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Interventional Radiology for Colorectal Liver Metastases

  • Diagnostic and Interventional Radiology Innovations in Colorectal Cancer (S Gourtsoyianni, Section Editor)
  • Published:
Current Colorectal Cancer Reports

Abstract

Purpose of the Review

To discuss the pivotal role of Interventional radiology (IR) for the management of colorectal liver metastases (CRLM).

Recent Findings

IR has three main objectives for the treatment of CRLM:

  • Complete tumor destruction using percutaneous ablation, as an alternative to or more frequently in combination with surgery

  • Intra-arterial therapies to improve objective response rate and to prolong survival

  • All support therapies such as portal vein embolization or fiducial placement to allow or facilitate further treatments

Summary

Radiofrequency ablation (RFA) is the most reported percutaneous ablation technique and provides high local control rates that exceed 90% for small metastases (< 3 cm). Novel technologies such as microwave ablation could help overcome some limitations of RFA. Liver metastases non-amenable to radical treatment can, because of their arterial supply, be targeted with hepatic arterial infusion chemotherapy (HAIC) or selective internal radiation therapy (SIRT). HAIC has demonstrated encouraging response rates in patients who have previously failed intravenous chemotherapy or as adjuvant therapies to decrease post-operative recurrence rates. Although large SIRT trials are negative, there is a benefit in terms of progression-free survival in the liver when used as first-line treatment in combination with systemic therapy as well as in selected patients with advanced disease that justifies further interest in this technique. More recent developments, such as stereotactic body radiation therapy of liver metastases or local administration of immunotherapies, require the contribution of IR. Interventional radiology is growing and is becoming standard of care for colorectal liver metastases. Further innovations are likely to improve its impact.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Torzilli G, Adam R, Vigano L, Imai K, Goransky J, Fontana A, et al. Surgery of colorectal liver metastases: pushing the limits. Liver Cancer. 2016;6(1):80–9. https://doi.org/10.1159/000449495.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Tsitskari M, Filippiadis D, Kostantos C, Palialexis K, Zavridis P, Kelekis N, et al. The role of interventional oncology in the treatment of colorectal cancer liver metastases. Ann Gastroenterol. 2019;32(2):147–55. https://doi.org/10.20524/aog.2018.0338.

    Article  PubMed  Google Scholar 

  3. •• Van Cutsem E, Cervantes A, Adam R, Sobrero A, Van Krieken JH, Aderka D, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 2016;27(8):1386–422. https://doi.org/10.1093/annonc/mdw235Most used guidelines for the management of CRLM including IR technics.

    Article  PubMed  Google Scholar 

  4. de Baere T, Deschamps F, Briggs P, Dromain C, Boige V, Hechelhammer L, et al. Hepatic malignancies: percutaneous radiofrequency ablation during percutaneous portal or hepatic vein occlusion. Radiology. 2008;248(3):1056–66. https://doi.org/10.1148/radiol.2483070222.

    Article  PubMed  Google Scholar 

  5. Van Tilborg AA, Meijerink MR, Sietses C, Van Waesberghe JH, Mackintosh MO, Meijer S, et al. Long-term results of radiofrequency ablation for unresectable colorectal liver metastases: a potentially curative intervention. Br J Radiol. 2011;84(1002):556–65. https://doi.org/10.1259/bjr/78268814.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Shady W, Petre EN, Do KG, Gonen M, Yarmohammadi H, Brown KT, et al. Percutaneous microwave versus radiofrequency ablation of colorectal liver metastases: ablation with clear margins (A0) provides the best local tumor control. J Vasc Interv Radiol. 2018;29(2):268–75 e1. https://doi.org/10.1016/j.jvir.2017.08.021.

    Article  PubMed  Google Scholar 

  7. • Tanis E, Nordlinger B, Mauer M, Sorbye H, van Coevorden F, Gruenberger T, et al. Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983. Eur J Cancer. 2014;50(5):912–9. https://doi.org/10.1016/j.ejca.2013.12.008Comparison of local recurrence after RFA and surgical management of CRLM showing no difference for tumor smaller than 4 cm.

