The Therapeutic Challenge

Disappearing liver metastases (DLM), also known as vanishing or missing liver metastases, refer to hepatic metastatic lesions that become undetectable on imaging studies following systemic chemotherapy ^[1]. This phenomenon is particularly noted in patients with colorectal liver metastases (CRLM) ^[1]. DLM represent a perplexing challenge in colorectal cancer management. Following chemotherapy, radiological disappearance of liver metastases occurs in a substantial number of cases, presenting a misleading sense of treatment success ^[1]. Up to 80% of these cases harbor residual microscopic disease, undetectable by standard imaging modalities ^[1]. The inability to visualize these lesions raises critical questions about surgical planning and long-term patient management.

Fig 1: Metastatic invasion of tumour cells into the liver. Originally published by Tsilimigras, D.I., Brodt, P., Clavien, PA. et al. Liver metastases. Nat Rev Dis Primers 7, 27 (2021). https://doi.org/10.1038/s41572-021-00261-6.

Fig 2: Schematic representation of morphological liver metastases appearance. Originally published by Maino C, Vernuccio F, Cannella R, Cortese F, Franco PN, Gaetani C, Giannini V, Inchingolo R, Ippolito D, Defeudis A, Pilato G, Tore D, Faletti R, Gatti M. Liver metastases: The role of magnetic resonance imaging. World J Gastroenterol 2023; 29(36): 5180-5197 [PMID: 37901445 DOI: 10.3748/wjg.v29.i36.5180].

DLM highlight a paradox - on the surface, imaging suggests remission, yet hidden threats lurk within. This conundrum necessitates innovative thinking and collaborative action. Can we truly declare success without knowing what lies beneath?

Fig 3: Differences among the three methods for analyzing the radiological response. The measurements taken are: A = 35 mm, B = 20 mm, A’ = 20 mm, A’’ = 18 mm, B’’ = 7 mm. According to these, for the RECIST 1.1 (response evaluation criteria in solid tumours updated in its 1.1 version) method, the patient had a partial response (57,14%); for the modified RECIST (mRECIST) and EASL (European Association for the Study of the Liver) methods, there is a partial response, as well (51,43% and 18%, respectively). Originally published by Cantero E, Llorca J, Cagigal-Cobo M L, Rodriguez-Sanjuan J C, Campos-Sanudo J A. Comparison of Methods for Analyzing Radiological Response of Colorectal Cancer Liver Metastasis After Neoadjuvant Chemotherapeutic Treatment. I J Radiol. 2021;18(2):e110747. https://doi.org/10.5812/iranjradiol.110747.