TY - JOUR
T1 - Update on the optimal management of patients with colorectal liver metastases
AU - Alberts, Steven R.
N1 - Funding Information:
Editorial assistance for the preparation of this manuscript was provided by Clinical Insights Inc., supported by Bristol-Myers Squibb .
Funding Information:
Dr. Alberts has a long-standing research career predating his appointment in medical oncology. He has a Masters in public health and has worked as an epidemiologist with the Indian Health Service and the Centers for Disease Control. In this former position Dr. Alberts participated in studies of cancer in the Alaska Native population. He has continued these interests and is currently partly funded through a Surveillance, Epidemiology, and End Result (SEER) Program, National Cancer Institute grant.
PY - 2012/10
Y1 - 2012/10
N2 - Patients with colorectal liver metastases represent a distinct subset of metastatic colorectal cancer. Optimal management requires a multidisciplinary approach, local and systemic. Curative hepatic surgery is standard for resectable cases, but unfortunately, the majority of patients are not initially resectable due to the size, location, and/or extent of disease, inadequate remnant liver volume, or comorbidities. Other local approaches may be complementary (such as portal vein embolization) or alternative (such as ablation, hepatic arterial infusion, selective internal radiation therapy, and stereotactic body radiotherapy) to surgery. Systemic therapy can downsize disease, allowing surgical resection and, potentially, long-term survival, but it must be balanced against the potential for hepatotoxicity. Current standard approaches including cytotoxics and biologics, such as bevacizumab and particularly anti-epidermal growth factor receptor therapy, improve response rates and may enhance downsizing and resection rates. Optimization of local therapies and systemic conversion strategies via controlled, randomized trials is still a pending question.
AB - Patients with colorectal liver metastases represent a distinct subset of metastatic colorectal cancer. Optimal management requires a multidisciplinary approach, local and systemic. Curative hepatic surgery is standard for resectable cases, but unfortunately, the majority of patients are not initially resectable due to the size, location, and/or extent of disease, inadequate remnant liver volume, or comorbidities. Other local approaches may be complementary (such as portal vein embolization) or alternative (such as ablation, hepatic arterial infusion, selective internal radiation therapy, and stereotactic body radiotherapy) to surgery. Systemic therapy can downsize disease, allowing surgical resection and, potentially, long-term survival, but it must be balanced against the potential for hepatotoxicity. Current standard approaches including cytotoxics and biologics, such as bevacizumab and particularly anti-epidermal growth factor receptor therapy, improve response rates and may enhance downsizing and resection rates. Optimization of local therapies and systemic conversion strategies via controlled, randomized trials is still a pending question.
KW - Ablation
KW - Bevacizumab
KW - Cetuximab
KW - Colorectal cancer liver metastases
KW - Hepatic arterial infusion
KW - Portal vein embolization
KW - Stereotactic body radiotherapy
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U2 - 10.1016/j.critrevonc.2012.02.007
DO - 10.1016/j.critrevonc.2012.02.007
M3 - Review article
C2 - 22425016
AN - SCOPUS:84866487024
SN - 1040-8428
VL - 84
SP - 59
EP - 70
JO - Critical Reviews in Oncology/Hematology
JF - Critical Reviews in Oncology/Hematology
IS - 1
ER -