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Updated: Jan 28, 2026

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Liver-Directed Therapy for Colorectal Cancer: Where Are We Now?

Yi Song1, Meenakshi Jeeva2,3, Robert P Liddell4

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For colorectal cancer with liver metastases (CRLM), surgical resection is ideal but not always possible. Liver-directed therapies offer crucial local-regional treatment options for unresectable disease, improving survival.

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Area of Science:

  • Oncology
  • Hepatology
  • Surgical Oncology

Background:

  • Colorectal cancer frequently metastasizes to the liver, with 25% of patients diagnosed with liver metastases and 50% developing them over time.
  • Surgical resection is the gold standard for liver metastases, but many patients with colorectal liver metastases (CRLM) are ineligible for upfront surgery.

Purpose of the Study:

  • To review the spectrum of liver-directed therapies for unresectable colorectal liver metastases (uCRLM).
  • To discuss the outcomes and ongoing developments in local-regional therapies for uCRLM.

Main Methods:

  • Review of current literature on liver-directed therapies for uCRLM.
  • Discussion of multidisciplinary approaches combining systemic therapy with local treatments.
  • Evaluation of various local-regional options including hepatic artery infusion, SBRT, ablation, and transarterial therapies.

Main Results:

  • Long-term survival for CRLM is significantly influenced by liver-directed treatments, even with advances in systemic chemotherapy.
  • Several local-regional options exist for uCRLM, including hepatic artery infusion pump therapy, SBRT, ablation, and transarterial chemoembolization/radioembolization.
  • Emerging evidence supports liver transplantation for selected patients with uCRLM.

Conclusions:

  • A multidisciplinary approach is essential for managing CRLM, tailoring treatment to individual patient goals.
  • Various liver-directed therapies provide valuable options for patients with unresectable CRLM, impacting survival outcomes.
  • Ongoing research and evolving techniques continue to expand the therapeutic landscape for CRLM.