Locoregional therapy for liver metastases from colorectal cancer: The possibilities of intraarterial chemotherapy, and new hepatic-directed modalities

Liver metastasis of colorectal cancer is a life-threatening prognostic fact or. Hepatic resection, when possible, is the best therapeutic modality, alt hough the overall survival rate is still low (30%). The diagnosis has been carried out by clinical examination, abnormal alkaline phosphatase, lactic acid dehydrogenase and tumor markers, abdominal liver echography and comput ed tomography scan. Angiography and intraoperative echography are useful fo r resection. The number of hepatic metastases and the surgical margin are p robably the most significant prognostic factors. Colorectal cancer may spre ad predominantly to the liver making regional treatment strategies viable o ptions. Subtotal hepatic resections and segmentectomies are potentially cur able procedures for single or small numbers of hepatic metastases without o ther sites of disease. However, there have been no prospective randomized t rials comparing patients with unresected liver metastases and resected Regional chemotherapy with floxuridine seems useful combined with hepatic r esection or as palliative therapy. Gastric ulcer and biliary sclerosis are the main related toxicities. Patients with localized, unresectable hepatic metastases or concomitant bad medical condition may be candidates for radia tion, percutaneous ethanol injection, cryosurgery, radiofrequency, hypoxic flow-stop perfusions with bioreductive alkilating agents, hepatic arterial ligation, embolization and chemoembolization. These new hepatic-directed mo dalities of treatment are being investigated and may offer new approaches t o providing palliation and prolonging survival. This review reports the pos sibilities of intraarterial chemotherapy and other novel hepatic directed a pproaches to the treatment of liver metastases from this common disease. me tastases.