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Liver Metastases: Basic Principles of Treatment and Clinical Data

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Radiation Therapy for Liver Tumors

Abstract

Metastatic disease is the most common malignancy effecting the liver. Although metastatic disease can develop in the liver via systemic spread from most solid malignancies, certain tumor types have the propensity to develop liver-dominant disease, and often isolated liver metastases. These include primarily colorectal cancer and, less commonly, neuroendocrine tumors, gastrointestinal stromal tumors, and others. There is a preponderance of evidence strongly suggesting that surgical resection offers the best potential cure for colorectal cancer metastatic to the liver, with long-term survival exceeding 50% at 5 years in most recent series. As surgical therapies have been shown to be increasingly safe and effective, more frequent and aggressive application of this local approach is being used. While standard of care in resectable patients with colorectal metastases, evidence is less clear for surgery in other primary tumor types. When local therapy such as hepatectomy is being considered, careful preoperative evaluation of the liver, primary tumor, and extrahepatic sites is important to exclude unresectable disease and select those patients who may benefit most from resection. Potential strategies currently under investigation for improving outcomes include combining resection with adjuvant regional or systemic chemotherapy. For unresectable disease, local ablative approaches, regional chemotherapy, and systemic chemotherapy may offer some benefit.

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References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2015;65(1):5–29.

    Article  PubMed  Google Scholar 

  2. Weiss L, Grundmann E, Torhorst J, Hartveit F, Moberg I, Eder M, et al. Haematogenous metastatic patterns in colonic carcinoma: an analysis of 1541 necropsies. J Pathol. 1986;150(3):195–203.

    Article  CAS  PubMed  Google Scholar 

  3. Ohlsson B, Pålsson B. Follow-up after colorectal cancer surgery. Acta Oncol. 2003;42(8):816–26.

    Article  PubMed  Google Scholar 

  4. Gallagher DJ, Kemeny N. Metastatic colorectal cancer: from improved survival to potential cure. Oncology. 2010;78(3–4):237–48.

    Article  PubMed  Google Scholar 

  5. Choti MA, Bowman HM, Pitt HA, Sosa JA, Sitzmann JV, Cameron JL, et al. Should hepatic resections be performed at high-volume referral centers? J Gastrointest Surg. 1998;2(1):11–20.

    Article  CAS  PubMed  Google Scholar 

  6. Choti MA, Sitzmann JV, Tiburi MF, Sumetchotimetha W, Rangsin R, Schulick RD, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg. 2002;235(6):759–66.

    Google Scholar 

  7. 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(3):309–18–discussion318–21.

    Google Scholar 

  8. Kingham TP, Correa-Gallego C, D’Angelica MI, Gonen M, Dematteo RP, Fong Y, et al. Hepatic parenchymal preservation surgery: decreasing morbidity and mortality rates in 4,152 resections for malignancy. J Am Coll Surg. 2015;220(4):471–9.

    Article  PubMed  Google Scholar 

  9. Farid SG, Aldouri A, Morris-Stiff G, Khan AZ, Toogood GJ, Lodge JPA, et al. Correlation between postoperative infective complications and long-term outcomes after hepatic resection for colorectal liver metastasis. Ann Surg. 2010;251(1):91–100.

    Article  PubMed  Google Scholar 

  10. Malik HZ, Prasad KR, Halazun KJ, Aldoori A, Al-Mukhtar A, Gomez D, et al. Preoperative prognostic score for predicting survival after hepatic resection for colorectal liver metastases. Ann Surg. 2007;246(5):806–14.

    Article  PubMed  Google Scholar 

  11. Scheele J, Stangl R, Altendorf-Hofmann A. Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg. 1990;77(11):1241–6.

    Article  CAS  PubMed  Google Scholar 

  12. Tomlinson JS, Jarnagin WR, Dematteo RP, Fong Y, Kornprat P, Gonen M, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25(29):4575–80.

    Article  PubMed  Google Scholar 

  13. House MG, Ito H, Gonen M, Fong Y, Allen PJ, Dematteo RP, et al. Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1,600 patients during two decades at a single institution. J Am Coll Surg. 2010;210(5):744–52–752–5.

    Google Scholar 

  14. Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, et al. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Française de Chirurgie. Cancer. 1996;77(7):1254–62.

    Article  CAS  PubMed  Google Scholar 

  15. de Jong MC, Pulitano C, Ribero D, Strub J, Mentha G, Schulick RD, et al. Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients. Ann Surg. 2009;250(3):440–8.

