The Treatment of Liver Metastases from Colorectal Cancer: Questions More than Answers?

Abstract

About 50% of all patients affected by CRC develop liver metastases. Surgery remains the only potentially curative strategy, but is impossible in the majority of patients. For non-resectable patients, two options are available: local treatment strategies (radiofrequency ablation and cryosurgery: alone or in combination with surgery) and chemotherapy. High rates of objective response achieved with Fluoropyrimidines, Oxaliplatin (OHP) and Irinotecan (CPT-11) based chemotherapy, enable initially non-resectable patients to undergo surgery, with a 5-year survival rate comparable to that observed for primary resectable patients. Therefore, chemotherapy has not only a palliative aim, but becomes a strategy with curative purposes. Adjuvant therapies have been investigated to reduce recurrence rates, some testing hepatic arterial infusion (HAI) schedules but definitive data are not yet available. Our experience, based on results from retrospective studies, suggests a possible role of systemic adjuvant chemotherapy in reducing nrecurrence rates after surgery. New targeted drugs and new loco-regional therapies are expected to further improve prognosis in neoadjuvant, adjuvant and palliative settings.