Management of hepatic metastases

Abstract

Although the liver is the most common site of metastatic disease from a variety of tumor types, isolated hepatic metastases most commonly occur from colorectal cancer and, less frequently, from neuroendocrine tumors, gastrointestinal sarcoma, ocular melanoma, and others. Complete evaluation of the extent of metastatic disease, both intrahepatically and extrahepatically, is important before considering treatment options. Based on a preponderance of uncontrolled studies for hepatic metastatic colorectal carcinoma, surgical resection offers the only potential for cure of selected patients with completely resected disease, with 5-year survival rates of 25% to 46%. Systemic and hepatic arterial infusion chemotherapy may be useful treatment options in patients with unresectable disease and possibly as an adjuvant treatment after liver resection. Other techniques of local tumor ablation, including cryotherapy and radiofrequency ablation, although promising, remain unproved. Management of hepatic metastases from neuroendocrine tumors and other noncolorectal primary tumors should be individualized based on the patient's clinical course, extent of disease, and symptoms. Copyright 1999 by the American Association for the Study of Liver DiseasesA s many as 50% of the patients with a primary malignancy will eventually develop metastases in the liver, a percentage greater than for any other organ, including the lung. Although primary tumors that drain principally into the portal circulation are more likely than others to develop hepatic metastases, many tumors arising in other sites, such as the breast and lung, also commonly develop hepatic metastases. Although the liver represents a common site of spread from many of these solid tumors, isolated hepatic metastases most commonly occur from colorectal and neuroendocrine tumors. Other less common malignancies also can metastasize predominantly to the liver. For most other solid malignancies, the pattern of metastatic disease is most often that of generalized dissemination. Colorectal MetastasesCancer of the colon and rectum is the third most commonly diagnosed cancer in the United States. An estimated 131,600 new cases will have been discovered in 1998, comprising 11% of new cancer diagnoses. 1 An estimated 56,500 deaths will occur from colorectal cancer that year, comprising 10% of all cancer deaths. 1 Although mortality from largebowel cancer has been improving over the past 30 years, largely because of improvements in early detection, diagnosis, and treatment, approximately 50% of the patients with colorectal cancer eventually die of their neoplastic disease. 1 The liver is the most commonly involved organ in patients with metastatic colorectal cancer. Approximately 20% of these patients have clinically recognizable liver metastases at the time of their primary diagnosis. 1,2 After resection of a primary colorectal cancer in the absence of apparent metastatic disease, approximately 50% of the patients will subsequently manifest metastatic liver disease. Given these figures,...

Selective inhibition of proprotein convertases represses the metastatic potential of human colorectal tumor cells

“…Although the liver is a common site for metastases from various forms of primary tumors, isolated hepatic metastases most commonly occur from colorectal cancer (1,2). The hepatic resection for metastatic tumors from colorectal cancer remains the only curative option, and systemic or intra-arterial hepatic chemotherapy constitutes an alternative in some cases for patients with unresectable disease (1)(2)(3)(4).…”

“…The hepatic resection for metastatic tumors from colorectal cancer remains the only curative option, and systemic or intra-arterial hepatic chemotherapy constitutes an alternative in some cases for patients with unresectable disease (1)(2)(3)(4). However, the significance of hepatic resection for gastric metastasis has been controversial (1,3). Thereby, better understanding of the cell and molecular biology of liver colorectal metastasis will facilitate the development of new efficient drugs and strategies that could supplement the conventional ones.…”

Surveillance of patients following surgery with curative intent for colorectal cancer

“…Detecting recurrent disease is only useful if early treatment leads to an improved prognosis. Although the majority of relapsing patients are incurable, around one third of patients with isolated distant or locoregional recurrence are alive at 5 years after treatment, and long-term survival is possible [21,[23][24][25][26][27][28][29][30][31][32][33] . Rates of resection for isolated or limited disease recurrence have increased, and approximately 20% of patients with hepatic relapse are currently considered for surgery [24,32,34] .…”

Role of percutaneous ethanol ablation in malignant liver tumours

“…Fluoroscopy, ultrasound, CT, MRI and CO2-enhanced sonography can all be employed for image guidance. [13,15] Ultrasound offered easy manoeuvrability, accurate localisation of tumours and real time monitoring but visibility of tumour and needle was hampered due to echogenicity produced by injected ethanol. So it is advisable to inject the deeper part of the tumour first.…”