    PubMed  Google Scholar 

  16. Bilchik AJ, Poston G, Adam R, Choti MA. Prognostic variables for resection of colorectal cancer hepatic metastases: an evolving paradigm. J Clin Oncol. 2008;26(33):5320–1.

    Article  PubMed  Google Scholar 

  17. Pawlik TM, Scoggins CR, Zorzi D, Abdalla EK, Andres A, Eng C, et al. Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases. Ann Surg. 2005;241(5):715–22–discussion722–4.

    Google Scholar 

  18. Are C, Gonen M, Zazzali K, Dematteo RP, Jarnagin WR, Fong Y, et al. The impact of margins on outcome after hepatic resection for colorectal metastasis. Ann Surg. 2007;246(2):295–300.

    Google Scholar 

  19. Hughes KS, Rosenstein RB, Songhorabodi S, Adson MA, Ilstrup DM, Fortner JG, et al. Resection of the liver for colorectal carcinoma metastases. A multi-institutional study of long-term survivors. Dis Colon Rectum. 1988;31(1):1–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Nuzzo G, Giuliante F, Ardito F, Vellone M, Giovannini I, Federico B, et al. Influence of surgical margin on type of recurrence after liver resection for colorectal metastases: a single-center experience. Surgery. 2008;143(3):384–93.

    Article  PubMed  Google Scholar 

  21. Inoue M, Ohta M, Iuchi K, Matsumura A, Ideguchi K, Yasumitsu T, et al. Benefits of surgery for patients with pulmonary metastases from colorectal carcinoma. Ann Thorac Surg. 2004;78(1):238–44.

    Article  PubMed  Google Scholar 

  22. Neeff H, Hörth W, Makowiec F, Fischer E, Imdahl A, Hopt UT, et al. Outcome after resection of hepatic and pulmonary metastases of colorectal cancer. J Gastrointest Surg. 2009;13(10):1813–20.

    Article  PubMed  Google Scholar 

  23. Headrick JR, Miller DL, Nagorney DM, Allen MS, Deschamps C, Trastek VF, et al. Surgical treatment of hepatic and pulmonary metastases from colon cancer. Ann Thorac Surg. 2001;71(3):975–9–discussion979–80.

    Google Scholar 

  24. Mineo TC, Ambrogi V, Tonini G, Bollero P, Roselli M, Mineo D, et al. Longterm results after resection of simultaneous and sequential lung and liver metastases from colorectal carcinoma. J Am Coll Surg. 2003;197(3):386–91.

    Article  PubMed  Google Scholar 

  25. van Duijnhoven FH, Jansen MC, Junggeburt JMC, van Hillegersberg R, Rijken AM, van Coevorden F, et al. Factors influencing the local failure rate of radiofrequency ablation of colorectal liver metastases. Ann Surg Oncol. 2006;13(5):651–8.

    Article  PubMed  Google Scholar 

  26. Kuehl H, Antoch G, Stergar H, Veit-Haibach P, Rosenbaum-Krumme S, Vogt F, et al. Comparison of FDG-PET, PET/CT and MRI for follow-up of colorectal liver metastases treated with radiofrequency ablation: initial results. Eur J Radiol. 2008;67(2):362–71.

    Article  PubMed  Google Scholar 

  27. Schraml C, Clasen S, Schwenzer NF, Koenigsrainer I, Herberts T, Claussen CD, et al. Diagnostic performance of contrast-enhanced computed tomography in the immediate assessment of radiofrequency ablation success in colorectal liver metastases. Abdom Imaging. 2008;33(6):643–51.

    Article  PubMed  Google Scholar 

  28. Wong SL, Mangu PB, Choti MA, Crocenzi TS, Dodd GD, Dorfman GS, 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(3):493–508.

    Google Scholar 

  29. Gleisner AL, Choti MA, Assumpcao L, Nathan H, Schulick RD, Pawlik TM. Colorectal liver metastases: recurrence and survival following hepatic resection, radiofrequency ablation, and combined resection-radiofrequency ablation. Arch Surg. 2008;143(12):1204–12.

    Article  PubMed  Google Scholar 

  30. Ruers TJM, Joosten JJ, Wiering B, Langenhoff BS, Dekker HM, Wobbes T, et al. Comparison between local ablative therapy and chemotherapy for non-resectable colorectal liver metastases: a prospective study. Ann Surg Oncol. 2007;14(3):1161–9.

    Article  PubMed  Google Scholar 

  31. Veltri A, Sacchetto P, Tosetti I, Pagano E, Fava C, Gandini G. Radiofrequency ablation of colorectal liver metastases: small size favorably predicts technique effectiveness and survival. Cardiovasc Intervent Radiol. 2008;31(5):948–56.

