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Rational treatment planning for isolated, potentially curable liver metastases
Oregon Health & Science University, Portland, OR
The liver is a frequent site of metastatic colorectal disease. Surgical resection remains the gold standard for treating isolated liver metastasis, but only 5%–10% of patients are eligible for resection. Chemotherapy is the treatment of choice for unresectable disease. Clinical trials with newer agents and combinations as well as drug delivery via the hepatic artery have shown that initially unresectable disease can become resectable with chemotherapy. Because of the high rate of recurrence after resection, chemotherapy is also used in the adjuvant setting to improve outcomes. The role of adjuvant therapy in resectable liver metastases is unclear. Neoadjuvant therapy now is being considered in patients with resectable liver metastases to decrease the size of the tumor prior to surgery. The timing and sequence of chemotherapy and surgery are important considerations in this setting and need to be defined. Additionally, the potential for liver toxicity associated with neoadjuvant chemotherapy needs to be weighed against the benefit of therapy.
| Commun Oncol 2007;4(suppl 3):11–16 | full text |  140 kb |