    Article  PubMed  CAS  Google Scholar 

  8. •• Ruers T, Van Coevorden F, Punt CJ, Pierie JE, Borel-Rinkes I, Ledermann JA, et al. Local treatment of unresectable colorectal liver metastases: results of a randomized phase II trial. J Natl Cancer Inst. 2017;109(9). https://doi.org/10.1093/jnci/djx015Pivotal prospective study showing the positive impact on survival of tumor ablation for bilateral CRLM.

  9. Karanicolas PJ, Jarnagin WR, Gonen M, Tuorto S, Allen PJ, DeMatteo RP, et al. Long-term outcomes following tumor ablation for treatment of bilateral colorectal liver metastases. JAMA Surg. 2013;148(7):597–601. https://doi.org/10.1001/jamasurg.2013.1431.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Song P, Sheng L, Sun Y, An Y, Guo Y, Zhang Y. The clinical utility and outcomes of microwave ablation for colorectal cancer liver metastases. Oncotarget. 2017;8(31):51792–9. https://doi.org/10.18632/oncotarget.15244.

    Article  PubMed  PubMed Central  Google Scholar 

  11. van Riel JM, Peters GJ, Mammatas LH, Honeywell RJ, Laan AC, Ruyter R, et al. A phase I and pharmacokinetic study of gemcitabine given by 24-h hepatic arterial infusion. Eur J Cancer. 2009;45(14):2519–27. https://doi.org/10.1016/j.ejca.2009.05.025.

    Article  PubMed  CAS  Google Scholar 

  12. Florcken A, Schaefer C, Bichev D, Breithaupt K, Dogan Y, Schumacher G, et al. Hepatic arterial infusion chemotherapy for liver metastases from gastric cancer: an analysis in Western patients. Tumori. 2011;97(1):19–24.

    Article  Google Scholar 

  13. Ensminger WD, Rosowsky A, Raso V, Levin DC, Glode M, Come S, et al. A clinical-pharmacological evaluation of hepatic arterial infusions of 5-fluoro-2′-deoxyuridine and 5-fluorouracil. Cancer Res. 1978;38(11 Pt 1):3784–92.

    PubMed  CAS  Google Scholar 

  14. Dzodic R, Gomez-Abuin G, Rougier P, Bonnay M, Ardouin P, Gouyette A, et al. Pharmacokinetic advantage of intra-arterial hepatic oxaliplatin administration: comparative results with cisplatin using a rabbit VX2 tumor model. Anti-Cancer Drugs. 2004;15(6):647–50.

    Article  CAS  Google Scholar 

  15. Mocellin S, Pasquali S, Nitti D. Fluoropyrimidine-HAI (hepatic arterial infusion) versus systemic chemotherapy (SCT) for unresectable liver metastases from colorectal cancer. Cochrane Database Syst Rev. 2009;3:CD007823. https://doi.org/10.1002/14651858.CD007823.pub2.

    Article  Google Scholar 

  16. Chapelle N, Matysiak-Budnik T, Douane F, Metairie S, Rougier P, Touchefeu Y. Hepatic arterial infusion in the management of colorectal cancer liver metastasis: current and future perspectives. Dig Liver Dis. 2018;50(3):220–5. https://doi.org/10.1016/j.dld.2017.12.004.

    Article  PubMed  Google Scholar 

  17. Kemeny NE, Melendez FD, Capanu M, Paty PB, Fong Y, Schwartz LH, et al. Conversion to resectability using hepatic artery infusion plus systemic chemotherapy for the treatment of unresectable liver metastases from colorectal carcinoma. J Clin Oncol. 2009;27(21):3465–71. https://doi.org/10.1200/JCO.2008.20.1301.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Goere D, Deshaies I, de Baere T, Boige V, Malka D, Dumont F, et al. Prolonged survival of initially unresectable hepatic colorectal cancer patients treated with hepatic arterial infusion of oxaliplatin followed by radical surgery of metastases. Ann Surg. 2010;251(4):686–91. https://doi.org/10.1097/SLA.0b013e3181d35983.

