Colorectal liver metastases (2026)

Description

Authors: D. Maiettini, F. Orsi and G. M. Varano

Reviewers: O. van Delden, D. Filippiadis, M. M. Fouad, T. K. Helmberger, R. Iezzi, A. Kovacs and R. Uberoi

This course corresponds to chapter 2.2.5.2 Vascular interventional oncology in the European Curriculum and Syllabus for Interventional Radiology.

Abstract

The multidisciplinary management of patients with metastatic colorectal cancer has undergone profound evolution in recent years, with interventional radiologists assuming an increasingly central role in therapeutic decision-making. Contemporary treatment paradigms incorporate minimally invasive interventional techniques including image-guided thermal ablations, selective internal radiation therapy, and trans-arterial chemoembolization as established therapeutic options. Major contemporary oncology guidelines include local ablative therapies as options for selected colorectal liver metastases, underscoring the established role of interventional oncology within multidisciplinary care. High-level evidence indicates that in appropriately selected patients with lesions ≤3 cm, thermal ablation is non-inferior to surgical resection for overall survival and shows a more favourable safety profile. This paradigm shift supports individualized treatment approaches based on patient characteristics, tumour biology, and treatment goals rather than traditional hierarchical algorithms.

This comprehensive educational module provides a detailed examination of the essential components required for optimal management of patients harbouring liver metastases from colorectal cancer. The curriculum encompasses fundamental anatomical considerations, evidence-based patient selection criteria, technical aspects of major interventional procedures, and critical analysis of outcomes data derived from contemporary randomized controlled trials.

Learning objectives

• Understand the relevant pathophysiology and anatomy: Explain the pathophysiologic and clinical background of hepatic involvement in CRC, identify anatomical relationships (especially proximity to major hepatic vascular and biliary structures) that guide technique selection, and apply this knowledge to protect at-risk structures when planning ablation, embolization, or radioembolization.
• Recognize molecular considerations: Recognize how molecular features (RAS, BRAF, MSI) and tumour sidedness—together with markers such as serum CEA and disease burden—inform prognostic assessment and MDT discussions when planning interventional strategies; current evidence does not justify technique-specific modifications based on molecular or microenvironmental profiles.
• Demonstrate technical competency in thermal ablation: Demonstrate competence in current technologies, including radiofrequency and microwave ablation, and techniques for achieving adequate ablation margins (≥5 mm).
• Understand alternative ablation technologies: Understand evolving technologies, including cryotherapy, irreversible electroporation (IRE), and electrochemotherapy.
• Understand navigation and fusion imaging systems: Understand electromagnetic navigation systems and fusion imaging technologies for improved procedural accuracy.
• Anticipate and mitigate risks during thermal ablation: Anticipate and mitigate risk to bile ducts, bowel, stomach, and diaphragm through trajectory optimization and fluid/gas interposition; consider non-thermal or trans-arterial options when safe separation is not achievable.
• Demonstrate trans-arterial therapy expertise: Demonstrate knowledge of the use of micro-catheters and micro-guidewires for superselective treatments, understand the differences between conventional TACE (cTACE) and drug-eluting bead TACE (DEB-TACE), and recognize the different radioembolic particles available (resin vs glass spheres).
• Apply advanced planning principles in trans-arterial therapies: Select selective versus superselective approaches based on tumour distribution and hepatic functional reserve; for TARE, perform activity planning with adjusted/personalised dosimetry to achieve tumouricidal dose while respecting normal-liver constraints; for TACE, choose the chemoembolic platform and drug-delivery strategy, define angiographic endpoints (e.g., near-stasis), and plan to minimise non-target embolization.
• Apply evidence-based practice and quality standards: Apply guideline-recommended indications for local therapies, appraise high-quality evidence, and distinguish established data from ongoing research; recognize limitations of current technologies, understand complication management, and follow current CIRSE guidelines.

Further information

This course covers a basic level of IR knowledge and is designed for trainees, students or young consultants aiming to acquire essential knowledge or prepare for the EBIR exam. Thereby, it is tailored to the European Curriculum and Syllabus for Interventional Radiology and corresponds to chapter 2.2.5.2 Vascular interventional oncology.

The format of the course is interactive and easy to use, including texts, graphics, videos and a quiz to support your learning. The course duration is around three hours and is accredited by the European Accreditation Council for Continuing Medical Education (EACCME) to award  European 3 CME credits (ECMEC). Please note that this course will be taken offline on July 27, 2031.

The acquired CME Certificate will be available in the myCIRSE area under CIRSE Academy.

The enrolment period of this course is linked to the validity of the All-Access Pass.

Release date: July 2026