Local Treatments in the Unresectable Patient with Colorectal Cancer Metastasis: A Review from the Point of View of the Medical Oncologist.

Javier Torres-Jiménez,Jorge Esteban-Villarrubia,Alfredo Carrato,Reyes Ferreiro-Monteagudo

doi:10.3390/cancers13235938

Abstract

For patients with isolated liver metastases from colorectal cancer who are not candidates for potentially curative resections, non-surgical local treatments may be useful. Non-surgical local treatments are classified according to how the treatment is administered. Local treatments are applied directly on hepatic parenchyma, such as radiofrequency, microwave hyperthermia and cryotherapy. Locoregional therapies are delivered through the hepatic artery, such as chemoinfusion, chemoembolization or selective internal radiation with Yttrium 90 radioembolization. The purpose of this review is to describe the different interventional therapies that are available for these patients in routine clinical practice, the most important clinical trials that have tried to demonstrate the effectiveness of each therapy and recommendations from principal medical oncologic societies.

Highlights

Colorectal cancer (CRC) is the third cancer in incidence rate in adults and the second most common cause of cancer-related death in Europe [1,2,3]
(18.2% of patients with CRC) with a controlled primary tumor and up to 5 metastatic lesions were randomized to systemic palliative therapy versus standard of care and Stereotactic body radiotherapy (SBRT) of all metastatic lesions
The treatment of liver metastases of colorectal cancer (LMCRC) is a clear example of advances in oncology that illustrates a change in a classic oncology idea

Summary

Introduction

Colorectal cancer (CRC) is the third cancer in incidence rate in adults and the second most common cause of cancer-related death in Europe [1,2,3]. Metastatic disease to the liver is present in 20% of patients with CRC at the time of diagnosis and appears in an additional 40% over the course of earlier-stage disease treated with resection. In 30% of patients, the liver is the only site of metastatic disease [4]. Liver resection or surgical metastasectomy is the best chance of cure for patients with liver metastases of colorectal cancer (LMCRC), especially in liver-limited or oligometastatic disease [5]. The number of metastases accepted as oligometastic disease that would benefit from local treatment is not well established, but the change in prognosis of these patients appears in the 8th American. Only up to 25% of eligible patients undergo resection because of the presence of co-morbidities or unresectability.

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