Management of liver metastases from colorectal cancer.
The liver is a frequent site of metastatic colorectal disease. Over the past 20 years, improvements in systemic chemotherapy and surgical techniques have improved the survival of patients with hepatic metastases. For 4 decades, fluorouracil and leucovorin were the only drugs available to treat metastatic colorectal cancer, but several new drugs and a variety of novel regimens are now available. Further improvements in results have been seen with the delivery of chemotherapy via the hepatic artery. Surgical resection of liver metastases has been encouraged when possible, and recent advances in surgery such as portal vein embolization, have made liver resection a possibility for more patients. This review considers the timing and sequence of chemotherapy and surgery in this setting, as well as the roles of cryoablation, radiofrequency ablation, and radiation therapy.
Kemeny
Nancy
N
Memorial Sloan-Kettering Cancer Center, New York, NY, USA. kemenyn@mskcc.org
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017115:Catheter Ablation; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D002986:Clinical Trials as Topic; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000628:therapy*; D003452:Cryosurgery; D004334:Drug Administration Schedule; D006499:Hepatic Artery; D006801:Humans; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods; D018579:Patient Selection; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors