Outcomes of Elderly Patients with Colorectal Liver Metastases Treated with Liver-Directed Therapies

Abstract Background Liver-directed therapy (LDT) is an essential component of multimodal management of colorectal liver metastases (CRLM), yet older adults are less likely to receive liver-directed or curative-intent treatment. We evaluated presentation, treatment patterns, and outcomes among elderly patients with CRLM. Methods We retrospectively reviewed patients with CRLM treated at the University of Texas Southwestern Medical Center and Parkland Memorial Hospital from 2016 to 2023. Liver-directed therapy was defined as liver resection, hepatic artery infusion pump therapy, ablation, liver-directed radiation including external beam radiation and stereotactic body radiation, transarterial chemoembolization, and/or Y-90 radioembolization. The primary outcome was overall survival (OS); the secondary outcome was receipt of LDT. Cox proportional hazards regression identified factors associated with OS among patients aged ≥70 years. Results Among 852 patients, 710 were aged <70 years and 142 were aged ≥70 years. Liver metastasis number, bilobar involvement, CEA level, and extrahepatic disease were similar between age groups. Older adults were less likely to receive LDT than younger patients (20% vs. 40%, p < 0.001). Among patients who underwent hepatic resection, perioperative outcomes were similar by age. Among older adults, LDT was associated with longer median OS than no LDT (44 vs. 9 months, p < 0.001). Among patients receiving LDT, median OS was comparable between age groups (44 vs. 52 months, p = 0.19). Performance status, CEA ≥200 ng/mL, chemotherapy, and LDT were independently associated with OS. Conclusions Older adults with CRLM were less likely to receive LDT. Among selected older adults, receipt of LDT was associated with longer OS than no LDT. Chronological age alone should not preclude consideration of LDT.