    Article  PubMed  Google Scholar 

  19. Boige V, Malka D, Elias D, Castaing M, De Baere T, Goere D, et al. Hepatic arterial infusion of oxaliplatin and intravenous LV5FU2 in unresectable liver metastases from colorectal cancer after systemic chemotherapy failure. Ann Surg Oncol. 2008;15(1):219–26. https://doi.org/10.1245/s10434-007-9581-7.

    Article  PubMed  Google Scholar 

  20. Ducreux M, Ychou M, Laplanche A, Gamelin E, Lasser P, Husseini F, et al. Hepatic arterial oxaliplatin infusion plus intravenous chemotherapy in colorectal cancer with inoperable hepatic metastases: a trial of the gastrointestinal group of the federation Nationale des Centres de Lutte Contre le Cancer. J Clin Oncol. 2005;23(22):4881–7. https://doi.org/10.1200/JCO.2005.05.120.

    Article  PubMed  CAS  Google Scholar 

  21. •• Kemeny N, Huang Y, Cohen AM, Shi W, Conti JA, Brennan MF, et al. Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med. 1999;341(27):2039–48. https://doi.org/10.1056/NEJM199912303412702First important paper on the impact of hepatic arterial infusion for CRLM.

    Article  PubMed  CAS  Google Scholar 

  22. Lygidakis NJ, Sgourakis G, Vlachos L, Raptis S, Safioleas M, Boura P, et al. Metastatic liver disease of colorectal origin: the value of locoregional immunochemotherapy combined with systemic chemotherapy following liver resection. Results of a prospective randomized study. Hepatogastroenterology. 2001;48(42):1685–91.

    PubMed  CAS  Google Scholar 

  23. House MG, Kemeny NE, Gonen M, Fong Y, Allen PJ, Paty PB, et al. Comparison of adjuvant systemic chemotherapy with or without hepatic arterial infusional chemotherapy after hepatic resection for metastatic colorectal cancer. Ann Surg. 2011;254(6):851–6. https://doi.org/10.1097/SLA.0b013e31822f4f88.

    Article  PubMed  Google Scholar 

  24. Kerr DJ, McArdle CS, Ledermann J, Taylor I, Sherlock DJ, Schlag PM, et al. Intrahepatic arterial versus intravenous fluorouracil and folinic acid for colorectal cancer liver metastases: a multicentre randomised trial. Lancet. 2003;361(9355):368–73. https://doi.org/10.1016/S0140-6736(03)12388-4.

    Article  PubMed  CAS  Google Scholar 

  25. Deschamps F, Rao P, Teriitehau C, Hakime A, Malka D, Boige V, et al. Percutaneous femoral implantation of an arterial port catheter for intraarterial chemotherapy: feasibility and predictive factors of long-term functionality. J Vasc Interv Radiol. 2010;21(11):1681–8. https://doi.org/10.1016/j.jvir.2010.08.003.

    Article  PubMed  Google Scholar 

  26. Deschamps F, Elias D, Goere D, Malka D, Ducreux M, Boige V, et al. Intra-arterial hepatic chemotherapy: a comparison of percutaneous versus surgical implantation of port-catheters. Cardiovasc Intervent Radiol. 2011;34(5):973–9. https://doi.org/10.1007/s00270-010-9996-6.

    Article  PubMed  CAS  Google Scholar 

  27. Fiorentini G, Aliberti C, Tilli M, Mulazzani L, Graziano F, Giordani P, et al. Intra-arterial infusion of irinotecan-loaded drug-eluting beads (DEBIRI) versus intravenous therapy (FOLFIRI) for hepatic metastases from colorectal cancer: final results of a phase III study. Anticancer Res. 2012;32(4):1387–95.

