The liver is the main target organ for colorectal cancer (CRC) metastases. About 50% of all patients affected by CRC develop liver metastases. Surgery remains the only potentially curative strategy, but indications to surgery and resectability criteria are now less restrictive than before so that a more aggressive approach in the treatment of metastatic lesions is the rule. However in spite of these increasing indications surgery is not possible in the majority of patients. For non resectable patients two options are available: local treatment strategies (intra-arterial infusion chemotherapy or radiofrequency ablation and cryosurgery alone or in combination with surgery) and systemic chemotherapy. Locoregional treatments are efficacious in obtaining objective responses, but they are expensive, not easy to manage, and are still accompanied by important side effects; for these reasons, their use is necessarily limited to centres with a good granding in these techniques. On the contrary, the new schedules of systemic infusion therapy, achieved with fluorouracil (5-FU), oxaliplatin (OHP) and irinotecan (CPT-11) are well tolerated and have high rates of objective response, enabling initially unresectable patients to undergo surgery, with a 5-year survival rate comparable to that observed for primary resectable patients. Therefore chemotherapy no longer has only a palliative aim, but becomes a fundamental moment of a combined medical and surgical treatment with curative purpose. After surgery, two-thirds of patients relapse in the first two years, so that adjuvant therapy has been investigated to reduce recurrence rates, mainly by testing hepatic arterial infusion (HAI) schedules. Unfortunately, no randomized trials have yet been published on the rôle of systemic intravenous adjuvant chemotherapy which could be useful in clinical practice. Finally, we report the results of our monoinstitutional experience, suggesting a possible rôle of systemic adjuvant chemo-therapy in reducing recurrence rates after liver meta-stasectomy. Probably, in the next few years, new targeted drugs and locoregional therapies will contribute to further improve prognosis of such patients, in neoadjuvant, adjuvant and palliative settings.
|Number of pages||10|
|Journal||European Journal of Oncology|
|Publication status||Published - Mar 2005|
- Colorectal cancer
- Liver metastases
ASJC Scopus subject areas
- Cancer Research