Liver-directed therapy (TACE, TARE, HAI, ablation)

Because the liver is a common and often the sole site of spread (colorectal cancer, uveal melanoma, neuroendocrine tumours) and the primary site of hepatocellular carcinoma, treating it locally can control disease for years. Options are resection and ablation for limited disease, TACE and radioembolisation for multifocal disease, hepatic arterial infusion of floxuridine via an implanted pump (MSK, PUMP trial) for colorectal metastases, percutaneous hepatic perfusion (chemosaturation) for uveal melanoma metastases, and SBRT or proton therapy for lesions near vessels. They are increasingly combined with systemic therapy, and trials test sequencing rather than replacement.