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) 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