Radiation Oncology/Liver/Liver Mets

Overview

• Liver is the second most frequently metastatic organ, after lymph nodes
  • Rich dual vascular supply and cell-promoting humoral factors
• In US/Europe, liver mets are much more frequent than primary liver tumors
• Primaries most commonly going to liver:
  • Adults: the eye, colon, stomach, pancreas, breast, and lung
  • Children: neuroblastoma, Wilms tumor, and leukemia
• Seeding: 77% both lobes, 10% single lesions. Multiple mets often vary in size, suggesting seeding from primary in waves
• Imaging: With an equivalent specificity, PET is the most sensitive (vs. U/S, CT, MRI)
• Treatment options:
  • Surgery
  • Transcatheter arterial chemoembolization (TACE)
  • Ablation (Cryoablation, Microwave ablation, EtOH ablation, RF ablation, Laser ablation
  • RT historically not used due to low median liver tolerance, but now increasing interest with conformal therapy and stereotactic radiotherapy
• Survival:
  • Colorectal primary: resection can offer cure, 5-year survival 20-40%
  • Breast, lung, pancreas primary: poor due to usually widespread metastatic disease outside of liver

Treatment

Most studies include both mets and primary liver cancer; for now they are kept together.

Please see the Liver/Treatment page.

Surgery

• MSKCC; 2007 (1985-1994) PMID 17925551 -- "Actual 10-year survival after resection of colorectal liver metastases defines cure." (Tomlinson JS, J Clin Oncol. 2007 Oct 10;25(29):4575-80.)
  • Retrospective. 612 consecutive patients, 102 10-year survivors
  • Outcome: If survive 10 years, 97% DSS; if survive 5 years, 66% DSS
  • Initial factors: 50% N+, 39% >1 met, 35% tumor size >5cm, 25% bilobar mets, 7% synchronous disease
  • Conclusion: Almost 20% cure in well-selected patients with CRC liver mets