Chemoembolization and radioembolization for metastatic disease to the liver: Available data and future studies

Opinion statement: Hepatic metastatic disease includes tumors from colorectal, neuroendocrine, breast, melanocytes, kidney, and other primary sites. Tumor characteristic, liver function, and performance status are factors that need to be considered while deciding on treatment. Surgery offers the most optimal therapeutic option for such patients. However, due to the diffuse nature of disease and large tumor burden, a majority of the patients are not operable. Moreover, because the morbidity and mortality is associated with hepatic metastatic disease, it is intuitive to investigate and develop treatment options that target the tumor locally, thereby minimizing systemic toxicities. Transarterial locoregional therapies, such as chemoembolization and radioembolization, have been widely investigated during the past decade for the treatment of hepatic metastatic disease and have generated encouraging outcomes in term of survival, response, and quality of life. Moreover, these options are applicable in many clinical scenarios, because they are less limited by tumor characteristics. Currently, a large number of trials are investigating the combination of locoregional and systemic therapies, and the results are expected to benefit the treating physicians and patients alike.