    Article  PubMed  Google Scholar 

  32. Solbiati L, Ahmed M, Cova L, Ierace T, Brioschi M, Goldberg SN. Small liver colorectal metastases treated with percutaneous radiofrequency ablation: local response rate and long-term survival with up to 10-year follow-up. Radiology. 2012;265(3):958–68.

    Article  PubMed  Google Scholar 

  33. Siperstein AE, Berber E, Ballem N, Parikh RT. Survival after radiofrequency ablation of colorectal liver metastases: 10-year experience. Ann Surg. 2007;246(4):559–65–discussion565–7.

    Google Scholar 

  34. Kennedy TJ, Cassera MA, Khajanchee YS, Diwan TS, Hammill CW, Hansen PD. Laparoscopic radiofrequency ablation for the management of colorectal liver metastases: 10-year experience. J Surg Oncol. 2013;107(4):324–8.

    Google Scholar 

  35. Hammill CW, Billingsley KG, Cassera MA, Wolf RF, Ujiki MB, Hansen PD. Outcome after laparoscopic radiofrequency ablation of technically resectable colorectal liver metastases. Ann Surg Oncol. 2011;18(7):1947–54.

    Article  PubMed  Google Scholar 

  36. Berber E, Tsinberg M, Tellioglu G, Simpfendorfer CH, Siperstein AE. Resection versus laparoscopic radiofrequency thermal ablation of solitary colorectal liver metastasis. J Gastrointest Surg. 2008;12(11):1967–72.

    Google Scholar 

  37. Groeschl RT, Pilgrim CHC, Hanna EM, Simo KA, Swan RZ, Sindram D, et al. Microwave ablation for hepatic malignancies: a multiinstitutional analysis. Ann Surg. 2014;259(6):1195–200.

    Article  PubMed  Google Scholar 

  38. Liang P, Dong B, Yu X, Yang Y, Yu D, Su L, et al. Prognostic factors for percutaneous microwave coagulation therapy of hepatic metastases. AJR Am J Roentgenol. 2003;181(5):1319–25.

    Google Scholar 

  39. Ogata Y, Uchida S, Hisaka T, Horiuchi H, Mori S, Ishibashi N, et al. Intraoperative thermal ablation therapy for small colorectal metastases to the liver. Hepatogastroenterology. 2008;55(82–83):550–6.

    PubMed  Google Scholar 

  40. Shibata T, Niinobu T, Ogata N, Takami M. Microwave coagulation therapy for multiple hepatic metastases from colorectal carcinoma. Cancer. 2000;89(2):276–84.

    Article  CAS  PubMed  Google Scholar 

  41. Correa-Gallego C, Fong Y, Gonen M, D’Angelica MI, Allen PJ, DeMatteo RP, et al. A Retrospective Comparison of Microwave Ablation vs. Radiofrequency Ablation for Colorectal Cancer Hepatic Metastases. Ann Surg Oncol. 2014;21(13):1–6.

    Google Scholar 

  42. Pathak S, Jones R, Tang JMF, Parmar C, Fenwick S, Malik H, et al. Ablative therapies for colorectal liver metastases: a systematic review. Colorectal Dis. 2011;13(9):e252–65.

    Google Scholar 

  43. Ackerman NB, Hodgson WB. Vascular patterns of liver tumors and their consequences for different therapeutic approaches. Recent Results Cancer Res. 1986;100:248–55.

    Article  CAS  PubMed  Google Scholar 

  44. Iezzi R, Marsico VA, Guerra A, Cerchiaro E, Cassano A, Basso M, et al. Trans-arterial chemoembolization with irinotecan-loaded drug-eluting beads (debiri) and capecitabine in refractory liver prevalent colorectal metastases: a phase ii single-center study. Cardiovasc Intervent Radiol. 2015;38(6):1523–31.

    Google Scholar 

  45. Kemeny NE. Regional chemotherapy of colorectal cancer. Eur J Cancer. 1995;31A(7–8):1271–6.

    Article  CAS  PubMed  Google Scholar 

  46. Meta-Analysis Group in Cancer, Piedbois P, Buyse M, Kemeny N, Rougier P, Carlson R, et al. Reappraisal of hepatic arterial infusion in the treatment of nonresectable liver metastases from colorectal cancer. J Natl Cancer Inst. 1996;88(5):252–258.

