Radiation Oncology/Liver/Liver Mets
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Overview
edit- 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
editMost studies include both mets and primary liver cancer; for now they are kept together.
Please see the Liver/Treatment page.
Surgery
edit- MSKCC; 2007 (1985-1994) PMID 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