The role of chemotherapy in the curative treatment of patients with liver metastases from colorectal cancer.

As improved surgical techniques allow more patients with CRLM to be operated on with intent to cure, new systemic chemotherapy combinations and regional chemotherapy via the hepatic artery improve disease-free survival. Candidates for complete surgical resection with curative intent should proceed to surgery without neoadjuvant chemotherapy. Postoperative adjuvant therapy is appropriate for those remaining fit with potential for cure. Patients whose liver metastases cannot be resected safely who are otherwise fit for surgery should be treated aggressively with systemic or regional chemotherapy to sufficiently down stage the tumor for surgical resection. Correct timing of surgery, especially with bevacizumab use, has not been established. Without a multidisciplinary team, the potential to cure a select group of patients could be missed.