Liver metastases - primary or multimodal therapy?

Multimodal therapeutic concepts for the treatment of liver metastasis are c urrently undergoing evaluation - prompted by the fact that few patients hav e lasting benefit from resection alone. Thus, for example, in practice, vir tually only metastases from colorectal carcinoma or neuroendocrine tumors c an be referred to surgical treatment, and, of these, only 20-25 % are techn ically resectable. Furthermore, even after an RO resection, recurrent disea se subsequently develops in 60-75 % of the cases. In primarily non-resectab le colorectal liver metastases, prior systemic treatment with 5-FU/folinic acid and oxaliplatin can result in partial or complete remission in 50-60 % of cases and, depending on patient selection criteria, a secondary RO rese ction rendered possible in 14-38 %. Theoretical oncological considerations suggest that neoadjuvant treatment should be applied in the case of resecta ble liver metastases too. The question of whether the prognosis is then imp roved compared with resection alone is currently being investigated in a pr ospective multicentre study conducted by the EORTC. The value of adjuvant t herapy administered with the aim of lowering the risk of recurrence followi ng "curative" resection of liver metastases is presently not considered to have been adequately demonstrated. With regard to the efficacy of regional chemotherapy, the results of two prospective randomized studies are contrad ictory. Nor can the multimodal approach decisively improve the outcome of n on-radical resection of metastatic lesions. This means that primary or seco ndary resection with a margin of clearance continues to represent the gold standard for the treatment of colorectal liver metastases. Neoadjuvant or a djuvant chemotherapy - where applicable with the additional use of various methods of thermal ablation (cryotherapy, laser therapy, high-frequency the rmotherapy) - should be restricted to clinical trials.