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Transarterial chemoembolization (TACE) for colorectal liver metastases—current status and critical review

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Abstract

Background

Transarterial liver-directed therapies are currently not recommended as a standard treatment for colorectal liver metastases. Transarterial chemoembolization (TACE), however, is increasingly used for patients with liver-dominant colorectal metastases after failure of surgery or systemic chemotherapy. The limited available data potentially reveals TACE as a valuable option for pre- and post-operative downsizing, minimizing time-to-surgery, and prolongation of overall survival after surgery in patients with colorectal liver only metastases.

Purpose

In this overview, the current status of TACE for the treatment of liver-dominant colorectal liver metastases is presented. Critical comments on its rationale, technical success, complications, toxicity, and side effects as well as oncologic outcomes are discussed. The role of TACE as a valuable adjunct to surgery is addressed regarding pre- and post-operative downsizing, conversion to resectability as well as improvement of the recurrence rate after potentially curative liver resection. Additionally, the concept of TACE for liver-dominant metastatic disease with a focus on new embolization technologies is outlined.

Conclusions

There is encouraging data with regard to technical success, safety, and oncologic efficacy of TACE for colorectal liver metastases. The majority of studies are non-randomized single-center series mostly after failure of systemic therapies in the 2nd line and beyond. Emerging techniques including embolization with calibrated microspheres, with or without additional cytotoxic drugs, degradable starch microspheres, and technical innovations, e.g., cone-beam computed tomography (CT) allow a new highly standardized TACE procedure. The real efficacy of TACE for colorectal liver metastases in a neoadjuvant, adjuvant, and palliative setting has now to be evaluated in prospective randomized controlled trials.

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Conflicts of interest

Götz M. Richter declares the following potential conflicts of interest regarding this article: technical study support and grants from Siemens Medical Solutions. Hans U. Kauczor declares the following potential conflicts of interest: consultant, honorars, grants, and advisory boards for Siemens Medical Solutions, Boehringer Ingelheim, Bayer, Novartis, Almirall, and GlaxoSmithKlein. Philippe L. Pereira declares the following potential conflicts of interest regarding this article: consultant, honorars, grants, and advisory boards for Terumo, Pharmacept, Celonova BioSciences, Bayer, Microventure, BTG, and Siemens Medical Solutions. Christof M. Sommer declares the following potential conflicts of interest regarding this article: technical study support and grants from Celonova BioSciences, PharmaCept, and Siemens Medical Solutions. All other authors declare that there is no conflict of interest regarding this article.

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This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent is not applicable for this study.

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Authors and Affiliations

  1. Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Geb. 50.1, 66421, Homburg Saar, Germany

    Alexander Massmann, Roland Seidel & Arno Bücker

  2. Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany

    Thomas Rodt, Steffen Marquardt & Frank Wacker

  3. Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Kriegsbergstrasse 50-55, 70174, Stuttgart, Germany

    Katrina Thomas, Götz M. Richter & Christof M. Sommer

  4. Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, INF 110, 69120, Heidelberg, Germany

    Hans U. Kauczor & Christof M. Sommer

  5. Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, Am Gesundbrunnen 20-26, 74078, Heilbronn, Germany

    Philippe L. Pereira

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  1. Alexander Massmann
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Massmann, A., Rodt, T., Marquardt, S. et al. Transarterial chemoembolization (TACE) for colorectal liver metastases—current status and critical review. Langenbecks Arch Surg 400, 641–659 (2015). https://doi.org/10.1007/s00423-015-1308-9

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