Regional Therapies for Colorectal Liver Metastases: Systematic Review and Clinical Practice Guideline

P Karanicolas; J R Beecroft; R Cosby; E David; M Kalyvas; E Kennedy; G Sapisochin; R Wong; K Zbuk; Gastrointestinal Disease Site Group

doi:10.1016/j.clcc.2020.09.008

Regional Therapies for Colorectal Liver Metastases: Systematic Review and Clinical Practice Guideline

Clin Colorectal Cancer. 2021 Mar;20(1):20-28. doi: 10.1016/j.clcc.2020.09.008. Epub 2020 Oct 12.

Authors

P Karanicolas¹, J R Beecroft², R Cosby³, E David⁴, M Kalyvas⁵, E Kennedy⁶, G Sapisochin⁷, R Wong⁸, K Zbuk⁹; Gastrointestinal Disease Site Group

Affiliations

¹ Department of Surgery, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada. Electronic address: [email protected].
² Department of Medical Imaging, Mount Sinai Hospital, and University Health Network, Toronto, Ontario, Canada.
³ Program in Evidence-Based Care, Department of Oncology, McMaster University, Juravinski Campus, Hamilton, Ontario, Canada.
⁴ Department of Medical Imaging, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
⁵ Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, Ontario, Canada.
⁶ Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
⁷ Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
⁸ Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
⁹ Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada.

PMID: 33257278
DOI: 10.1016/j.clcc.2020.09.008

Abstract

Background: Resection is the foundation for cure for colorectal cancer (CRC) liver metastases; however, only 20% of patients are suitable for surgery. Those suitable would be considered for resection or local therapies before being considered for regional therapies. Noncurative treatment is usually systemic chemotherapy. For patients with liver-only or liver-predominant metastases that are unresectable, regional therapies [conventional transarterial chemoembolization (cTACE), drug-eluting bead transarterial chemoembolization (DEB-TACE), and transarterial radioembolization (TARE)] may be considered. We review the current evidence for regional therapies for CRC liver metastases.

Patients and methods: Literature searches (January 2000 to March 2019 or January 2010 to March 2019 depending on the specific systematic review question) were conducted, including Medline, Embase, Cochrane Library, and 2018 American Society of Clinical Oncology (ASCO) abstracts.

Results: A total of 4100 articles were identified; 15 studies were included in the review. There were no comparative data regarding the resectable population. There was either insufficient evidence (cTACE or DEB-TACE) or evidence against (TARE) the addition of regional therapies to systemic therapy in the first line in the unresectable population. There was either no evidence (cTACE) or weak evidence (DEB-TACE or TARE) for the addition of regional therapies with or without systemic therapy in the second line or later in the unresectable population.

Conclusion: Limited evidence supports the delivery of percutaneous regional therapies in patients with unresectable CRC liver metastases. There are strong data demonstrating positive effects of TARE within the liver, but they do not translate to a benefit in patient-important outcomes. DEB-TACE appears to offer a survival benefit in the second-line setting, although the evidence is limited by small sample size and larger trials are needed.

Keywords: Colorectal cancer; Practice guidelines development cycle; Systemic therapy; Transarterial chemoembolization; Transarterial radioembolization.

Publication types

Systematic Review

MeSH terms

Brachytherapy
Carcinoma, Hepatocellular / secondary
Carcinoma, Hepatocellular / therapy*
Chemoembolization, Therapeutic / methods*
Colorectal Neoplasms / pathology
Colorectal Neoplasms / therapy*
Humans
Liver Neoplasms / secondary
Liver Neoplasms / therapy*
Survival Analysis
Time Factors
Treatment Outcome