Liver metastases of colorectal carcinomas

Wasser K, Giebel F, Fischbach R, Tesch H, Landwehr P (2005) Transarterial chemoembolization of liver metastases of colorectal carcinoma using absorbable starch microspheres (Spherex). Our own investigations and review of the literature. Radiologe 45 633-643... 

Imaging During Therapy 154 Clinical Data of MR-Guided LITT of Liver Metastases 155 Results and Prognostic Factors of Liver Metastases of Colorectal Carcinoma 157 Liver Metastases of Breast Cancer 160 Liver Metastases of Gastric Cancer 161 Liver Metastases of Pancreatic Cancer 161 References 163... 

The mean values of the applied energy were statistically significantly higher in liver metastases of colorectal carcinoma versus liver metastases of breast carcinoma and hepatocellular carcinoma (ANOVA test p< 0.01). 

Results and Prognostic Factors of Liver Metastases of Colorectal Carcinoma... 

The lymph node status, the time interval between primary tumor and liver metastases, and the number of initial liver metastases after MR-guided LITT were prognostic factors regarding the survival of patients. MR-guided LITT yields high local tumor control and survival rates in patients with liver metastases of colorectal carcinoma. In surgical candidates LITT seems to be superior to resection. 

Dimitrakopoulou, A., Strauss, L.G., Clorius, J.H., Ostertag, H., Schlag, R, Heim, M., Oberdorfer, R, Heins, R, Haberkorn, U., van Kaick, G. Studies with positron emission tomography after systemic administration of fluorine-18-uracil in patients with liver metastases from colorectal carcinoma. J. Nucl. Med. 1993 34 1075-1081... 

Pentecost MJ, Daniels JR, Teitelbaum GP, Stanley P (1993) Hepatic chemoembolization safety with portal vein thrombosis. J Vase Interv Radiol 4 347-351 Popov I, Lavrnic S, Jelic S, Jezdic S, Jasovic A (2002) Chemoembolization for liver metastases from colorectal carcinoma risk or a benefit. Neoplasma 49 43-48 Ramsey DE, Kernagis LY, Soulen MC, Geschwind JF (2002) Chemoembolization of hepatocellular carcinoma. J Vase Interv Radiol 13 S211-221... 

Liver metastases are the most common tumors in Europe and the United States and are 20 times more common than in Africa, Japan and Eastern countries. The liver is the most common site of metastasis. Colorectal cancer is the third leading cause of death in Western communities, outnumbered only by lung and breast cancer. At the time of death, approximately two-thirds of patients with colorectal cancer have liver metastases. Survival in metastatic liver disease depends on the extent of liver involvement and the presence of metastatic tumors. In several studies, liver metastases of colon carcinoma which were confined to one lobe and involved an area of less than 25% of the liver caused death in 6 months when untreated (Stangl et al. 1994). When 25-75% of the liver was involved, survival was 5.5 months and when more than 75% of the liver was involved, death occurred in 3.4 months. 

Cady B, Stone MD (1991) The role of surgical resection of liver metastases in colorectal carcinoma. Semin Oncol... 

Lorenz M, Heinrich S, Staib-Sebler E,et al (2000) Relevance of locoregional chemotherapy in patients with liver metastases from colorectal primaries. Swiss Surg 6 11-22 Lorenz M, Waldeyer M (1997) The resection of the liver metastases of primary colorectal tumors. The development of a scoring system to determine the individual prognosis based on an assessment of 1568 patients. Strahlenther Onkol 173 118-119 Lorenz M, Muller HH (2000) Randomized multicenter trial of fluorouracil plus leucovorin administered either via hepatic arterial or intravenous infusion versus fluoro-deoxyuridine administered via hepatic arterial infusion in patients with nonresectable liver metastases from colorectal carcinoma (see comments]. J Clin Oncol 18 243-254... 

Kemeny N, Conti JA, Cohen A, et al (1994) Phase II study of hepatic arterial floxuridine, leucovorin and dexametha-sone for unresectable liver metastases from colorectal carcinoma. J Clin Oncol 12 2288-2295... 

Rivoire M, De Cian F, Meeus P, et al (2002) Combination of neoadjuvant chemotherapy with cryotherapy and surgical resection for the treatment of unresectable liver metastases from colorectal carcinoma. Cancer 95 2283-2292... 

