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Gastrointestinal Malignancies pp 313–332Cite as

Colorectal Cancer Liver Metastases

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Part of the book series: Practical Guides in Radiation Oncology ((PGRO))

Abstract

Radiation therapy as a viable and major treatment option for liver metastases is a relatively recent development in clinical oncology. The limited role of radiation has largely been due to the availability of surgery and percutaneous thermal ablation therapies, as well as the relative radiosensitivity of the liver. Technological advances in treatment planning and radiation delivery have enabled the safe and effective application of hypofractionated radiation treatments to liver tumors, including patients with colorectal cancer liver metastases. In this chapter, I discuss current clinical practice regarding the management of colorectal cancer liver metastases as well as practical details of treatment planning.

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References

  1. Weiss L, et al. Hematogenous metastatic patterns in colonic carcinoma: an analysis of 1541 necropsies. J Pathol. 1986;150(3):195–203.

    Article  CAS  PubMed  Google Scholar 

  2. Pawlik TM, Choti MA. Surgical therapy for colorectal metastases to the liver. J Gastrointest Surg. 2007;11(8):1057–77.

    Article  PubMed  Google Scholar 

  3. Sugarbaker PH. Metastatic inefficiency: the scientific basis for resection of liver metastases from colorectal cancer. J Surg Oncol Suppl. 1993;3:158–60.

    Article  CAS  PubMed  Google Scholar 

  4. Fong Y, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer. Ann Surg. 1999;230(3):309–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. House MG, et al. Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1,600 patients during two decades at a single institution. J Am Coll Surg. 2010;210(5):744–52.

    Article  PubMed  Google Scholar 

  6. Hoch G, et al. Is intraoperative ultrasound still useful for the detection of colorectal cancer liver metastases? HPB (Oxford). 2015;17(6):514–9.

    Article  Google Scholar 

  7. Grunhagen D, et al. The history of adoption of hepatic resection for metastatic colorectal cancer: 1984–95. Crit Rev Oncol Hematol. 2013;86(3):222–31.

    Article  CAS  PubMed  Google Scholar 

  8. Pawlik TM, et al. Expanding criteria for resectability of colorectal liver metastases. Oncologist. 2008;13(1):51–64.

    Article  PubMed  Google Scholar 

  9. Niemierko A, Goitein M, et al. Modeling of normal tissue response to radiation: the critical volume model. Int J Radiat Oncol Biol Phys. 1993;25(1):135–45.

    Article  CAS  PubMed  Google Scholar 

  10. Schefter TE, et al. A phase I trial of stereotactic body radiation therapy (SBRT) for liver metastases. Int J Radiat Oncol Biol Phys. 2005;62(5):1371–8.

    Article  PubMed  Google Scholar 

  11. Vauthey JN, et al. Standardized measurement of the future liver remnant prior to extended liver resection: methodology and clinical associations. Surgery. 2000;127(5):512–9.

    Article  CAS  PubMed  Google Scholar 

  12. Jaeck D, et al. A two-stage hepatectomy procedure combined with portal vein embolization to achieve curative resection for initially unresectable multiple and bilobar colorectal liver metastases. Ann Surg. 2004;240(6):1037–49.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Malde DJ, et al. Inferior vena cava resection with hepatectomy: challenging but justified. HPB (Oxford). 2011;13(11):802–10.

    Article  Google Scholar 

  14. Kelley ME, et al. Synchronous colorectal liver metastasis: a network meta-analysis review comparing classical, combined, and liver-first surgical strategies. J Surg Oncol. 2015;111(3):341–51.

    Article  Google Scholar 

  15. Breedis C, Young G. The blood supply of neoplasms in the liver. Am J Pathol. 1954;30(5):227–32.

    Google Scholar 

  16. Brown KT, et al. Randomized trial of hepatic artery embolization for hepatocellular carcinoma using doxorubicin-eluting microspheres compared with embolization with microspheres alone. J Clin Oncol. 2016;34(17):2046–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Gulec SA. Y-90 radiomicrosphere therapy for colorectal cancer liver metastases. Semin Nucl Med. 2016;46(2):126–34.

    Article  PubMed  Google Scholar 

  18. Meyer J, Toomay S. Update on treatment of liver metastases: focus on ablation therapies. Curr Oncol Rep. 2015;17(1):420.

    Article  PubMed  Google Scholar 

  19. Oshowo A. Comparison of resection and radiofrequency ablation for treatment of solitary colorectal liver metastases. Br J Surg. 2003;90(10):1240–3.

    Article  CAS  PubMed  Google Scholar 

  20. Mulier S, et al. Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial? Ann Surg Oncol. 2008;15(1):144–57.

    Article  PubMed  Google Scholar 

  21. Mulier S, et al. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg. 2005;242(2):158–71.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kim SK, Rhim H, Kim YS, et al. Radiofrequency thermal ablation of hepatic tumors: pitfall and challenges. Abdom Imaging. 2005;30(6):727–33.

