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Management of Metastatic Liver Tumors
This issue of the Surgical Oncology Clinics of North America focuses on the Management of Metastatic Liver Tumors. Over the last several decades, as systemic and targeted agents have become more effective in treating and prolonging the life of patients with a wide range of malignancies, indications for treatment of metastatic disease have broadened. Perhaps this point is best illustrated among patients with colorectal liver metastasis. In particular, while 20 or 30 years ago colorectal liver metastasis size and number, as well as CEA level, “dictated” operability, surgeons now focus less on these morphologic and labora...
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Authors: Timothy M. Pawlik Tags: Foreword Source Type: research

Management of Metastatic Liver Tumors
SURGICAL ONCOLOGY CLINICS OF NORTH AMERICA (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Authors: Michael D ’Angelica Source Type: research

Copyright
ELSEVIER (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Source Type: research

Contributors
TIMOTHY M. PAWLIK, MD, MPH, PhD, FACS, FRACS (Hon) (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Source Type: research

Contents
Timothy M. Pawlik (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Source Type: research

Forthcoming Issues
Pediatric Cancer (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - November 19, 2020 Category: Surgery Source Type: research

Surgical Management of Genitourinary Cancer Liver Metastases
Genitourinary cancers are common. Liver metastases from genitourinary cancers are uncommon; isolated liver metastasis is rare. Liver resection in select patients with metastatic renal cell carcinoma can lead to prolonged survival. Patients with metachronous and low-burden disease are most likely to benefit. Chemotherapy is first-line treatment of metastatic germ cell tumors. Liver resection is dependent on germ cell lineage and initial response to chemotherapy. Prognosis with liver metastases from prostate cancer is poor; liver-only lesions are rare. Liver resection generally is not indicated. Cumulative experience with li...
Source: Surgical Oncology Clinics of North America - October 28, 2020 Category: Surgery Authors: Guillaume Martel, Kimberly A. Bertens, Christina Canil Source Type: research

Is There a Role for Locoregional Therapies for Non-colorectal Gastrointestinal Malignancies?
The liver is the most common site of metastases from solid gastrointestinal tract tumors. Over the past few decades, the role of locoregional therapies, resection and thermal ablation, for neuroendocrine and colorectal liver metastases has been widely studied. However, for liver metastases originating from other gastrointestinal organs, the role of locoregional treatment remains unclear. This review summarizes and discusses the available evidence regarding benefits, risks, and indications for locoregional therapies for non-colorectal and non-neuroendocrine gastrointestinal liver metastases, highlighting the importance of m...
Source: Surgical Oncology Clinics of North America - October 28, 2020 Category: Surgery Authors: Gilton Marques Fonseca, Maria Ignez Freitas Melro Braghiroli, Jaime Arthur Pirola Kruger, Fabricio Ferreira Coelho, Paulo Herman Source Type: research

Systemic Therapy Improvements Will Render Locoregional Treatments Obsolete for Patients with Cancer with Liver Metastases
Hepatic metastases are a major cause of morbidity and mortality for patients with cancer. Apart from curative resection, which offers patients the potential for long-term survival, an array of locoregional therapies, with limited evidence of improving survival, are used to treat them. The authors use examples from the realm of gastrointestinal cancer, largely focusing on the experience of patients with neuroendocrine cancer, hepatobiliary cancer, and colorectal cancer, to suggest that current systemic therapies offer, at minimum, similar survival outcomes for patients compared with these locoregional approaches. (Source: S...
Source: Surgical Oncology Clinics of North America - October 28, 2020 Category: Surgery Authors: Satya Das, Jordan Berlin Source Type: research

Surgical Management of Breast Cancer Liver Metastasis
This article reviews data related to hepatic resection and ablative therapies of BCLM, as well as long-term outcomes of women treated with these approaches. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - October 28, 2020 Category: Surgery Authors: Amir A. Rahnemai-Azar, Luke V. Selby, Maryam B. Lustberg, Timothy M. Pawlik Source Type: research

Debate
The benefit of resection of liver metastases depends on primary diseases. Neuroendocrine tumors are associated with favorable prognosis after resection of liver metastases. Gastric cancer has worse tumor biology, and resection of gastric liver metastases should be performed in selected patients. A multidisciplinary approach is well established for colorectal liver metastases (CLMs). Resection remains the only curative treatment of CLM. Chemotherapy and molecular-targeted therapy have improved survival in unresectable metastatic colorectal cancer. Understanding of the following two strategies, conversion therapy and two-sta...
Source: Surgical Oncology Clinics of North America - October 27, 2020 Category: Surgery Authors: Yoshikuni Kawaguchi, Mario De Bellis, Elena Panettieri, Gregor Duwe, Jean-Nicolas Vauthey Source Type: research

Surgical Management of Neuroendocrine Tumor Liver Metastases
Patients with neuroendocrine tumor liver metastases (NETLMs) may develop carcinoid syndrome, carcinoid heart disease, or other symptoms from overproduction of hormones. Hepatic resection and cytoreduction is the most direct treatment of NETLMs in eligible patients, and cytoreduction improves symptoms, may reduce the sequelae of carcinoid syndrome, and extends survival. Parenchymal-sparing procedures, such as ablation and enucleation, should be considered during cytoreduction to maximize treatment of multifocal tumors while preserving healthy liver tissue. For patients with large hepatic tumor burdens, high-grade disease, o...
Source: Surgical Oncology Clinics of North America - October 20, 2020 Category: Surgery Authors: Catherine G. Tran, Scott K. Sherman, Chandrikha Chandrasekharan, James R. Howe Source Type: research

Surgical Management of Sarcoma Metastatic to Liver
Sarcomas are rare mesenchymal tumors with a propensity for hematogenous metastasis. Gastrointestinal stromal tumor (GIST) is the most common histologic subtype and the most common source of hepatic metastases. In the case of metastatic GIST, neoadjuvant imatinib can be used as a selection tool for the judicious application of surgery, where treatment-responsive patients who undergo resection to prevent the development of treatment-resistant clones have associated 10-year actuarial survival of 40%. Further advances for many of the non-GIST sarcoma subtypes will depend on the development of improved systemic therapies and ev...
Source: Surgical Oncology Clinics of North America - October 20, 2020 Category: Surgery Authors: Brett L. Ecker, Robert G. Maki, Michael J. Cavnar, Ronald P. DeMatteo Source Type: research

Intraarterial Chemotherapy for Liver Metastases
This article summarizes the role of HAI chemotherapy in the treatment of liver metastatic CRC. (Source: Surgical Oncology Clinics of North America)
Source: Surgical Oncology Clinics of North America - October 20, 2020 Category: Surgery Authors: Louise C. Connell, Nancy E. Kemeny Source Type: research

External Beam Radiation Therapy for Liver Metastases
Stereotactic ablative radiotherapy (SABR) commonly is used for small liver metastases. Modern conformal radiotherapy techniques, including 3-dimensional conformal radiotherapy and intensity-modulated radiation therapy, enable the safe delivery of SABR to small liver volumes. For larger tumors, the safe delivery of SABR can be challenging due to a more limited volume of healthy normal liver parenchyma and the proximity of the tumor to radiosensitive organs, such as the stomach, duodenum, and large intestine. Controlling respiratory motion, the use of image guidance, and increasing the number of radiation fractions sometimes...
Source: Surgical Oncology Clinics of North America - October 20, 2020 Category: Surgery Authors: Paul B. Romesser, Brian P. Neal, Christopher H. Crane Source Type: research