Neoadjuvant downsizing of liver metastases by transarterial chemoembolization (TACE) before laser-induced thermotherapy (LITT)

Purpose: To evaluate a treatment protocol with repeated transarterial chemoembolization (TACE) before laser-induced thermotherapy (LITT) in patients with unresectable liver metastases too large for LITT alone. Materials and Methods: A total of 162 patients with unresectable liver metastases (the largest lesion smaller than 80 mm in diameter, no more than 4 lesions) were treated with repeated TACE between March 1999 and December 2001. TACE was performed with a maximum of 10 mg/m 2 Mitomycin C as the chemotherapeutic agent and a maximum of 15 ml/m 2 of Lipiodol and microspheres for vessel occlusion. The tumor volume before and during the treatment was measured by MRI imaging. If the diameter of the tumor was observed to have decreased to less than 50 mm, the patients were treated with MRI-guided LITT 4 to 6 weeks following embolization. Results: A total of 82 patients (62 with metastases from colorectal cancer, 14 with metastases from breast cancer and 6 with metastases from other primary tumors) responded to TACE with a reduction in tumor size of a mean value of 29%±14 and were treated with LITT. Each patient underwent 2 to 7 TACE treatments (mean 4.3) prior to LITT. In 47 patients, no reduction in tumor size was achieved, which led to further follow-up, and in 33 patients disease progression was found, with either an increasing size of the lesions (n= 18) or newly developing metastases (n= 15), resulting in further TACE treatments or change to systemic chemotherapy. Median survival of the patients who responded to this combined treatment was 26.2 months; in the group of the patients treated only with TACE survival was 12.8 months (ranging from 0.3 to 29.4 months). Conclusion: Repeated TACE is able to reduce the size of primary unresectable hepatic metastases in 50.6% of cases allowing local ablative treatments like MRI-guided LITT.