A review on regional therapies for colorectal cancer liver metastases

This study reviewed regional treatment options for patients with colorectal cancer (CRC) and liver metastases (LM; spread to the liver). 

CRC is the third most common cancer in the world. The most common organ where the cancer spreads is the liver. Surgery is the standard treatment for LM. However, only 20% of these patients are suitable for surgery. These patients might also receive chemotherapy. Regional therapies are only considered if patients progressed after surgery or localized therapies. Some of these therapies are transarterial chemoembolization (TACE), drug-eluting bead TACE (DEB-TACE), transarterial radioembolization (TARE).

TACE consists of cutting the blood supply of the tumor after chemotherapy is given in blood vessels near the tumor. In DEB-TACE chemotherapy is attached to beads that are injected into the liver artery that feeds the tumor. TARE is a similar treatment but with radiation therapy. Beads filled with radiation are injected into the liver artery. This method allows for more chemotherapy or radiation to enter the tumor for a longer period. Therapies like TACE also cause fewer side effects because other parts of the body are not affected. However, which of these therapies is associated with the best outcomes is still not known.

This study reviewed 15 other studies including information about patients with CRC and inoperable LMs. All patients received either TACE, DEB-TACE, or TARE.

No significant evidence was observed for the addition of TACE or DEB-TACE to first-line chemotherapy. The addition of TARE to chemotherapy treatment was not recommended.

There was no evidence of a positive effect of TACE as second-line therapy. The evidence for DEB-TACE and TARE was considered weak.

This study concluded that there is limited evidence to support the delivery of TACE, DEB-TACE, and TARE to patients with CRC and inoperable LMs outside of clinical trials.