Treatment for colorectal liver metastases: a review.
BACKGROUND
Over the past decade, the emergence of surgical adjuncts such as portal vein embolization, two-stage hepatectomy, and ablative therapies not only decreases mortality and morbidity after an extended hepatectomy but also broadens the indication for surgical treatment of liver metastasis from colorectal cancer. Combination chemotherapeutic regimens, namely 5-fluorouracil/folinic acid with irinotecan or oxaliplatin, and targeted monochromal antibodies can downsize the tumor burden to the extent that formerly unresectable metastases can sometimes be excised.


CONCLUSIONS
The 5-year survival rate following liver resection ranges between 25% and 58%. During the 5-fluorouracil/folinic acid with oxaliplatin and 5-fluorouracil/folinic acid with irinotecan treatment period, the patients who were deemed to be resectable should be considered as surgical candidates regardless of the associated adverse predictive factors. The emergence of epidermal growth factor receptor antibody agents, which act effectively in patients with Kras wild-type tumor, fosters treatment individualization.


CONCLUSIONS
The efficacy of the perioperative chemotherapy on survival benefit for resectable liver metastases has not been justified. However, the timing and indication of surgical treatment paradigm in colorectal liver metastasis, including for synchronous disease and extrahepatic disease, are dramatically changing with the development of chemotherapeutic agents.
Shimada
Hiroshi
H
The Medical Division of the Head Office, Japan Labor Health and Welfare Organization, Kawasaki, Japan. hs440312@yahoo.co.jp
Tanaka
Kuniya
K
Endou
Itaru
I
Ichikawa
Yasushi
Y
D055011:Ablation Techniques; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
D000970:Antineoplastic Agents