Liver-Directed Therapy in Metastatic Colorectal Cancer

Approximately 50–70 % of patients with colorectal cancer ultimately develop colorectal liver metastases. Determining which patients may benefit from aggressive treatment has historically been achieved through clinical predictive models. However, factors such as radiographic response to neoadjuvant therapy should also be taken into consideration. Recently, molecular markers have emerged as an adjunct to clinical-pathologic factors and provide a surrogate for tumor biology. With improved understanding of tumor biology, the likelihood of recurrence can be better predicted. However, when feasible, the best chance for cure entails surgical resection as a part of multimodal therapy, and select patients can achieve prolonged median survival. Alternatively, ablation techniques may be used in conjunction with surgery or as isolated therapy in patients who are not candidates for surgical resection. Transarterial therapy may also provide clinical benefit in certain patient subsets with unresectable disease. These strategies have allowed for a more tailored approach to patients with colorectal liver metastases.