Indications for locoregional tumor therapies: CRC liver metastases

The liver represents the most affected site in patients affected by colorectal carcinoma (mCRC) [1]. More than half cases develop colorectal liver metastases (CLMs) during the evolution of the disease, and about one-quarter occur at the disease onset [1, 2]. To date, the standard treatment of CLM is represented by liver surgery, which has allowed to achieve interesting long-term survival rates (40-60%) [3] in reported series, while it is less than 25% for patients who do not undergo surgery [4]. Unfortunately, most patients (80%), however, are not immediately eligible for surgery [5, 6]. For these patients, surgical treatment may be administered in combination with chemotherapy regimens (+/− target agents) aiming to downsize neoplasm and to allow a surgically and oncologically radical intervention. In addition, the greater effectiveness of the abovementioned new chemotherapeutic options has allowed to revolutionize the liver resection criteria considered until recently, thus widening the proportion of patients able to obtain long-term benefit from surgery. Locoregional liver treatments (including ablative technologies and transarterial treatments) can be considered additional options able to downsize CLMs and have been shown to improve quality of life, prolonging time to local progression and overall survival [7, 8]. Of course, to achieve optimal results, it is necessary to set up a multidisciplinary team, including interventionist radiologists, able to evaluate individual cases in order to select the best therapeutic strategy for each patient.