Liver
metastasis of
colorectal cancer is a life-threatening prognostic factor. Hepatic resection, when possible, is the best therapeutic modality, although 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 computed tomography scan. Angiography and intraoperative echography are useful for resection. The number of hepatic
metastases and the
surgical margin are probably the most significant prognostic factors.
Colorectal cancer may spread predominantly to the liver making regional treatment strategies viable options. Subtotal hepatic resections and
segmentectomies are potentially curable procedures for single or small numbers of hepatic
metastases without other sites of disease. However, there have been no prospective randomized trials comparing patients with unresected liver
metastases and resected
metastases. Regional
chemotherapy with
floxuridine seems useful combined with hepatic resection 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 radiation, percutaneous
ethanol injection,
cryosurgery, radiofrequency, hypoxic flow-stop perfusions with bioreductive
alkylating agents, hepatic arterial
ligation, embolization and chemoembolization. These new hepatic-directed modalities of treatment are being investigated and may offer new approaches to providing palliation and prolonging survival. This review reports the possibilities of intraarterial
chemotherapy and other novel hepatic directed approaches to the treatment of liver
metastases from this common disease.