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Table 8. Recommendations on Liver-Directed Therapies in
Patients with Metastatic Colorectal Cancer
Note: is table pertains to only Maximal settings
ASCO Resource Level
Strength of
Recommendation Population Rec # Maximal
Patients with liver
metastases
5.1 Upfront surgery of metastases Strong
Highly selected
patients with liver
metastases
5.2 Combination surgery and
ablation
Moderate
Patients with liver
metastases
5.3 Ablative therapies:
radiofrequency, thermal,
cryoablation, alcohol ablation
Weak
Radiation therapies: external
beam radiation, SBRT
In Maximal Settings, when patients are deemed to have unresectable liver metastases,
depending on institutional expertise and aer careful review by MDT, patients may
receive/discuss the options of 5.4 – 5.6.
Patients with liver
metastases*
5.4 Hepatic arterial infusion
(HAI) of chemotherapy in
combination with systemic
chemotherapy.
Qualifying statement: HAI
therapy has limited availability
in the USA and is used only
in institutions with high level
of expertise for this procedure
and for select patients.
Weak
Patients with liver
metastases*
5.5 Transarterial
chemoembolization (TACE)
Weak
Patients with liver
metastases*
5.6 Selective internal radiation
therapy (SIRT) in
combination with systemic
chemotherapy may be
discussed to prolong time to
liver disease progression in the
second-line setting or beyond.
Moderate
* NOTE: Recommendations should be implemented in centers of expertise in the specific technique
aer multidisciplinary review, or in the context of a clinical trial.
