Local therapies for hepatic metastases

Area of Science:

• Hepatology
• Surgical Oncology
• Interventional Radiology

Background:

• The liver is a frequent site for metastatic disease, primarily from colorectal and neuroendocrine cancers.
• Surgical resection is curative but often not feasible due to disease extent, location, or patient comorbidities.
• Locoregional therapies are crucial for managing unresectable liver metastases.

Purpose of the Study:

• To evaluate current regional treatment strategies for liver metastases, focusing on colorectal liver metastases (CRLM) and neuroendocrine liver metastases (NELM).
• To highlight the clinical utility and limitations of various locoregional modalities.
• To inform multidisciplinary management decisions for patients with liver metastases.

Main Methods:

• Review of available evidence on regional strategies for liver metastases.
• Emphasis on locoregional treatments including ablation, hepatic arterial infusion, radioembolization, and stereotactic body radiotherapy.
• Evaluation of complementary approaches like portal vein embolization.

Main Results:

• Locoregional therapies offer options for converting unresectable CRLM to resectable and improving local control.
• For NELM, liver-directed treatments can reduce hormone-related morbidity and potentially extend survival.
• Various local approaches serve as alternatives or adjuncts to surgical resection.

Conclusions:

• Multidisciplinary management is essential for optimizing the care of patients with liver metastases.
• Locoregional therapies play a vital role in managing unresectable colorectal and neuroendocrine liver metastases.
• Understanding the evidence for each modality is key to effective treatment planning.