    PubMed  CAS  Google Scholar 

  28. Akinwande O, Dendy M, Ludwig JM, Kim HS. Hepatic intra-arterial injection of irinotecan drug eluting beads (DEBIRI) for patients with unresectable colorectal liver metastases: a systematic review. Surg Oncol. 2017;26(3):268–75. https://doi.org/10.1016/j.suronc.2017.05.003.

    Article  PubMed  Google Scholar 

  29. Benzakoun J, Ronot M, Lagadec M, Allaham W, Garcia Alba C, Sibert A, et al. Risks factors for severe pain after selective liver transarterial chemoembolization. Liver Int. 2016. https://doi.org/10.1111/liv.13235.

    Article  CAS  Google Scholar 

  30. Denys A, Pracht M, Duran R, Guiu B, Adib S, Boubaker A, et al. How to prepare a patient for transarterial radioembolization? Pract Guide Cardiovasc Intervent Radiol. 2015;38(4):794–805. https://doi.org/10.1007/s00270-015-1071-x.

    Article  Google Scholar 

  31. •• van Hazel GA, Heinemann V, Sharma NK, Findlay MP, Ricke J, Peeters M, 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. J Clin Oncol. 2016;34(15):1723–31. https://doi.org/10.1200/JCO.2015.66.1181Negative Randomized phase 3 trial on the added value of SIRT for metastatic colorectal cancer at 1st line.

    Article  PubMed  CAS  Google Scholar 

  32. Wasan HS, Gibbs P, Sharma NK, Taieb J, Heinemann V, Ricke J, et al. First-line selective internal radiotherapy plus chemotherapy versus chemotherapy alone in patients with liver metastases from colorectal cancer (FOXFIRE, SIRFLOX, and FOXFIRE-global): a combined analysis of three multicentre, randomised, phase 3 trials. Lancet Oncol. 2017;18(9):1159–71. https://doi.org/10.1016/S1470-2045(17)30457-6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Sofocleous CT, Violari EG, Sotirchos VS, Shady W, Gonen M, Pandit-Taskar N, et al. Radioembolization as a salvage therapy for heavily pretreated patients with colorectal cancer liver metastases: factors that affect outcomes. Clin Colorectal Cancer. 2015;14(4):296–305. https://doi.org/10.1016/j.clcc.2015.06.003.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sangro B, Gil-Alzugaray B, Rodriguez J, Sola I, Martinez-Cuesta A, Viudez A, et al. Liver disease induced by radioembolization of liver tumors: description and possible risk factors. Cancer. 2008;112(7):1538–46. https://doi.org/10.1002/cncr.23339.

    Article  PubMed  Google Scholar 

  35. Smits ML, Nijsen JF, van den Bosch MA, Lam MG, Vente MA, Mali WP, et al. Holmium-166 radioembolisation in patients with unresectable, chemorefractory liver metastases (HEPAR trial): a phase 1, dose-escalation study. Lancet Oncol. 2012;13(10):1025–34. https://doi.org/10.1016/S1470-2045(12)70334-0.

    Article  PubMed  CAS  Google Scholar 

  36. de Baere T, Denys A, Paradis V. Comparison of four embolic materials for portal vein embolization: experimental study in pigs. Eur Radiol. 2009;19(6):1435–42. https://doi.org/10.1007/s00330-008-1277-2.

    Article  PubMed  Google Scholar 

  37. • Guiu B, Chevallier P, Denys A, Delhom E, Pierredon-Foulongne MA, Rouanet P, et al. Simultaneous trans-hepatic portal and hepatic vein embolization before major hepatectomy: the liver venous deprivation technique. Eur Radiol. 2016;26(12):4259–67. https://doi.org/10.1007/s00330-016-4291-9Novel technic of venous pre-operative liver embolization technic to improve results.

