Advertisement

Malignant Liver Tumors (Metastatic Liver Disease)

  • Neal M. Mineyev
  • Karla M. Chaffee
  • Joyce Wong
Chapter

Abstract

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.

Keywords

Metastatic liver disease Functional liver remnant Liver-directed therapies Yittrium-90 radioembolization Combined resection Staged resection 

References

  1. 1.
    Covey AM, Brown KT, Jarnagin WR, et al. Combined portal vein embolization and neoadjuvant chemotherapy as a treatment strategy for resectable hepatic colorectal metastases. Ann Surg. 2008;247:451–5.CrossRefGoogle Scholar
  2. 2.
    Poultsides GA, Servais EL, Saltz LB, et al. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. JCO. 2009;27(20):3379–84.CrossRefGoogle Scholar
  3. 3.
    NCCN Clinical Practice Guidelines in Oncology, Colon Cancer. Version 2.2017 – March 13, 2017. NCCN.org.
  4. 4.
    Abdalla EK, Vauthey JN, Ellis LM, et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg. 2004;239:818–25.CrossRefGoogle Scholar
  5. 5.
    Van Hazel GA, Heinemann V, Sharma NK, et al. SIRFLOX: randomized phase III trial comparing first-line mFOLFOX6 (plus or minus bevacizumab) versus mFOLFOX6 (plus or minus bevacizumab) plus selective internal radiation therapy in patients with metastatic colorectal cancer. JCO. 2016;34:1723–31.CrossRefGoogle Scholar
  6. 6.
    Zacharias AJ, Jayakrishnan TT, Rajeev R, et al. Comparative effectiveness of hepatic artery based therapies for unresectable colorectal liver metastases: a meta-analysis. PLoS One. 2015;10:e0139940.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Neal M. Mineyev
    • 1
  • Karla M. Chaffee
    • 1
  • Joyce Wong
    • 1
  1. 1.Department of General SurgeryLenox Hill HospitalNew YorkUSA

Personalised recommendations