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World J Gastroenterol. Mar 21, 2016; 22(11): 3127-3149
Published online Mar 21, 2016. doi: 10.3748/wjg.v22.i11.3127
Evidence-based medical oncology and interventional radiology paradigms for liver-dominant colorectal cancer metastases
Alan Alper Sag, Fatih Selcukbiricik, Nil Molinas Mandel
Alan Alper Sag, Division of Interventional Radiology, Department of Radiology, Koc University School of Medicine, Istanbul 34450, Turkey
Fatih Selcukbiricik, Nil Molinas Mandel, Division of Medical Oncology, Department of Internal Medicine, Koc University School of Medicine, Istanbul 34450, Turkey
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: Authors declare no conflicts of interest or potential conflicts of interest for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alan Alper Sag, MD, Division of Interventional Radiology, Department of Radiology, Koc University School of Medicine, Rumelifeneri Yolu, Sariyer, Istanbul 34450, Turkey. asag@ku.edu.tr
Telephone: +90-212-3381176 Fax: +90-212-3381165
Received: October 27, 2015
Peer-review started: October 27, 2015
First decision: December 11, 2015
Revised: December 22, 2015
Accepted: January 17, 2016
Article in press: January 17, 2016
Published online: March 21, 2016
Processing time: 138 Days and 21.4 Hours
Abstract

Colorectal cancer metastasizes predictably, with liver predominance in most cases. Because liver involvement has been shown to be a major determinant of survival in this population, liver-directed therapies are increasingly considered even in cases where there is (limited) extrahepatic disease. Unfortunately, these patients carry a known risk of recurrence in the liver regardless of initial therapy choice. Therefore, there is a demand for minimally invasive, non-surgical, personalized cancer treatments to preserve quality of life in the induction, consolidation, and maintenance phases of cancer therapy. This report aims to review evidence-based conceptual, pharmacological, and technological paradigm shifts in parenteral and percutaneous treatment strategies as well as forthcoming evidence regarding next-generation systemic, locoregional, and local treatment approaches for this patient population.

Keywords: Colonic neoplasms; Rectal neoplasms; Neoplasm metastasis; Antineoplastic agents; FOLFOX protocol; Irinotecan, 5-flurouracil, and leucovorin protocol; Radiofrequency ablation; Microwave ablation; Chemoembolization; Therapeutic; Immunotherapy

Core tip: Survival is increasing in patients with colorectal cancer because of major advances in the domain of modern chemotherapy and personalized biological agents. As a result, there is increased demand for minimally-invasive non-surgical strategies to treat liver metastases and their recurrences. Non-surgical Interventional Radiology treatments such as percutaneous ablation and endovascular-directed therapy have emerged as adjuncts or alternatives to other forms of treatment in this population.