

  22. Abdalla EK, Hicks ME, Vauthey JN. Portal vein embolization: rationale, technique and future prospects. Br J Surg. 2001;88:165–75.

    Article  CAS  PubMed  Google Scholar 

  23. Tschuor C, Croome KP, Sergeant G, Cano V, Schadde E, Ardiles V, et al. Salvage parenchymal liver transection for patients with insufficient volume increase after portal vein occlusion—an extension of the ALPPS approach. Eur J Surg Oncol. 2013;39(11):1230–5.

    Article  PubMed  Google Scholar 

  24. Gauzolino R, Castagnet M, Blanleuil ML, Richer JP. The ALPPS technique for bilateral colorectal metastases: three “variations on a theme”. Updat Surg. 2013;65(2):141–8.

    Article  Google Scholar 

  25. Adam R, Pascal G, Castaing D, et al. Tumor progression while on chemotherapy: a contraindication to liver resection for multiple colorectal metastases? Ann Surg. 2004;240:1052–61.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Karagkounis G, Torbenson MS, Daniel HD, Azad NS, Diaz Jr LA, Donehower RC, et al. Incidence and prognostic impact of KRAS and BRAF mutation in patients undergoing liver surgery for colorectal metastases. Cancer. 2013;119(23):4137–44. Series of patients undergoing liver resection in whom determination of KRAS and BRAF status was assessed as a prognostic factor. Investigators found that mutation of KRAS was associated with poorer outcome. BRAF was uncommonly found in resected patients.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Curley SA, Marra P, Beaty K, et al. Early and late complications after radiofrequency ablation of malignant liver tumors in 608 patients. Ann Surg. 2004;239:450–8.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Curley SA, Izzo F, Delrio P, et al. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg. 1999;230:1–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Gillams AR, Lees WR. Five-year survival in 309 patients with colorectal liver metastases treated with radiofrequency ablation. Eur Radiol. 2009;19:1206–13.

    Article  CAS  PubMed  Google Scholar 

  30. Schindera ST, Nelson RC, DeLong DM, Clary B. Intrahepatic tumor recurrence after partial hepatectomy: value of percutaneous radiofrequency ablation. J Vasc Interv Radiol. 2006;17:1631–7.

    Article  PubMed  Google Scholar 

  31. Suppiah A, White TJ, Roy-Choudhury SH, et al. Long-term results of percutaneous radiofrequency ablation of unresectable colorectal hepatic metastases; final outcomes. Dig Surg. 2007;24:358–60.

    Article  CAS  PubMed  Google Scholar 

  32. Wong SL, Mangu PB, Choti MA, et al. American Society of Clinical Oncology 2009 clinical evidence review on radiofrequency ablation of hepatic metastases from colorectal cancer. J Clin Oncol. 2010;28:493–508. Comprehensive review of the existing literature of radiofrequency ablation for colorectal liver metastases.

    Article  PubMed  Google Scholar 

  33. White TJ, Roy-Choudhury SH, Breen DJ, et al. Percutaneous radiofrequency ablation of colorectal hepatic metastases—initial experience. An adjunct technique to systemic chemotherapy for those with inoperable colorectal hepatic metastases. Dig Surg. 2004;21:314–20.

    Article  CAS  PubMed  Google Scholar 

  34. Stippel DL, Bohm S, Beckurts KT, Brochhagen HG, Holscher AH. Intraoperative radiofrequency ablation using a 3D navigation tool for treatment of colorectal liver metastases. Onkologic. 2002;25:346–50.

    Article  CAS  Google Scholar 

  35. Oshowo A, Gillams AR, Lees WR, Taylor I. Radiofrequency ablation extends the scope of surgery in colorectal liver metastases. Eur J Surg Oncol. 2003;29:244–7.

    Article  CAS  PubMed  Google Scholar 

  36. Tepel J, Hinz S, Klomp HJ, Kapischke M, Kremer B. Intraoperative radiofrequency ablation (RFA) for irresectable liver malignancies. Eur J Surg Oncol. 2004;30:551–5.

    Article  CAS  PubMed  Google Scholar 

  37. Solbiati L, Ierace T, Tonolini M, Osti V, Cova L. Radiofrequency thermal ablation of hepatic metastases. Eur J Ultrasound. 2001;13:149–58.

    Article  CAS  PubMed  Google Scholar 

  38. Lubner MG, Brace CL, Hinshaw JL, Lee FT. Microwave tumor ablation: mechanism of action, clinical results, and devices. J Vasc Intervent Radiol. 2010;21:S192–203.

    Article  Google Scholar 

  39. Shibata T, Niinobu T, Ogata N, Takami M. Microwave coagulation therapy for multiple hepatic metastases from colorectal carcinoma. Cancer. 2000;89:276–84.

    Article  CAS  PubMed  Google Scholar 

  40. Martin R, Scoggins C, McMasters K. Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience. Ann Surg Oncol. 2010;17:171–8.

    Article  PubMed  Google Scholar 

  41. Stättner S, Primavesi F, Yip VS, Jones RP, Ofner D, Malik HZ, et al. Evolution of surgical microwave ablation for the treatment of colorectal cancer liver metastasis: review of the literature and a single centre experience. Surg Today. 2014.

  42. Scheffer HJ, Nielsen K, de Jong MC, van Tilborg AA, Vieveen JM, Bouwman AR, et al. Irreversible electroporation for nonthermal tumor ablation in the clinical setting: a systematic review of safety and efficacy. J Vasc Interv Radiol. 2014.

