Malignant Liver Tumors (Metastatic Liver Disease)
Treatment for metastatic disease to the liver involves understanding the full disease burden, including the primary tumor, and disease behavior. Dedicated liver imaging is essential to determine the number and distribution of hepatic lesions. The potential functional liver remnant must be ascertained. Depending on previously mentioned factors, surgical resection or liver-directed therapies can offer enhanced survival but must be balanced with systemic therapy, which should always be considered in metastatic disease. Surgery for the primary tumor should be considered in addition to the liver but may occur either in a staged or combined setting. Surveillance should occur following treatment to monitor for disease recurrence. Patients with hepatic disease that progresses on first-line chemotherapy should be switched to second-line therapy and monitored. For those who have disease that is unresectable and progressive, systemic therapy or a clinical trial remain the only options.
KeywordsMetastatic liver disease Functional liver remnant Liver-directed therapies Yittrium-90 radioembolization Combined resection Staged resection
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