Interventional Oncologic Approaches to Liver Metastases

The adequate treatment of non-resectable liver metastases from colorectal cancer which are resistant to systemic chemotherapy currently provides a great challenge. The aim is to identify and review key strategies in the treatment of colorectal liver metastases. A search for current literature on the topic of interventional strategies for colorectal metastases was performed in Medline in order to achieve this goal. Studies before 2005 and with ,20 patients treated for colorectal metastases were excluded. Transarterial chemoembolization (TACE), transarterial embolization and selective internal radiation therapy (SIRT) were identified as examples of regional strategies for colorectal liver metastases, utilizing the unique blood supply of the liver. Radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation were selected as examples for currently available ablative techniques. Median survival in the key studies reviewed ranged from 7.7 to 28.6 for TACE, 8.3-12.6 for SIRT, 8.2-53.2 for RFA and 29-43 months for MWA. After review of the literature, it can be concluded that interventional oncologic therapies are a safe and effective method for treating colorectal liver metastases. The use of new chemotherapeutic agents for local therapy and new ablation technologies and techniques may increase patient survival and allows a neoadjuvant therapy setting. In addition, a combination of local therapies may be used to increase effectiveness in the future, which is subject to further research. INTRODUCTIONColorectal cancer is one of the most common cancers that shows fatal progression.1 Colorectal carcinoma most commonly metastasises to the liver due to haematogenous spread.2 At the time of diagnosis, 20-30% of patients have liver metastases, and during the course of disease, up to 60% of patients develop hepatic metastases.3 Although surgical excision is the first-line treatment for colorectal metastases, only 10-25% of patients are candidates for surgical resection. 4 Neoadjuvant systemic chemotherapy only allows 10-30% of patients with unresectable colorectal liver metastases sufficient downsizing for resection.

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“…For the remaining patients, locoregional therapies can be used for neoadjuvant, symptomatic and palliative treatments. 6,7 …”

Section: Introductionmentioning

confidence: 99%

Current strategies in interventional oncology of colorectal liver metastases

Gruber‐Rouh

Marko

Thalhammer

et al. 2016

BJR

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“…The main treatment options in metastatic liver tumors, particularly in colorectal tumors, are surgery and chemotherapy, and locoregional therapies are also preferred in appropriate patients (5).…”

Section: Introductionmentioning

confidence: 99%

Radioembolization Treatment for Liver Cancer

Erdoğan¹,

Özdemir²,

Aydın³

2016

Bezmialem Science

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Although curative treatment is surgery (resection/transplantation) and for small lesions ablative strategies, in primary liver carcinomas such as hepatocellular carcinoma and cholangiocellular carcinoma, palliative treatment is used for most of these patients because of lack of surgical options. These treatments are regional treatments such as transarterial chemoembolization, radiofrequency ablation, or microwave ablation and systemic treatments such as tyrosine kinase inhibitors. Surgery and chemotherapy are the main treatment options for metastatic liver tumors, particularly in colorectal tumors, although local treatment options are used for these patients. In recent years, transarterial radioembolization with yttrium-90 microsphere has emerged as a local treatment option in primary and metastatic liver tumors. The aim of this treatment is to provide an effective radiation dose distribution for the tumor in the liver tissue and to give the lowest dose in order to not harm the intact liver tissue. Radioembolization has proven to be as effective as other available palliative treatments in primary and secondary liver tumors and is a treatment method that is well tolerated. It has a risk for serious life-threatening complications, although this rate is low. Toxicity can be kept at a minimum with adequate technical and rigorous application in experienced hands and in accordance with multidisciplinarity. It is hoped that the effectiveness of radioembolization is further increased in the future by technological developments, researches on dosimetry, its use along with radiosensitizing agents, and various treatment combinations.Keywords: Radioembolization, Yttrium-90 microsphere, liver treatment IntroductionHepatocellular carcinoma (HCC) is one of the world's most common abdominal malignancies. Most patients have an underlying liver disease. The stage of tumor and the functional capacity of the liver determine the prognosis. A practical staging system based on the tumor burden, the liver function reserve, physical condition, and symptoms associated with cancer was developed by the Barcelona group (Barcelona Clinic Liver Cancer, BCLC). The tumor burden is determined by the number of tumors, size of tumor, portal vein invasion, or presence of extrahepatic metastasis. Here, the functional reserve of the liver is determined according to the Child-Pugh staging system (consists of serum albumin and bilirubin levels, the presence of acid and encephalopathy, prothrombin time/INR findings) and the physical condition is determined according to the performance classification of the Eastern Cooperative Oncology Group (ECOG). This staging system and accordingly, the overall treatment approach are summarized in Table 1 (1, 2).While only 30%-40% of patients are appropriate for curative treatment (resection, transplantation and ablation for small lesions), the vast majority of about 60% is in the middle (B) or advanced (C) stage (2). The general prognosis is poor in these patients with no potential curative treatment. Until n...

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“…По данным другого исследования, медиана выжи-ваемости варьирует между 24 и 52 мес с общей 5-лет-ней выживаемостью от 18 до 44 % после первой про-цедуры радиочастотной абляции [19].…”

Section: Introductionunclassified

“…Современные мультидисциплинарные подходы к терапии этой патологии практически немыслимы без участия врачей-рентгенохирургов. Традиционные сосудистые методы воздействия на метастазы в пече-ни включают в себя химиоинфузию, химиоэмболиза-цию, эмболизацию питающего сосуда и радиоэмбо-лизацию [19].…”

Section: Introductionunclassified