title: Transarterial chemoembolization (TACE) for colorectal liver metastases--current status and critical review.
abstract: BACKGROUND
  Transarterial liver-directed therapies are currently not recommended as a standard treatment for colorectal liver metastases. Transarterial chemoembolization (TACE), however, is increasingly used for patients with liver-dominant colorectal metastases after failure of surgery or systemic chemotherapy. The limited available data potentially reveals TACE as a valuable option for pre- and post-operative downsizing, minimizing time-to-surgery, and prolongation of overall survival after surgery in patients with colorectal liver only metastases.
  
  
  OBJECTIVE
  In this overview, the current status of TACE for the treatment of liver-dominant colorectal liver metastases is presented. Critical comments on its rationale, technical success, complications, toxicity, and side effects as well as oncologic outcomes are discussed. The role of TACE as a valuable adjunct to surgery is addressed regarding pre- and post-operative downsizing, conversion to resectability as well as improvement of the recurrence rate after potentially curative liver resection. Additionally, the concept of TACE for liver-dominant metastatic disease with a focus on new embolization technologies is outlined.
  
  
  CONCLUSIONS
  There is encouraging data with regard to technical success, safety, and oncologic efficacy of TACE for colorectal liver metastases. The majority of studies are non-randomized single-center series mostly after failure of systemic therapies in the 2nd line and beyond. Emerging techniques including embolization with calibrated microspheres, with or without additional cytotoxic drugs, degradable starch microspheres, and technical innovations, e.g., cone-beam computed tomography (CT) allow a new highly standardized TACE procedure. The real efficacy of TACE for colorectal liver metastases in a neoadjuvant, adjuvant, and palliative setting has now to be evaluated in prospective randomized controlled trials.
authors.affiliation: Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Kirrberger Straße, Geb. 50.1, 66421, Homburg Saar, Germany, alexander.massmann@uks.eu.
authors.forename: Alexander
authors.initials: A
authors.lastname: Massmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Rodt
authors.forename: Steffen
authors.initials: S
authors.lastname: Marquardt
authors.forename: Roland
authors.initials: R
authors.lastname: Seidel
authors.forename: Katrina
authors.initials: K
authors.lastname: Thomas
authors.forename: Frank
authors.initials: F
authors.lastname: Wacker
authors.forename: Götz M
authors.initials: GM
authors.lastname: Richter
authors.forename: Hans U
authors.initials: HU
authors.lastname: Kauczor
authors.forename: Arno
authors.initials: A
authors.lastname: Bücker
authors.forename: Philippe L
authors.initials: PL
authors.lastname: Pereira
authors.forename: Christof M
authors.initials: CM
authors.lastname: Sommer
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D016461:Chemoembolization, Therapeutic; D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents