Management of Metastic Liver Cancer
The liver is the most common site for blood-borne metastasis from colorectal cancers, and is the dominant metastatic disease site just prior to death (Stewart et al. 2018). Until the early 1980s, it was generally accepted that hepatic metastases from colorectal cancer represented just one site in a wide systemic dissemination of tumor, and partial hepatectomy was rarely used as treatment. Since then, numerous studies have shown that resection can prolong survival and potentially provide cure. Surgical excision for hepatic metastases from colorectal cancer is now considered standard therapy for patients with metastases isolated to the liver. In the next section, we will summarize the data supporting such therapies, as well as clinical parameters that influence outcome. Since acceptance of surgery as a local therapy for this disease, a number of other local therapies have emerged as effective treatment options for hepatic metastases. The data supporting use of ablative, radioembolic, and radiation therapies will also be presented. These tissue-sparing local treatments for hepatic colorectal metastases have further extended treatment possibilities. Recent advancements in chemotherapies and biologic therapies have also contributed to effective treatment for hepatic colorectal metastases and extended the possibility for cure. Patients previously beyond curative therapies can be converted by systemic therapies to becoming resectable. Those not resectable for cure are effectively treated by systemic and regionally delivered therapies, including hepatic artery infusion pump therapy, to achieve extension of life. In the following sections we will also present the current approach of palliative neoadjuvant, and adjuvant systemic and regional infusion therapies. The combined advances in surgery, systemic and regional infusion therapies, along with radiation, radioembolization, and ablative therapies have transformed this disease from uniformly and immediately fatal to an increasingly curable one.