    Article  CAS  PubMed  Google Scholar 

  23. Bhardwaj N, et al. A comparative histological evaluation of the ablations produced by microwave, cryotherapy, and radiofrequency in the liver. Pathology. 2009;41(2):168–72.

    Article  CAS  PubMed  Google Scholar 

  24. Reed GB Jr, Cox AJ Jr. The human liver after radiation injury. A form of veno-occlusive disease. Am J Pathol. 1966;48(4):597–611.

    PubMed  PubMed Central  Google Scholar 

  25. Pan CC, et al. Radiation-associated liver injury. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S94–100.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Dawson LA, et al. Escalated focal liver radiation and concurrent hepatic artery fluorodeoxyuridine for unresectable intrahepatic malignancies. J Clin Oncol. 2000;18(11):2210–8.

    Article  CAS  PubMed  Google Scholar 

  27. Blomgren H, et al. Stereotactic high dose fraction radiation therapy of extracranial tumors using an accelerator. Clinical experience of the first thirty-one patients. Acta Oncol. 1995;34(6):861–70.

    Article  CAS  PubMed  Google Scholar 

  28. Herfarth KK, et al. Stereotactic single-dose radiation therapy of liver tumors: results of a phase I/II trial. J Clin Oncol. 2001;19(1):164–70.

    Article  CAS  PubMed  Google Scholar 

  29. Goodman KA, et al. Dose-escalation study of single-fraction stereotactic body radiotherapy for liver malignancies. Int J Radiat Oncol Biol Phys. 2010;78(2):486–93.

    Article  PubMed  Google Scholar 

  30. Meyer JJ, et al. A phase I dose-escalation trial of single-fraction stereotactic radiation therapy for liver metastases. Ann Surg Oncol. 2016;23(1):218–24.

    Article  PubMed  Google Scholar 

  31. Rusthoven KE, et al. Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol. 2009;27(10):1572–8.

    Article  PubMed  Google Scholar 

  32. Van der Pool AE, et al. Stereotactic body radiation therapy for colorectal liver metastases. Br J Surg. 2010;97(3):377–82.

    Article  PubMed  Google Scholar 

  33. Hoyer M, et al. Phase II study on stereotactic body radiotherapy of colorectal metastases. Acta Oncol. 2006;45(7):823–30.

    Article  PubMed  Google Scholar 

  34. Scorsetti M, et al. Final results of a phase II trial for stereotactic body radiation therapy for patients with inoperable liver metastases from colorectal cancer. J Cancer Res Clin Oncol. 2015;141(3):543–53.

    Article  CAS  PubMed  Google Scholar 

  35. Kamada T, et al. Carbon ion radiotherapy in Japan: an assessment of 20 years of clinical experience. Lancet Oncol. 2015;16(2):e93–100.

    Article  PubMed  Google Scholar 

  36. Pennington JD, et al. Dosimetric comparison of brachyablation and stereotactic ablative body radiotherapy in the treatment of liver metastasis. Brachytherapy. 2015;14(4):537–42.

    Article  PubMed  Google Scholar 

  37. Ahmedzadehfar H, et al. Radioembolization of liver tumors with yttrium-90 microspheres. Semin Nucl Med. 2010;40(2):105–21.

    Article  Google Scholar 

  38. Riaz A, et al. Radiation segmentectomy: a novel approach to increase safety and efficacy of radioembolization. Int J Radiat Oncol Biol Phys. 2011;79(1):163–71.

    Article  PubMed  Google Scholar 

  39. van Hazel GA. 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. J Clin Oncol. 2016;34(15):1723–31.

    Article  PubMed  Google Scholar 

  40. Bekaii-Saab T, Wu C. Seeing the forest through the trees: a systematic review of the safety and efficacy of combination chemotherapies used in the treatment of metastatic colorectal cancer. Crit Rev Oncol Hematol. 2014;91(1):9–34.

    Article  PubMed  Google Scholar 

  41. Mahipal A, Grothey A. Role of biologics in first-line treatment of colorectal cancer. J Oncol Pract. 2016;12(12):1219–28.

    Article  PubMed  Google Scholar 

  42. Le DT, et al. PD-1 blockade in tumors with mismatch-repair deficiency. N Engl J Med. 2015;372(26):2509–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Kingham TP, et al. Role of intra-arterial hepatic chemotherapy in the treatment of colorectal cancer metastases. J Surg Oncol. 2010;102(8):988–95.

