Towards more individualized treatment of patients with colorectal cancer liver metastases

Colorectal cancer liver metastases (CRLM) is the major cause of colorectal cancer-related deaths. However, in patients with metastases confined to the liver, local treatment of CRLM may offer a chance of long-term survival with 5-year survival rates of 45-60% or even cure. As such, optimizing treatment outcomes of CRLM patients may help to improve outcomes in the overall CRC population. At initial diagnosis, 20% of patients with CRLM are considered upfront resectable. Systemic treatment with the combination of chemotherapy and targeted therapy converts up to 57% of patients with initially unresectable CRLM to secondary resectable CRLM. In this thesis we focus on survival outcomes and comparison of established first line systemic conversion treatments and safety-outcomes of local treatments of advanced initially unresectable CRLM. Furthermore, we evaluate prognostic and predictive technical-anatomical and tumor-biological preoperative factors and focus on clinically relevant endpoints of prediction models to help guide clinical-decision making in CRLM patients. Finally, we analyze the performance of promising novel diagnostic techniques in CRLM patients. The aim of the research in this thesis is to contribute to a more individualized treatment of patients with CRLM by providing valuable disease- and treatment-related insights of CRLM.