Alternative techniques for the treatment of colon carcinoma metastases in the liver: Current status in The Netherlands

Background: Review of current treatment modalities for liver metastases res ulting from colorectal cancer. Methods: Literature review. Results: An incr easing number of techniques are available for the treatment of colorectal l iver metastases. When it is not possible to use the current gold standard, radical surgical resection. many patients can be treated with alternative t echniques. Chemotherapy in its present form must be considered as purely pa lliative. perhaps with the exclusion of isolated liver perfusion: however. this therapy should still be considered as experimental. Most other possibl e treatments focus on local destruction of the metastases. This can be achi eved using either immuno-guided techniques (tumor antibodies which carry a local active agent), direct local application of a toxic agent (injection) or thermo therapy, which has been applied in patients on a large scale. The rmo therapy involves either localized heating, by means of laser photocoagu lation or radiofrequency or microwave ablation, or localized freezing using cryo probes. Conclusions: Local destruction of liver metastases. especiall y by means of thermo therapy, is feasible and safe. Currently, cryotherapy is most frequently used in patients. New treatment modalities. such as radi ofrequency ablation, are very promising but their true clinical value shoul d be determined in a randomized clinical trial.