Liver-Directed Therapies in Colorectal Cancer: Old Hats and New Tricks

Resection of liver metastases is considered the only treatment with curative potential for patients with metastatic colorectal cancer to the liver (CRLM). However, only a minority of patients with CRLM are eligible for up-front resection of liver metastases. Despite advances in systemic chemotherapy, long-term survival is rare without resection of liver metastases. This highlights the unmet need for alternative localized treatment options for patients with unresectable colorectal liver metastases (uCRLM). Liver-directed therapies include hepatic artery infusion pump (HAIP) therapy and nonsurgical locoregional approaches including image-guided ablation, Y90 radioembolization (TARE), and stereotactic body radiation therapy. More recently, emergent data support the use of liver transplantation (LT) in select patients with uCRLM. In this chapter, we review the data for various liver-directed therapies revolutionizing the treatment approach and improving clinical outcomes for patients with uCRLM.