Liver metastases: the value of regional long-term chemotherapy

In numerous tumors, metastasis can be limited to the liver. In non-resectab le patients, regional treatment modalities, especially arterial cytostatic infusion, are favored in contrast to systemic chemotherapy, whereas intrapo rtal or intraperitoneal application is not successful. Improved results wit h high response rates have been reported after development of intra-arteria l (i.a.) long-term regimens with FUdR in patients with colorectal liver met astases using implantable pumps and ports. However, a survival benefit coul d only be demonstrated in comparison with a control group only treated symp tomatically. Because of several reports on major local toxicity of i.a. FUd R treatment (i.e. chemical hepatitis and biliary sclerosis) several other e ffective i.a. 5-FU regimens have been developed. A randomized study has dem onstrated superiority of i.a. 5-FU versus i.a. FUdR. In comparison with sys temic treatment, superiority has only been demonstrated in patients with an intrahepatic tumor burden of < 25 %. Publications about regional treatment of patients with breast, gastric cancer or carcinoid liver metastases are rare. Despite the high response rates reported, the benefit of arterial che motherapy remains questionable. Overall, local long-term chemotherapy canno t be recommended outside of studies as a primary treatment. However, extens ive experience and new drugs support the idea of conducting further regiona l studies.