  43. Vogl TJ, Zangos S, Eichler K, Yakoub D, Nabil M. Colorectal liver metastases: regional chemotherapy via transarterial chemoembolization (TACE) and hepatic chemoperfusion: an update. Eur Radiol. 2007;17:1025–34.

    Article  PubMed  Google Scholar 

  44. Sanz-Altamira PM, Spence LD, Huberman MS, et al. Selective chemoembolization in the management of hepatic metastases in refractory colorectal carcinoma: a phase II trial. Dis Colon Rectum. 1997;40:770–5.

    Article  CAS  PubMed  Google Scholar 

  45. Tellez C, Benson 3rd AB, Lyster MT, et al. Phase II trial of chemoembolization for the treatment of metastatic colorectal carcinoma to the liver and review of the literature. Cancer. 1998;82:1250–9.

    Article  CAS  PubMed  Google Scholar 

  46. Jones RP, Stättner S, Dunne DF, O’Grady E, Smethurst A, Terlizzo M, et al. Radiological assessment of response to neoadjuvant transcatheter hepatic therapy with irinotecan-eluting beads (DEBIRI(®)) for colorectal liver metastases does not predict tumour destruction or long-term outcome. Eur J Surg Oncol. 2013;39(10):1122–8.

    Article  CAS  PubMed  Google Scholar 

  47. Lencioni R, Aliberti C, de Baere T, Garcia-Monaco R, Narayanan G, O’Grady E, et al. Transarterial treatment of colorectal cancer liver metastases with irinotecan-loaded drug-eluting beads: technical recommendations. J Vasc Interv Radiol. 2014;25(3):365–9.

    Article  PubMed  Google Scholar 

  48. Scorsetti M, Arcangeli S, Tozzi A, Comito T, Alongi F, Navarria P, et al. Is stereotactic body radiation therapy an attractive option for unresectable liver metastases? A preliminary report from a phase 2 trial. Int J Radiat Oncol Biol Phys. 2013;86(2):336–42.

    Article  PubMed  Google Scholar 

  49. Habermehl D, Herfarth KK, Bermejo JL, Hof H, Rieken S, Kuhn S, et al. Single-dose radiosurgical treatment for hepatic metastases—therapeutic outcome of 138 treated lesions from a single institution. Radiat Oncol. 2013;8(1):175.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Garrean S, Muh A, Bui JT, et al. Complete eradication of hepatic metastasis from colorectal cancer by yttrium-90 SIRT. World J Gastroenterol. 2007;13:3016–9.

    PubMed  Google Scholar 

  51. Gulec SA, Pennington K, Wheeler J, Barot TC, Suthar RR, Hall M, et al. Yttrium-90 microsphere-selective internal radiation therapy with chemotherapy (chemo-SIRT) for colorectal cancer liver metastases: an in vivo double-arm-controlled phase II trial. Am J Clin Oncol. 2013;36(5):455–60.

    Article  CAS  PubMed  Google Scholar 

  52. Benson 3rd AB, Geschwind JF, Mulcahy MF, Rilling W, Siskin G, Wiseman G, et al. Radioembolisation for liver metastases: results from a prospective 151 patient multi-institutional phase II study. Eur J Cancer. 2013;49(15):3122–30. Large prospective series of the current experience with Y-90 radioembolization of hepatic metastasis.

    Article  PubMed  Google Scholar 

  53. Rougier P, Laplanche A, Huguier M, et al. Hepatic arterial infusion of floxuridine in patients with liver metastases from colorectal carcinoma: long-term results of a prospective randomized trial. J Clin Oncol. 1992;10:1112–8.

    CAS  PubMed  Google Scholar 

  54. Lorenz M, Muller HH. Randomized, multicenter trial of fluorouracil plus leucovorin administered either via hepatic arterial or intravenous infusion versus fluorodeoxyuridine administered via hepatic arterial infusion in patients with nonresectable liver metastases from colorectal carcinoma. J Clin Oncol. 2000;18:243–54.

    CAS  PubMed  Google Scholar 

  55. Kemeny NE, Niedzwiecki D, Hollis DR, et al. Hepatic arterial infusion versus systemic therapy for hepatic metastases from colorectal cancer: a randomized trial of efficacy, quality of life, and molecular markers (CALGB 9481). J Clin Oncol. 2006;24:1395–403.

    Article  CAS  PubMed  Google Scholar 

  56. Lorenz M, Muller HH, Schramm H, et al. Randomized trial of surgery versus surgery followed by adjuvant hepatic arterial infusion with 5-fluorouracil and folinic acid for liver metastases of colorectal cancer. German Cooperative on Liver Metastases (Arbeitsgrupppe Lebermetastasen). Ann Surg. 1998;228:756–62.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  57. Kemeny N, Huang Y, Cohem AM, et al. Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med. 1999;341:2039–48.

    Article  CAS  PubMed  Google Scholar 

  58. Lygidakis NJ, Sgourakis G, Vlachos L. Metastatic liver disease of colorectal origin: the value of locoregional immunochemotherapy combined with systemic chemotherapy following liver resection. Results of a prospective randomized study. Hepatogastroenterology. 2001;48:1685–91.

    CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Michael A. Choti reports nonfinancial support from Bayer Healthcare and grants from BMS.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9031, USA

    Michael A. Choti MD

Authors
  1. Michael A. Choti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael A. Choti MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Choti, M.A. Liver-Directed Treatments for Metastatic Colorectal Cancer. Curr. Treat. Options in Oncol. 15, 456–464 (2014). https://doi.org/10.1007/s11864-014-0297-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-014-0297-1

Keywords

Search

Navigation