An update on locoregional percutaneous treatment technologies in colorectal cancer liver metastatic disease

ABSTRACT

Introduction

Liver-dominant metastatic colorectal cancer is noted in approximately 20%–35% of the patients. Systemic chemotherapy remains the first-line treatment for mCRC, but the prognosis is poor due to liver failure. Novel minimally invasive technologies have enabled the optimization of locoregional treatment options.

Areas Covered

This is a comprehensive review of novel locoregional treatment technologies, both percutaneous ablation and transcatheter arterial treatments, which can be used to decrease hepatic disease progression in patients with mCRC. Trans-arterial radioembolization is the most recently developed locoregional treatment for metastatic liver disease, and robust evidence has been accumulated over the past years.

Expert Opinion

Image-guided techniques, endovascular and ablative, have gained wide acceptance for the treatment of liver malignancies, in selected patients with non-resectable disease. The optimization of dosimetry and microsphere technological advancement will certainly upgrade the role of liver radioembolization segmentectomy or lobectomy in the upcoming years, due to its curative intent. Also, ablative interventions provide local curative intent, offering significant and sustained local tumor control. Standardization protocols in terms of predictability and reliability using immediate treatment assessment and ablation zone software could further ameliorate clinical outcomes.

KEYWORDS:

• Colorectal liver metastasis
• locoregional percutaneous therapy
• interventional oncology
• ablation
• internal radiation therapy
• chemoembolization

Article highlights

• In recent years, interventional radiology has proposed a wide toolbox of new of locoregional percutaneous treatment options in colorectal cancer liver metastatic disease.

• Trans-arterial chemo- and radio-embolization focus on the delivery of therapy via the hepatic arterial system. High-quality data supporting the use of these methods in CRLM are limited. Since TACE is more investigated compared to TARE, it is generally preferred. Nevertheless, dosimetry and technology optimization will probably upgrade the role of TARE in CRLM in the next years.

• Thermal ablation offers significant and sustained local tumor control, with lower morbidity, mortality, and cost compared to chemotherapy.

• The ablation margin is the most important technical factor in optimizing local tumor control.

• Tumor size and number, location, biology, and genetics are additional factors that can affect efficacy and safety.

• More data from large randomized controlled trials are needed to improve decision-making in patients with advanced CRLM.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers Disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.