Non Surgical Treatment of Liver Metastatses


Once a patient develops metastasis to the liver from another primary site of disease they are classified as having Stage IV cancer.  Since colorectal cancer is the most common source of liver metastases, we will examine this situation in more detail on this webpage.  However, these general principles can be applied to other cancers that have metastasized to the liver as well.  The main treatment approach for stage IV colorectal cancer is to use a combination chemotherapy regimen where medications are taken by mouth and/or administered intravenously into the blood system.

Added benefit can be obtained by directly targeting the cancer deposits in the liver of patients who remain active enough to take care of themselves, with no additional or only moderate help from others, and have shown a response to the chemotherapy. 

Liver directed therapy is individualized based on the number of cancer deposits in the liver. Those with one or a few metastases (typically less than 4) are good candidates for more aggressive therapy to the liver.  Treatment directed to the liver includes Radiosurgery, Radiofrequency Ablation (heating), Laser Therapy and Cryotherapy (freezing).  These options will be explored in more detail.

Patients with four or more metastases are best treated initially with additional chemotherapy administered to the whole body or directed to the liver alone. A new option involves directing spheres of radiation intravenously throughout the liver.  This is called Selective Internal Radiotherapy Microsphere Embolization (SIR Embolization).

 

Liver Directed Therapy

 

Radiosurgery

cyberknife Radiosurgery

cyberknife

Radiosurgery is the application of a high dose of radiation therapy over a few daily sessions (usually less than five) performed in an out-patient setting.  Special techniques are used to ensure that the radiation dose tightly conforms to the target and minimal dose to the adjacent normal structures is maintained.  Special techniques (stereoscopic imaging or cone beam CT imaging) are also used to precisely target the cancer deposit. For lesions in the liver additional measures are needed to account for the fact that the liver moves as the patient breathes.  Radiosurgery systems use x-ray imaging and robots to account for this movement as well as infrared imaging cameras.

 

Radiofrequency Ablation

RFA Liver

RFA Liver

 An electric device is inserted into the tumor and a rapidly alternating electric current is passed through the device.  The electric current generates heat and the tumor is treated with this high temperature.  The Radiofrequency Ablation (RFA) device can be inserted into the tumor using multiple methods.  These include open surgery, laparoscopic assisted surgery, and CT or Ultrasound guided insertion across the skin.  Most studies show improved outcomes when the device is inserted using an open or laparoscopic assisted surgery.  However, it is important to note that many patients with stage IV cancer cannot easily tolerate traditional surgery.


Cryotherapy

Cryotherapy is an older technique that is not used in America much.  Like RFA, a device is inserted into the tumor.  The tips of the device is then cooled and an iceball forms around the tips.  It is this thermal injury that is used to kill the tumor deposit.  Cryotherapy typically requires open surgery although percutaneous approaches have also been recently developed.


© Rizwan Nurani 2012