Colorectal cancer was the third most common
malignancy worldwide in 2018, and most patients present with or develop distant
metastases. Colorectal liver
metastases are most commonly observed because of the vascular drainage of the colon and superior rectum. Current guidelines recommend surgical resection as first-line treatment; however, 80% to 90% of patients with colorectal liver
metastases are ineligible for primary resection. For patients with unresectable disease, a multidisciplinary treatment approach is favored, incorporating systemic
therapy and a toolbox of local ablative
therapies. These treatments either aim at cytoreduction to enable a conversion to surgical resectability or control of
disease progression and spread. Each of these treatments carries unique outcomes and risk profiles, thereby contributing to an individualized treatment strategy for patients with colorectal liver
metastases. This review summarizes evidence on hepatic artery infusion, stereotactic body
radiation therapy, thermal ablation, transarterial chemoembolization with drug-eluding beads, and transarterial radioembolization for treatment of colorectal liver
metastases. Results of large-scale prospective and retrospective studies and international guidelines are discussed to provide detailed background on the current and prospective use of local ablative techniques in management of colorectal liver
metastases.