Liver - Metastatic Tumors

Occasionally, patients who had a history of a tumor in the past, may develop a recurrence of this tumor into the liver. In the past, chemotherapy had been the only treatment available to such patients. Unfortunately, the usual scenario with chemotherapy was that the tumors “responded” initially (i.e.: shrank in size), but then later grew back up again (having become “unresponsive” to chemotherapy). Today, there are several other additional treatment modalities available. A lot has to do with the number of metastatic lesions, the pattern of their distribution (their exact location) within the liver, the initial kind of tumor where this new one originated from, and of course with a dedicated team of an oncologist, an interventional radiologist and an experienced liver surgeon. Today, the aim is to have these metastatic liver tumors removed, and not simply undergoing continuous cycles of shrinking and growing, until they become altogether resistant to any treatment and claim the life of the patient. Modern available treatment modalities may be utilized individually, or in combination depending on the individual characteristics of the tumor and of the patient. The team of physicians taking care of such patients has to have the expertise, first, to apply each and every treatment modality safely and efficiently, and second, to choose among them the one that fits each individual patient the most, or design the correct strategy of sequential application of more than one modalities in order to completely eliminate the disease. These treatment modalities are the following:

1. Radiofrequency Ablation (RFA). This modality is presented separately.

2. Regional Chemotherapy. Systemic intravenous chemotherapy is often associated with several side-effects that may not be well tolerated by the patient. For this reason selective infusion of chemotherapeutic agent(s) solely into the liver may be administered. This way, a much greater quantity of appropriate chemotherapy is delivered directly into the liver without being distributed all over the rest of the body, so the systemic side-effects are far lower. In addition, the metastatic lesions are more likely to shrink a lot more because a far greater quantity of medication is delivered to them directly without any previous dilution in the blood circulation.

3. Portal Vein Embolization (PVE). During PVE, certain preselected branches of the portal vein, those which supply a tumor-bearing area of the liver with blood, are selectively occluded (“embolized”). The result of this “selective embolization” is that this particular portion of the liver is progressively being shrunk in size (because of blood deprivation to it), and the remaining portion of the liver is overgrowing. This process may allow removal of an otherwise large part of the liver, while the remaining has grown enough to take over liver function without any compromise for the patient.

By selecting the most appropriate modality alone, or in combination with others, metastatic tumors may be initially shrunk, the volume of the tumor-bearing area of the liver may by decreased while the remaining is increased, so safe removal of part(s) of the liver can be achieved. It is important to understand that 35-40% of patients with colon cancer metastatic to the liver, who undergo appropriate sequence of aggressive treatments, remain free of disease for five years or more.