    Google Scholar 

  47. Mocellin S, Pilati P, Lise M, Nitti D. Meta-analysis of hepatic arterial infusion for unresectable liver metastases from colorectal cancer: the end of an era? J Clin Oncol. 2007;25(35):5649–54.

    Google Scholar 

  48. Kemeny N. The management of resectable and unresectable liver metastases from colorectal cancer. Curr Opin Oncol. 2010;22(4):364–73.

    Article  PubMed  Google Scholar 

  49. Allen-Mersh TG, Glover C, Fordy C, Mathur P, Quinn H. Randomized trial of regional plus systemic fluorinated pyrimidine compared with systemic fluorinated pyrimidine in treatment of colorectal liver metastases. Eur J Surg Oncol. 2000;26(5):468–73.

    Article  CAS  PubMed  Google Scholar 

  50. Kemeny N, Jarnagin W, Paty P, Gonen M, Schwartz L, Morse M, et al. Phase I trial of systemic oxaliplatin combination chemotherapy with hepatic arterial infusion in patients with unresectable liver metastases from colorectal cancer. J Clin Oncol. 2005;23(22):4888–96.

    Article  CAS  PubMed  Google Scholar 

  51. Kemeny N, Gonen M, Sullivan D, Schwartz L, Benedetti F, Saltz L, et al. Phase I study of hepatic arterial infusion of floxuridine and dexamethasone with systemic irinotecan for unresectable hepatic metastases from colorectal cancer. J Clin Oncol. 2001;19(10):2687–95.

    Article  CAS  PubMed  Google Scholar 

  52. Ammori JB, Kemeny NE, Fong Y, Cercek A, Dematteo RP, Allen PJ, et al. Conversion to complete resection and/or ablation using hepatic artery infusional chemotherapy in patients with unresectable liver metastases from colorectal cancer: a decade of experience at a single institution. Ann Surg Oncol. 2013;20(9):1–7.

    Google Scholar 

  53. McEntee GP, Nagorney DM, Kvols LK, Moertel CG, Grant CS. Cytoreductive hepatic surgery for neuroendocrine tumors. Surgery. 1990;108(6):1091–6.

    CAS  PubMed  Google Scholar 

  54. Sarmiento JM, Heywood G, Rubin J, Ilstrup DM, Nagorney DM, Que FG. Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival. J Am Coll Surg. 2003;197(1):29–37.

    Article  PubMed  Google Scholar 

  55. Glazer ES, Tseng JF, Al-Refaie W, Solorzano CC, Liu P, Willborn KA, et al. Long-term survival after surgical management of neuroendocrine hepatic metastases. HPB (Oxford). 2010;12(6):427–33.

    Article  Google Scholar 

  56. Mayo SC, de Jong MC, Bloomston M, Pulitano C, Clary BM, Reddy SK, et al. Surgery versus intra-arterial therapy for neuroendocrine liver metastasis: a multicenter international analysis. Ann Surg Oncol. 2011;18(13):3657–65.

    Google Scholar 

  57. Graff-Baker AN, Sauer DA, Pommier SJ, Pommier RF. Expanded criteria for carcinoid liver debulking: Maintaining survival and increasing the number of eligible patients. Surgery. 2014;156(6):1369–76–discussion1376–7.

    Google Scholar 

  58. Berber E, Flesher N, Siperstein AE. Laparoscopic radiofrequency ablation of neuroendocrine liver metastases. World J Surg. 2002;26(8):985–90.

    Article  PubMed  Google Scholar 

  59. Mazzaglia PJ, Berber E, Milas M, Siperstein AE. Laparoscopic radiofrequency ablation of neuroendocrine liver metastases: a 10-year experience evaluating predictors of survival. Surgery. 2007;142(1):10–9.

    Article  PubMed  Google Scholar 

  60. Gupta S, Johnson MM, Murthy R, Ahrar K, Wallace MJ, Madoff DC, et al. Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors: variables affecting response rates and survival. Cancer. 2005;104(8):1590–602.

    Google Scholar 

  61. Ruutiainen AT, Soulen MC, Tuite CM, Clark TWI, Mondschein JI, Stavropoulos SW, et al. Chemoembolization and bland embolization of neuroendocrine tumor metastases to the liver. J Vasc Interv Radiol. 2007;18(7):847–55.

    Article  PubMed  Google Scholar 

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Porembka, M.R., Choti, M.A. (2017). Liver Metastases: Basic Principles of Treatment and Clinical Data. In: Meyer, J., Schefter, T. (eds) Radiation Therapy for Liver Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-54531-8_17

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