Liver directed therapy: treatments for colorectal cancer metastasis

During Hepatic Artery Infusion (HAI) therapy, a high dose of the drug is pumped into the hepatic artery — the main source of blood and nutrients for liver tumors — through a palm-sized pump under the skin in the lower abdomen. The pump is refilled every two weeks, on an outpatient basis. Because HAI therapy is delivered regionally (only to the tumor site), it does not add additional systemic side effects to the rest of the body, unlike systemic chemotherapy. During HAI therapy, patients can travel and enjoy most of their daily activities.

In patients who cannot have liver metastases removed because of their number, size, or location, HAI plus systemic therapy may be able to shrink tumors so resection (surgery on the liver) can be made possible. Or, if liver tumors have been removed, HAI can help prevent them from returning.

Common Side Effects

Because the therapy in the pump is quickly extracted by the liver, HAI is rarely associated with the side effects of systemic chemotherapy. The major side effect from HAI is liver toxicity, so liver enzymes should be monitored every two weeks. Other side effects may include stomach ulcers and biliary sclerosis or inflammation/thickening of the bile ducts.

Recovery

The pump is typically implanted during an open surgical procedure under general anesthesia, which requires an incision be made in the abdomen. Implantation can be performed as a standalone surgery or during other scheduled surgeries, such as the removal of existing tumors, and recovery will depend on the amount of surgery performed at the time of the pump implant.

Read more about HAI therapy

Embolization is a procedure that injects tiny substances called beads or particles directly into an artery in the liver to block or reduce the blood flow to a tumor in the liver. Over a few months, the embolized (blocked) vessels will shrink and the tumor will decrease in size. Cutting off the blood supply to the tumor also allows for higher doses of chemotherapy to be delivered.

Common side effects

The side effects will differ depending upon the type of embolization used. The most common complications reported are pain, nausea, severe post-embolization syndrome (fever, pain, extreme fatigue, nausea/vomiting), hepatic injury, and liver abscess.

Recovery

Most patients can be discharged a few hours after the procedure. If post-embolization syndrome occurs, an overnight stay is normally required.

SIRT (Selective Internal Radiation Therapy) is a targeted radiation therapy that uses tiny beads called microspheres to treat liver metastases. During the procedure, a small flexible tube is guided through an artery into the liver and the microspheres are delivered directly into the tumor, where they become trapped.

The microspheres then send out radiation to the site for a period of about two weeks. This targeted therapy delivers a dose of internal radiation up to 40 times higher than conventional radiation therapy.

Common side effects

Some patients may experience tightness or pain in the abdomen, nausea, and loss of appetite, which normally subsides within a week. Many patients may develop a mild fever that may last for up to a week, and fatigue which may last for several weeks. As a precaution, specific medications are prescribed to control these symptoms.

Recovery

The treatment normally takes about 60 to 90 minutes. Patients will be sleepy during the procedure but able to communicate with the doctor and the team. Most patients are able to return home a few hours following treatment.

With conventional therapy, radiation is delivered in relatively small doses over the course of several weeks, with patients receiving daily treatments during that time. With Steriotactic Body Radiation Therapy (SBRT), physicians are able to deliver a greater combined dose of radiation over the course of far fewer treatments. SBRT has shown dramatically better outcomes than conventional radiation therapy. Whereas two-year success rates for conventional treatment range from 30 to 40 percent, the success rates for SBRT range from 80 to 90 percent — comparable to those of resection surgery but with far fewer risks.

Common side effects

Despite the fact that SBRT delivers higher biological dosage of radiation, patients have experienced fewer side effects, including radiation pneumonia. Slight fatigue for one week following treatment is SBRT’s most common side effect.

Recovery

After the procedure, you will be comfortable enough to walk out of the treatment room.

Microwave ablation (MA) destroys liver tumors using heat generated by microwave energy. Using a CT scan or ultrasound, a surgeon inserts an ablation antenna into the center of the liver tumor, where it delivers thermal (heat) energy to destroy cancer cells.

Common side effects

Many patients experience a low-grade fever and pain for a few days following the procedure. Major complications include liver abscess, bile duct injury, infections, bleeding, and skin burn.

Recovery

Typically, the patient will go home the same day. If a laparoscopic procedure is selected, the patient often goes home the following day. The recovery period may be longer if the procedure requires an open surgical procedure and general anesthesia.

Radiofrequency Ablation (RFA) uses electrical energy to “superheat” and attack the tumor. The procedure is performed by inserting a needle through the skin under X-ray guidance, then placing a probe through the needle and positioning it in the liver tumor.

Alternatively, the procedure can be done laparoscopically, using a laparoscope that is inserted through a tiny incision in the abdomen. It may also be done as an open surgical procedure.

Common Side Effects

Many patients experience a low-grade fever for a few days following the procedure. There is a very low risk of infection, bleeding, and skin burn.

Recovery

Typically, the patient will go home the same day. If a laparoscopic procedure is selected, the patient usually goes home the following day. The recovery period may be longer if the procedure requires an open surgical procedure and general anesthesia.