    Article  PubMed  Google Scholar 

  38. Petrelli F, Comito T, Barni S, Pancera G, Scorsetti M, Ghidini A, et al. Stereotactic body radiotherapy for colorectal cancer liver metastases: a systematic review. Radiother Oncol. 2018;129(3):427–34. https://doi.org/10.1016/j.radonc.2018.06.035.

    Article  PubMed  Google Scholar 

  39. Chang DT, Swaminath A, Kozak M, Weintraub J, Koong AC, Kim J, et al. Stereotactic body radiotherapy for colorectal liver metastases: a pooled analysis. Cancer. 2011;117(17):4060–9. https://doi.org/10.1002/cncr.25997.

    Article  PubMed  Google Scholar 

  40. Park SH, Won HJ, Kim SY, Shin YM, Kim PN, Yoon SM, et al. Efficacy and safety of ultrasound-guided implantation of fiducial markers in the liver for stereotactic body radiation therapy. PLoS One. 2017;12(6):e0179676. https://doi.org/10.1371/journal.pone.0179676.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  41. Marsico M, Gabbani T, Livi L, Biagini MR, Galli A. Therapeutic usability of two different fiducial gold markers for robotic stereotactic radiosurgery of liver malignancies: a pilot study. World J Hepatol. 2016;8(17):731–8. https://doi.org/10.4254/wjh.v8.i17.731.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Jarraya H, Chalayer C, Tresch E, Bonodeau F, Lacornerie T, Mirabel X, et al. Novel technique for hepatic fiducial marker placement for stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys. 2014;90(1):119–25. https://doi.org/10.1016/j.ijrobp.2014.05.002.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Interventional Radiology, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France

    Frederic Deschamps, Thierry de Baere & Lambros Tselikas

  2. Department of Radiology, Beaujon Hospital, APHP, Clichy, France

    Maxime Ronot

  3. Department of visceral and oncological surgery, Gustave Roussy, F-94805, Villejuif, France

    Maximiliano Gelli

  4. Department of Radiotherapy, Gustave Roussy, F-94805, Villejuif, France

    Jerome Durand-Labrunie

  5. Department of Radiology, Gustave Roussy, F-94805, Villejuif, France

    Melodie Tazdait

  6. Drug development department (DITEP), Gustave Roussy, F-94805, Villejuif, France

    Antoine Hollebecque

  7. Department of Pathology, Gustave Roussy, F-94805, Villejuif, France

    Peggy Dartigues

  8. Université Paris-Sud, F-91400, Orsay, France

    Thierry de Baere

  9. Immunotherapies Translational Research Laboratory (LRTI), UMR 1015, Université Paris-Saclay, F-94805, Villejuif, France

    Lambros Tselikas

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  1. Frederic Deschamps
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  6. Antoine Hollebecque
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Correspondence to Lambros Tselikas.

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Conflict of Interest

F. Deschamps, M. Ronot, M. Gelli, J. Durand-Labrunie, M. Tazdait, and P. Dartigues each declare no potential conflicts of interest. A. Hollebecque has received personal fees from Incyte, Spectrum Pharmaceuticals, Debiopharm, and EISAI and nonfinancial support from Lilly, Servier, and Bayer. Dr. Hollebecque has also received grants from Astra Zeneca, BMS, Boehringer Ingelheim, Janssen Cilag, Merck, Novartis, Pfizer, Sanofi, and Roche. T. de Baere has received personal fees from Terumo, BTG, SIRTEX, GE, COOK, GUERBET, and CANON. L. Tselikas has received grants from Terumo and BMS and personal fees from COOK, EISAI, and AMGEN.

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This article is part of the Topical Collection on Diagnostic and Interventional Radiology Innovations in Colorectal Cancer

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Deschamps, F., Ronot, M., Gelli, M. et al. Interventional Radiology for Colorectal Liver Metastases. Curr Colorectal Cancer Rep 16, 29–37 (2020). https://doi.org/10.1007/s11888-020-00449-0

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