Managing disappearing liver metastases following chemotherapy

Liver metastases that can no longer be identified on radiographic images after chemotherapy are termed disappearing metastases. This most commonly occurs in patients with multifocal bilobar metastases of differing size who are extensively treated with chemotherapy. The most effective treatment for disappearing liver metastases is prevention, through the use of high-quality pretreatment imaging, early involvement of a liver surgeon, and limitation of neoadjuvant chemotherapy to as few cycles as are needed for the metastases to become resectable. If a treated metastasis cannot be identified on CT, then MRI should be used to confirm a true disappearance. As the disappearance of a metastasis does not necessarily signify a pathologic complete response at that site, when possible, resection of liver metastases should include all sites that initially contained disease. If this is not possible, then these patients can be considered for other local therapies and should be followed closely for disease recurrence.