Cytoreductive approach to treatment of multiple liver metastases

Abstract

Patients with colorectal liver metastases fall into three general categories (Figure 1). Liver metastases can occur with clinical evidence of unresectable extrahepatic disease. Usually the clinical picture includes liver metastases and lung metastases. Currently these patients are treated with 5-FU and leucovorin, with a response rate of approximately 40% and a suggestion of prolonged survival as a result of systemic chemotherapy [1,2]. In patients who have colorectal liver metastases between one and three in number with an anatomic location that allows their complete resection, there can be no argument that surgical removal is indicated. In these patients made clinically disease free by surgery, several promising research protocols now operate in an attempt to identify a successful adjuvant treatment [3–6]. In the third group of patients with isolated liver metastases, no established pattern of treatment exists. These patients have multiple metastases or metastases unresectable because of their location or distribution within the liver. In the past many of these patients were treated in clinical studies evaluating hepatic artery infusion [7>–17]. However, because of the marginal results, high costs in dollars, and excessive morbidity, these infusional treatments have fallen into disuse [reviewed in 7].