Disappearing Colorectal Liver Metastases: Do We Really Need a Ghostbuster?

Abstract

The development of new systemic treatment strategies has resulted in a significant increase in the response rates of colorectal liver metastases (CRLM) in the last few years. Although the radiological response is a favorable prognostic factor, complete shrinkage of CRLM, known as disappearing liver metastases (DLM), presents a therapeutic dilemma, and proper management is still debated in the literature. In fact, DLM is not necessarily equal to cure, and when resected, pathological examination reveals in more than 80% of patients a variable percentage of the tumor as residual disease or early recurrence in situ. Moreover, while a higher incidence of intrahepatic recurrence is documented in small series when surgery is avoided, its clinical significance for long-term OS is still under investigation. In light of this, a multidisciplinary approach and, in particular, radiologists’ role is needed to assist the surgeon in the management of DLM, thanks to emerging technology and strategy. Therefore, the aim of this review is to provide an overview of the DLM phenomenon and current management.

Assessment of the response to systemic treatment of colorectal liver metastases on cross-sectional imaging – a systematic review

“…The best treatment option for these lesions is still being disputed in the literature, highlighting radiological response as a favourable prognostic factor [ 54 ]. In reality, DLM is not always synonymous with cure, and when resected, pathological analysis shows that in more than 80% of patients there is a variable percentage of the residual tumour or an early recurrence in situ [ 55 ]. The complete curing of CRLM with systemic therapy is a rare phenomenon that now occurs in less than 5% of cases [ 55 ].…”

“…In reality, DLM is not always synonymous with cure, and when resected, pathological analysis shows that in more than 80% of patients there is a variable percentage of the residual tumour or an early recurrence in situ [ 55 ]. The complete curing of CRLM with systemic therapy is a rare phenomenon that now occurs in less than 5% of cases [ 55 ]. Thanks to the development of innovative oncological strategies, a higher rate of patients will develop DLM in the future [ 56 ].…”