Treating Liver Metastases in Colorectal Cancer

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In the setting of hepatic metastatic disease from colorectal cancer (CRC), surgical resection is the mainstay of therapy. Furthermore, extrahepatic metastases no longer preclude liver resection, since induction chemotherapy can be used to reduce the volume of metastases, says Volker Heinemann, MD.

The number of options for local regional and liver-directed therapies has increased dramatically over the years. Two main categories include ablation technologies, such as radiofrequency ablation, cryoablation, microwave, and irreversible electropolation, which eliminate, burn, freeze, or disrupt visible tumors based on image guidance methods, explains David Liu, MD. As such, ablation therapies are appropriate for larger, visible tumors.

In micrometastatic disease, embolotherapies encompass chemoembolization, drug eluting beads, and radioembolization. Chemoembolization is rarely performed in this setting, as there is no level 1 evidence demonstrating its efficacy in metastatic CRC, states Liu; however, radioembolization may be appropriate. The products that are available have unique properties that have to be considered, adds Liu.

The multidisciplinary tumor board is integral to the contemporary management of metastatic CRC, comments Liu. On the multidisciplinary board, experts meet to discuss various options, the level of evidence behind them, and to make critical decisions as a collaborative effort. The multidisciplinary team is the best way to ensure quality when treating CRC liver metastases, Heinemann agrees.