by Dr. C.H.Weaver M.D. updated 2/2019
More than 50% of individuals diagnosed with colorectal cancer (CRC) will have cancer spread to their liver. (1,2) Many individuals with CRC involving the liver erroneously conclude that they have no treatment options other than systemic therapy. There are however several therapeutic options for the treatment of liver metastases, and others being developed in clinical trials.
The type of liver directed therapy used is determined by the size of the cancer, the number of metastases, and the location of the cancers within the liver. Patients need to understand that many advanced treatment options are only be available at cancer centers specializing in the treatment of CRC and patients should consider getting an opinion at one of these centers. For example:
- Many liver metastases can be effectively treated with surgery, but not all cancer clinics have the expertise to offer surgery as a treatment option. One analyses has demonstrated that surgery for liver metastases that can be resected has produced long-term overall survival of nearly 50% at five years and nearly 30% at 10 years.6
- Additional clinical trials have demonstrated that the addition of chemotherapy following surgery for liver metastases further improves treatment outcomes.7
- In some patients with inoperable liver metastases, an initial round of chemotherapy or neoadjuvant radiation therapy can be used to shrink the liver metastases enough so that surgery becomes possible.8
- Using minimally invasive techniques such as ablation, embolization, or radioembolization allows the delivery of radiation therapy or chemotherapy directly to the liver tumor(s).
SIR-Spheres® Y-90 microspheres have been added as a new treatment option in the latest National Comprehensive Cancer Network® (NCCN®) Clinical Practice Guidelines in Oncology for colon cancer and rectal cancer. SIR-Spheres Y-90 resin microspheres are a medical device used in an interventional radiology procedure known as selective internal radiation therapy (SIRT), or radioembolization, which targets high doses of radiation directly to liver tumors. The treatment consists of tens of millions of radioactive Y-90 coated resin particles, each no bigger in diameter than a human hair. SIR-Spheres Y-90 are injected into the hepatic artery, which is the main blood supply to the liver via a catheter inserted into the femoral artery through an incision in the groin. The Y-90 resin microspheres become lodged in the smaller blood vessels that surround cancer in the liver, where they deliver a high dose of radiation to the cancer, while sparing healthy liver tissue.3,4,5
Patients with CRC that has spread to the liver need to make sure they are evaluated at a cancer center that offers advanced liver directed treatment options. They should also consider the role of clinical trials.
Ongoing research is being conducted in clinical trials to find new treatments for CRC. By learning about clinical trials you can identify opportunities that advance the treatment of CRC and possibly benefit your personal prognosis.
- American Cancer Society. Colorectal Cancer Facts & Figures 2017-2019. Atlanta: American Cancer Society, 2017.
- Cho M, Gong J and Fakih M.The state of regional therapy in the management of metastatic colorectal cancer to the liver. Expert Review of Anticancer Therapy, 2016; 16(2): 229–245.
- van Hazel GA, Heinemann V, Sharma NK et al. SIRFLOX: Randomized Phase III trial comparing first-line mFOLFOX6 (plus or minus bevacizumab) plus selective internal radiation therapy in patients with metastatic colorectal cancer. Journal of Clinical Oncology. 2016; 34: 1723–1731.
- Kennedy AS, Ball D, Cohen SJ et al.Multicenter evaluation of the safety and efficacy of radioembolization in patients with unresectable colorectal liver metastases selected as candidates for 90Y resin microspheres. Journal of Gastrointestinal Oncology. 2015; 6: 134–142.
- SIR-Spheres® microspheres (Yttrium-90 Microspheres) Product Information.
Available at: com/us/clinicians/package-insert/.
- Wei A, Greig P, Grant D, et al. Survival After Hepatic Resection for Colorectal Metastases: A 10-Year Experience. Annals of Surgical Oncology. 2006; 13:668-676.
- Portier G, Elias D, Bouche O, et al. Multicenter Randomized Trial of Adjuvant Fluorouracil and Folinic Acid Compared With Surgery Alone After Resection of Colorectal Liver Metastases: FFCD ACHBTH AURC 9002 Trial. Journal of Clinical Oncology. 2006; 24: 4976-4982.
- Capussotti L, Muratore A, Mulas MM, Massucco P, Aglietta M. Neoadjuvant Chemotherapy and Resection for Initially Irresectable Colorectal Liver Metastases. British Journal of Surgery. 2006;93:1001-1006.
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