Liver metastases are secondary tumors that have spread from another primary cancer; they are not the same disease as hepatocellular carcinoma or cholangiocarcinoma. Treatment depends on the biology and control of the primary cancer, number and distribution of liver lesions, extrahepatic disease, prior systemic therapy, liver reserve and whether all relevant disease can be treated safely. German university metastasis and liver-surgery programs publish multidisciplinary pathways combining systemic treatment, resection, ablation, radiation and selected regional treatments. International patients should therefore request a review of the complete cancer history rather than asking for one liver procedure in isolation.
Start with the primary cancer, not only the liver lesions
Charité's European Metastasis Center emphasizes that treatment for metastatic disease is based on the type of primary cancer. Heidelberg notes that colorectal cancer is a common source of liver metastases but also lists breast cancer, melanoma, renal-cell carcinoma, pancreatic cancer and gastric cancer. The German team therefore needs the original cancer pathology and systemic-treatment history as well as liver imaging.
Resectability is an individualized multidisciplinary decision
Heidelberg states that liver resection for metastases is always an individual decision based on the course and extent of the underlying cancer and the local findings in the liver. The review should consider lesion number and location, relationship to major vessels and bile ducts, future liver remnant, extrahepatic disease and whether surgery fits the wider systemic-treatment plan.
Colorectal liver metastases have a particularly established surgical pathway
Freiburg describes major progress in multimodal treatment of liver metastases and highlights surgery together with systemic and interventional approaches. For colorectal cancer, liver-directed surgery can be especially important in selected resectable or convertible disease, but operability should be assessed by a liver/metastasis team rather than inferred from lesion count alone.
Systemic therapy depends on the primary tumor biology
A liver-metastasis plan cannot use one universal chemotherapy or immunotherapy approach. Breast cancer, colorectal cancer, melanoma, renal-cell carcinoma and other primaries have different systemic strategies and biomarkers. The German center should coordinate liver-directed treatment with the oncology team responsible for the primary disease.
Ablation can complement or sometimes substitute for surgery in selected lesions
Freiburg publishes radiofrequency and microwave ablation for liver metastases, and its liver-surgery program lists non-operative local therapies for selected patients. Suitability depends on lesion size, number, location, prior surgery and the overall disease pattern; ablation should not be presented as equivalent to resection for every patient.
Radiation and CyberKnife are selected local options
Charité's metastasis program includes radiation-based approaches for organ metastases, while stereotactic treatment can be considered for selected lesions when anatomy and prior treatment make it appropriate. The radiation team must assess target geometry, nearby organs and the number of lesions rather than treating SBRT or CyberKnife as a universal liver-metastasis solution.
SIRT/TARE is a regional liver treatment for selected disease patterns
Freiburg documents selective internal radiation therapy for liver tumors and metastases as an inpatient nuclear-medicine and interventional-radiology procedure. Whether SIRT/TARE is relevant depends on primary tumor, liver-dominant disease, prior systemic therapy, vascular anatomy and liver function and should be decided in multidisciplinary review.
Repeat or staged liver treatment can be possible in selected patients
Some metastatic-cancer pathways involve systemic therapy followed by liver surgery, staged resections, repeat surgery for recurrence, or combinations of resection and ablation. This makes the treatment sequence and the interval restaging plan as important as the first procedure itself.
Records to send before travelling
A useful German metastasis review should allow the team to reconstruct both the primary cancer and the complete current disease pattern.
- Original primary-cancer pathology report and relevant biomarkers/molecular findings
- Current contrast CT or MRI of the liver in DICOM format
- Chest and body staging imaging, PET/CT when already clinically indicated
- Reports from previous primary-tumor and liver surgery
- Complete systemic-treatment history with dates and response
- Prior liver ablation, radiation, TACE/TARE/SIRT or other local-treatment reports
- Current liver and kidney laboratory results
- Tumor markers relevant to the primary cancer when already followed
- Current medication and major comorbidities
- A clear question about resection, ablation, radiation, regional therapy or second opinion
Plan follow-up around both liver and extrahepatic disease
After liver-directed treatment, surveillance must continue for the original cancer and for disease elsewhere in the body. Before returning home, clarify when restaging is due, which imaging should be performed locally, and how results will be sent back to the German metastasis or liver team.
Sources and review
This guide was last source-reviewed on 2026-08-30.
- European Metastasis Center – metastatic disease and multidisciplinary treatment — Charité – Universitätsmedizin Berlin ↗
- Liver metastases – individualized resection assessment — Heidelberg University Hospital ↗
- Liver metastases – surgery and multimodal treatment — University Medical Center Freiburg ↗
- Liver and biliary surgery – liver metastasis clinic — University Medical Center Freiburg ↗
- SIRT for liver tumors and metastases — University Medical Center Freiburg ↗