Global approach to hepatic metastases from colorectal cancer: indication and outcome of intra-arterial chemotherapy and other hepatic-directed treatments

Liver metastases of colorectal cancer is present in more than 20% of new di agnosed patients and in 40-60% of relapsed patients. It is a life-threateni ng prognostic aspect. Hepatic resection, when possible, is the best therape utic modality, although the overall survival rate is still low (30%). Angio graphy and intraoperative ultrasonography are useful for resection. The num ber of hepatic metastases and the surgical margin are probably the most sig nificant prognostic factors. Colorectal cancer may spread predominantly to the liver making regional treatment strategies viable options. Subtotal hep atic resections and segmentectomies are potentially curable procedures for single or small numbers of hepatic metastases without other sites of diseas e. However, there have been no prospective randomized trials comparing pati ents with unresected liver metastases and resected metastases. Regional che motherapy with floxuridine seems usefull combined with hepatic resection er as palliative therapy. Gastric ulcer and biliary sclerosis are the main rel ated toxicities. Patients with localized, unresectable hepatic metastases o r concomitant bad medical condition may be candidates for radiation, percut aneous ethanol injection, cryosurgery, percutaneous radiofrequency, hypoxic flow-stop perfusions with bioreductive alkylating agents, hepatic arterial ligation, embolization and chemoembolization. These new hepatic-directed m odalities of treatment are being investigated and may offer new approaches to providing palliation and prolonging survival. This review will report th e possibilities of intra-arterial chemotherapy and other novel hepatic-dire cted approaches to the treatment of liver metastases from colorectal cancer .