Management of colorectal liver metastasis

This study investigated the surgical treatment and associated outcomes of colorectal liver metastasis (the cancer has spread to the liver). Researchers suggested that individualized care for each patient is crucial to better plan the treatment and extent survival.

The liver is the most common place for colorectal cancer metastasis. Fortunately, significant improvements have been made for these patients. Better understanding of liver metastasis, tumor removal methods and post-surgery care improved metastatic cancer outcomes. Prior studies showed that the use of hepatic artery infusion (HAI) to deliver chemotherapy directly to the liver helps manage the metastasis. Analysis of the tumor mutations (permanent change), such as KRAS and BRAF mutations (in more aggressive cancers), is an important prognostic factor that will help predicting the cancer outcomes.

The objective of this study was to evaluate, through other studies, surgical treatment and associated outcomes in the treatment of colorectal cancer liver metastasis. In addition, analyze the role and effectiveness of HAI and the importance of detecting mutations for cancer prognosis.

In general, the tumor is considered operable if it can be removed with a negative margin (no cancer cells are found in the surroundings when the tumor is removed), and the liver can still be functional. 20% of patients are considered operable. Of those undergoing surgery, 5-year survival is roughly 50% and the cure rates are 20-25%.  These rates are higher than with chemotherapy alone.

Prior studies showed that HAI is more effective than systemic chemotherapy (delivered to the entire body) in inoperable liver metastasis. One study showed an average survival of 17 months for HAI patients and 12 months for chemotherapy patients. Disease progression was lower in patients who received HAI and chemotherapy in combination. Recurrence (when the cancer comes back) was also lower in patients who received HAI and chemotherapy after surgery (72.2 months) compared to chemotherapy alone (59.3 months).

KRAS and BRAF mutations have been associated with worse prognosis. In one study, patients with a KRAS mutation had 3-year survival of 52%, compared to 81% for those without the mutation. In another study, patients with a BRAF mutation had a 2-year survival of 61%, compared to 86% for those without the mutation.

This study determined that individualized care for each patient with colorectal liver metastasis is important to plan the best treatment program.