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  • Review Article
  • Published:

Modern therapeutic approaches for the treatment of malignant liver tumours

Nature Reviews Gastroenterology & Hepatology volume 17, pages 755–772 (2020)Cite this article

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Abstract

Malignant liver tumours include a wide range of primary and secondary tumours. Although surgery remains the mainstay of curative treatment, modern therapies integrate a variety of neoadjuvant and adjuvant strategies and have achieved dramatic improvements in survival. Extensive tumour loads, which have traditionally been considered unresectable, are now amenable to curative treatment through systemic conversion chemotherapies followed by a variety of interventions such as augmentation of the healthy liver through portal vein occlusion, staged surgeries or ablation modalities. Liver transplantation is established in selected patients with hepatocellular carcinoma but is now emerging as a promising option in many other types of tumour such as perihilar cholangiocarcinomas, neuroendocrine or colorectal liver metastases. In this Review, we summarize the available therapies for the treatment of malignant liver tumours, with an emphasis on surgical and ablative approaches and how they align with other therapies such as modern anticancer drugs or radiotherapy. In addition, we describe three complex case studies of patients with malignant liver tumours. Finally, we discuss the outlook for future treatment, including personalized approaches based on molecular tumour subtyping, response to targeted drugs, novel biomarkers and precision surgery adapted to the specific tumour.

Key points

  • Contraindications for two-stage hepatectomy owing to a small future liver remnant should always be evaluated at expert centres.

  • The minimally invasive resection of selective liver tumours is oncologically efficient and offers faster postoperative recovery than invasive procedures.

  • Ablation therapy is an essential component of the treatment of liver tumours as it enables parenchymal preservation and treatment of high-risk patients and can be applied in combination with liver resection or as a bridge to liver transplantation.

  • Liver transplantation and transplant oncology are evolving as life-saving treatment options for patients with otherwise unresectable liver tumours.

  • Stereotactic body radiotherapy is a non-invasive treatment that achieves local tumour control in challenging situations such as when tumour size is >3 cm and tumour location is close to central vessels and the biliary system.

  • Systemic therapy is used to convert unresectable tumours into resectable tumours, target micrometastatic disease and provide disease control for staged procedures.

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Fig. 1: Liver surgery strategies tailored to specific tumour scenarios.
Fig. 2: Treatment algorithm of CRLM at the Swiss HPB Center, Zurich, Switzerland.
Fig. 3: The RAPID approach for colorectal liver metastases.
Fig. 4: Personalized perioperative treatment for CRLM and ICC based on molecular profiling.

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Acknowledgements

The authors thank S. Gaal for her dedication and very efficient work during the editorial process. The authors are supported by the Liver and Gastrointestinal Disease Foundation (LGID), Switzerland, and the Swiss National Foundation Grant ‘Division of tasks in the regenerating liver — metabolic restraints to successful recovery after tissue loss’.

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Authors and Affiliations

  1. Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland

    Henrik Petrowsky, Michelle L. De Oliveira, Philipp Dutkowski & Pierre-Alain Clavien

  2. Department of Medical Oncology and Haematology, University Hospital Zurich, Zurich, Switzerland

    Ralph Fritsch

  3. Department of Radio Oncology, University Hospital Zurich, Zurich, Switzerland

    Matthias Guckenberger

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The authors contributed equally to all aspects of the article.

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Petrowsky, H., Fritsch, R., Guckenberger, M. et al. Modern therapeutic approaches for the treatment of malignant liver tumours. Nat Rev Gastroenterol Hepatol 17, 755–772 (2020). https://doi.org/10.1038/s41575-020-0314-8

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