    Article  PubMed  Google Scholar 

  44. Reddy SK, et al. Timing of multimodality therapy for resectable synchronous colorectal liver metastases: a retrospective multi-institutional analysis. Ann Surg Oncol. 2009;16(7):1809–19.

    Article  PubMed  Google Scholar 

  45. Sabanathan D, et al. Use of neoadjuvant chemotherapy plus molecular targeted therapy in colorectal liver metastases: a systematic review and meta-analysis. Clin Colorectal Cancer. 2016;15(4):e141–7.

    Article  PubMed  Google Scholar 

  46. Adam R, et al. Patients with initially unresectable colorectal liver metastase: is there a possibility of cure? J Clin Oncol. 2009;28(11):1829–35.

    Article  Google Scholar 

  47. Rubbia-Brandt L, et al. Sinusoidal obstruction syndrome and nodular regenerative hyperplasia are frequent oxaliplatin-associated liver lesions and partially prevented by bevacizumab in patients with hepatic colorectal metastasis. Histopathology. 2010;56(4):430–9.

    Article  PubMed  Google Scholar 

  48. Unal E, et al. Liver function assessment by magnetic resonance imaging. Semin Ultrasound CT MR. 2016;37(6):549–60.

    Article  PubMed  Google Scholar 

  49. Pollom EL, et al. Gastrointestinal toxicities with combined antiangiogenic and stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys. 2015;92(3):568–76.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Uppal A, et al. Towards a molecular basis of oligometastatic disease: potential role of micro-RNAs. Clin Exp Metastasis. 2014;31(6):735–48.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Lee Y, et al. Therapeutic effects of ablative radiation on local tumor require CD8+ T cells: changing strategies for cancer treatment. Blood. 2009;114(3):589–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Seung SK. Phase 1 study of stereotactic body radiotherapy and interleukin-2-tumor and immunological responses. Sci Transl Med. 2012;4(137):137.

    Article  Google Scholar 

  53. Asvadi NH, et al. CT-guided percutaneous microwave ablation of tumors in the hepatic dome: assessment of efficacy and safety. J Vasc Interv Radiol. 2016;27(4):496–502.

    Article  PubMed  Google Scholar 

  54. Yoon SS, et al. Surgical placement of biologic mesh spacers to displace bowel away from unresectable liver tumors followed by delivery of dose-intense radiation therapy. Pract Radiat Oncol. 2014;4(3):167–73.

    Article  PubMed  Google Scholar 

  55. Wahl DR, et al. Outcomes after stereotactic body radiotherapy or radiofrequency ablation for hepatocellular carcinoma. J Clin Oncol. 2016;34(5):452–9.

    Article  CAS  PubMed  Google Scholar 

  56. Sintzing S, et al. Percutaneous radiofrequency ablation (RFA) or robotic radiosurgery (RRS) for salvage treatment of colorectal liver metastases. Acta Oncol. 2013;52(5):971–9.

    Article  Google Scholar 

  57. Elias D, et al. New perspectives in the treatment of colorectal metastases. Liver Cancer. 2016;6(1):90–8.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Benedict SH, et al. Stereotactic body radiation therapy: the report of AAPM Task Group 101. Med Phys. 2010;37(8):4078–101.

    Article  PubMed  Google Scholar 

  59. Mageras GS, Yorke E. Deep inspiration breath hold and respiratory gating strategies for reducing organ motion in radiation treatment. Semin Radiat Oncol. 2004;14:65–75.

    Article  PubMed  Google Scholar 

  60. Wong JW, et al. The use of active breathing control (ABC) to reduce margin for breathing motion. Int J Radiat Oncol Biol Phys. 1999;44:911–9.

    Article  CAS  PubMed  Google Scholar 

  61. Heinzerling JH, et al. Four-dimension computed tomography scan analysis of tumor and organ motion at varying levels of abdominal compression during stereotactic treatment of lung and liver. Int J Radiat Oncol Biol Phys. 2008;70(5):1571–8.

    Article  PubMed  Google Scholar 

  62. Ozhasoglu C, et al. Synchrony—cyberknife respiratory compensation technology. Med Dosim. 2008;33(2):117–23.

    Article  PubMed  Google Scholar 

  63. Murray B, et al. Frame-based immobilization and targeting for stereotactic body radiation therapy. Med Dosim. 2007;32(2):86–91.

    Article  PubMed  Google Scholar 

  64. Zhong R, et al. Hypofractionation radiotherapy of liver tumor using cone beam computed tomography guidance combined with active breath control by long breath-holding. Radiother Oncol. 2012;104(3):379–85.

    Article  PubMed  Google Scholar 

  65. Dawson LA, et al. The reproducibility of organ position using active breathing control (ABC) during liver radiotherapy. Int J Radiat Oncol Biol Phys. 2001;51(5):1410–21.

    Article  CAS  PubMed  Google Scholar 

  66. Eccles C, et al. Reproducibility of liver position using the active breathing coordinator for liver cancer radiotherapy. Int J Radiat Oncol Biol Phys. 2006;64(3):751–9.

    Article  PubMed  Google Scholar 

  67. Foster R, et al. Localization accuracy and immobilization effectiveness of a stereotactic body frame for a variety of treatment sites. Int J Radiat Oncol Biol Phys. 2013;87(5):911–6.

    Article  PubMed  Google Scholar 

  68. Tirumani SH, Kim KW, et al. Update on the role of imaging in management of metastatic colorectal cancer. Radiographics. 2014;34(7):1908–28.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Shaffer JL, et al. Stereotactic body radiation therapy and central liver toxicity: a case report. Pract Radiat Oncol. 2015;5(5):282–5.

    Article  PubMed  Google Scholar 

  70. Timmerman R, et al. Excessive toxicity when treating central lung tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol. 2006;24(30):4833–9.

    Article  PubMed  Google Scholar 

  71. Eriguchi T, et al. Acceptable toxicity after stereotactic body radiation therapy for liver tumors adjacent to the central biliary system. Int J Radiat Oncol Biol Phys. 2013;85(4):1006–11.

    Article  PubMed  Google Scholar 

  72. Lasley FD, et al. Treatment variables related to liver toxicity in patients with hepatocellular carcinoma, child-pugh class a and b enrolled in a phase 1-2 trial of stereotactic body radiation therapy. Pract Radiat Oncol. 2015;5(5):e. 443–9.

    Article  Google Scholar 

  73. Kopek N, et al. Stereotactic body radiotherapy for unresectable cholangiocarcinoma. Radiother Oncol. 2010;94(1):47–52.

    Article  PubMed  Google Scholar 

  74. Murphy JD, et al. A dosimetric model of duodenal toxicity after stereotactic body radiotherapy for pancreatic cancer. Int J Radiat Oncol Biol Phys. 2010;8(5):1420–6.

    Article  Google Scholar 

  75. Rule W, et al. Phase I dose-escalation study of stereotactic body radiotherapy in patients with hepatic metastases. Ann Surg Oncol. 2011;18(4):1081–7.

    Article  PubMed  Google Scholar 

  76. Chang DT, et al. Stereotactic body radiotherapy for colorectal liver metastases: a pooled analysis. Cancer. 2011;117(17):4060–9.

    Article  PubMed  Google Scholar 

  77. Tao R, et al. Ablative radiotherapy doses lead to a substantial prolongation of survival in patients with inoperable intrahepatic cholangiocarcinoma: a retrospective dose response analysis. J Clin Oncol. 2016;34(3):219–26.

    Article  CAS  PubMed  Google Scholar 

  78. Papiez L, et al. Extracranial stereotactic radioablation: physical principles. Acta Oncol. 2003;42(8):882–94.

    Article  PubMed  Google Scholar 

  79. Marks LB, et al. Conformal radiation therapy with fixed shaped coplanar or noncoplanar radiation beam bouquets: a possible alternative to radiosurgery. Int J Radiat Oncol Biol Phys. 1995;33(5):1209–19.

    Article  CAS  PubMed  Google Scholar 

  80. Cardinale RM, et al. Determining the optimal block margin on the planning target volume for extracranial stereotactic radiotherapy. Int J Radiat Oncol Biol Phys. 1999;45(2):515–20.

    Article  CAS  PubMed  Google Scholar 

  81. Court L, et al. Evaluation of the interplay effect when using RapidArc to treat targets moving in the craniocaudal or right-left direction. Med Phys. 2010;37(1):4–11.

    Article  PubMed  Google Scholar 

  82. Selvaraj J, et al. 4D radiobiological modelling of the interplay effect in conventionally and hypofractionated lung tumour IMRT. Br J Radiol. 2015;88(1045).

    Google Scholar 

  83. Craft D, et al. The price of target dose uniformity. Int J Radiat Oncol Biol Phys. 2016;96(4):913–4.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Johns Hopkins University, Baltimore, MD, 21231, USA

    Jeffrey Meyer M.D., M.S.

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  1. Jeffrey Meyer M.D., M.S.
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Editors and Affiliations

  1. Department of Radiation Oncology, Case Western Reserve University, Cleveland, Ohio, USA

    Suzanne Russo

  2. Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA

    Sarah Hoffe

  3. Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington, USA

    Edward Kim

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Meyer, J. (2018). Colorectal Cancer Liver Metastases. In: Russo, S., Hoffe, S., Kim, E. (eds) Gastrointestinal Malignancies. Practical Guides in Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-64900-9_12

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  • DOI: https://doi.org/10.1007/978-3-319-64900-9_12

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