Colorectal cancer (CRC) is a highly prevalent malignant disease in industrialized nations. The annual incidence of invasive CRC in the U.S. is among the highest in the world, and the liver is the only metastatic site in approximately one third of patients. Without treatment, patients with metastatic disease have a poor prognosis; however, long-term survival benefits and even cure have been reported in patients undergoing surgical resection of
metastases. In addition, advances in
chemotherapy, imaging, and surgical techniques have increased the proportion of patients who are eligible for resection. Combination
therapy with
fluorouracil and
leucovorin has been the mainstay of treatment for metastatic CRC; however, the introduction of newer agents, such as
oxaliplatin and
irinotecan, and targeted agents, such as
cetuximab and
bevacizumab, has yielded improvements in response rates (RRs) and survival. Maximizing the exposure of hepatic
metastases to high target concentrations of cytotoxic drugs using hepatic arterial infusion (HAI) increases RRs further than with systemic
chemotherapy; however, the impact of HAI on survival is unclear. As the goals of chemotherapeutic treatment for metastatic CRC increasingly shift from palliation to prolongation of survival, improvement in RRs, and downsizing of
tumors in order to enable or optimize resection, treatment in a multidisciplinary environment involving a medical oncologist, radiologist, and surgical oncologist with hepatobiliary expertise will become central to deciding the best course of
therapy and timing of surgery.