Interventional Radiology for Colorectal Liver Metastases

Purpose of the Review: To discuss the pivotal role of Interventional radiology (IR) for the management of colorectal liver metastases (CRLM). Recent Findings: IR has three main objectives for the treatment of CRLM:Complete tumor destruction using percutaneous ablation, as an alternative to or more frequently in combination with surgeryIntra-arterial therapies to improve objective response rate and to prolong survivalAll support therapies such as portal vein embolization or fiducial placement to allow or facilitate further treatments Summary: Radiofrequency ablation (RFA) is the most reported percutaneous ablation technique and provides high local control rates that exceed 90% for small metastases (< 3 cm). Novel technologies such as microwave ablation could help overcome some limitations of RFA. Liver metastases non-amenable to radical treatment can, because of their arterial supply, be targeted with hepatic arterial infusion chemotherapy (HAIC) or selective internal radiation therapy (SIRT). HAIC has demonstrated encouraging response rates in patients who have previously failed intravenous chemotherapy or as adjuvant therapies to decrease post-operative recurrence rates. Although large SIRT trials are negative, there is a benefit in terms of progression-free survival in the liver when used as first-line treatment in combination with systemic therapy as well as in selected patients with advanced disease that justifies further interest in this technique. More recent developments, such as stereotactic body radiation therapy of liver metastases or local administration of immunotherapies, require the contribution of IR. Interventional radiology is growing and is becoming standard of care for colorectal liver metastases. Further innovations are likely to improve its impact.