Management of hepatic metastases

Although the liver is the most common site of metastatic disease from a var iety of tumor types, isolated hepatic metastases most commonly occur from c olorectal cancer and, less frequently, from neuroendocrine tumors, gastroin testinal sarcoma, ocular melanoma, and others. Complete evaluation of the e xtent of metastatic disease, both intrahepatically and extrahepatically, is important before considering treatment options. Based on a preponderance o f uncontrolled studies for hepatic metastatic colorectal carcinoma, surgica l resection offers the only potential for cure of selected patients with co mpletely resected disease, with 5-year survival rates of 25% to 46%, System ic and hepatic arterial infusion chemotherapy may be useful treatment optio ns in patients with unresectable disease and possibly as an adjuvant treatm ent after liver resection, Other techniques of local tumor ablation, includ ing cryotherapy and radiofrequency ablation, although promising, remain unp roved, Management of hepatic metastases from neuroendocrine tumors and othe r noncolorectal primary tumors should be individualized based on the patien t's clinical course, extent of disease, and symptoms. Copyright (C) 1999 by the American Association for the Study of Liver Diseases.