Rougier P, Laplanche A, Huguier M, et al (1992) Hepatic arterial infusion of floxuridine in patients with liver metastases from colorectal carcinoma long-term results of a prospective randomized trial. J Clin Oncol 10 1112-1118... 

Moehler M, Dimitrakopoulou-Strauss A, Gutzler F et at. (1998) 18F-labeled fluorouradl positron emission tomography and the prognoses of colorectal carcinoma patients with metastases to the liver treated with 5-fluorouracil. Cancer 83 245-253... 

The liver is the most frequent site of metastases as a result of the portal circulation and up to 60%-80% of patients with a history of colorectal carcinoma, pancreas carcinoma, breast cancer or other tumor types will develop metastases within the liver during the follow-up period [1]. There is no doubt that surgical resection of these metastases is the only potential curative option for these patients and is therefore considered as gold standard. However, due to anatomic or technical reasons or simple inoperability. 

Our data in a large population with liver metastases of different primary tumors, mainly colorectal carcinomas, show a very high local control rate (over 97% in 3- and 6-month control studies) and a very low local recurrence rate. LITT treatment can be performed easily under local anesthesia on an outpatient basis in metastases up to 5 cm in diameter with a 1-cm safety margin, which is very important for a low recurrence rate. Multiple applications can be performed simultaneously. 

In patients presenting hepatobiliary malignancies without chronic liver disease, Abdalla et al. reported equivalent median survival durations when they underwent PVE or not prior to extended hepatectomy (> or = 5 segments), respectively 40 and 52 months [2]. We have reported 5-year survival and 5-year disease-free survival of 34% and 24% respectively in 60 patients who underwent PVE for liver metastases, that was comparable with the survival rates obtained after resection without PVE [14]. Compared long-term results from the literature, in specific groups of patients presenting with liver metastases from colorectal primary or with hepatocellular carcinoma, are summarized in Table 13 4. All these studies demonstrated equivalence in 5-year survival and 5-year disease-free survival between groups of patients preoperatively treated by PVE or not (Table 13.4). 

Table 13.4. Long-term survival of patients with liver metastases from colorectal cancer or hepatocellular carcinoma statistical equivalence in long-term survival rates between groups of patients who underwent preoperative PVE (PVE) or not (NPVE)...

Two thirds of patients with colorectal carcinoma (CRC) have liver metastases by the time of death (Vogl et al. 2004). For CRC hepatic metastases, survival is determined by the number and extent of metastases. In untreated patients with liver metastases of CRC the median survival time is from 4.5 to 15 months (Vogl et al. 2004). Only 5%-10% of all patients with liver metastases of CRC are suitable for resection (Nordlinger et al. 1996 Petrelli et al. 1985 Hughes et al. 1988). After resection, the 5-year survival time improves from 16% to 40%. Only 20%-30% of patients undergoing liver resection will remain free from tumor recurrence (Vogl et al. 2004). 

Fernandez-Trigo V, Shamsa F, Sugarbaker PH (1995) Repeat liver resection from colorectal metastases. Repeat Hepatic Metastases Registry. Surgery 117 296-304 Finlay IG, Meek D, Brunton F, et al (1988) Growth rate of hepatic metastases in colorectal carcinoma. Br J Surg 75 641-644... 

Hunt TM, Carty N, Johnson CD (1990) Resection of liver metastases from a colorectal carcinoma does not benefit the patient. Ann R Coll Surg Engl 72 199-205 Imamura H, Sano K, Harihara Y, et al (2003) Complete remission of disease for 5 years following initial and repeat resection of the liver for the removal of 22 metastases of colorectal origin. J Hepatobiliary Pancreat Surg 10 321-324... 

Animal experiments in BALB/c-mice and in DBA/2-mice confirmed that the blockade of HL with D-Gal-containing eompounds can inhibit metastatic spread into liver. In a clinical trial of colorectal carcinoma patients (UICC stages I-III) with D-Gal treatment (1.5 g/kg body weight per day), the patients with stage III carcinoma showed some indication for an overall benefit in survival [58]. Similar D-Gal treatment of stomach adenocarcinoma patients also showed significantly reduced hepatic metastases and significantly improved overall survival for patients in the treatment group [59]. 

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