Local Treatment Options for Unresectable Liver Metastases in Colorectal Cancer

Despite the increase in effectiveness of systemic therapy, cure for colorectal cancer with liver metastases (CRLM) is rarely achieved without surgical resection, with less than 20% of patients initially suitable for surgery. Liver-directed therapies are continually being investigated in the hope of improving cure rates in patients with unresectable liver metastases. These modalities include selective internal radiation therapy (SIRT), radiofrequency ablation (RFA), transarterial chemoembolization (TACE) and hepatic artery infusion (HAI) chemotherapy. While there is evidence of activity for all these treatments, they are somewhat lacking in high level randomized, controlled trial evidence (RCT) with appropriate control arms relevant to current standard of care. This review examines the efficacy and safety of these treatments in unresectable CRLM