Treatment of colorectal cancer metastases confined to the liver.

Hepatic metastases are a major cause of death in patients with disseminated colorectal cancer. The prognosis of patients with hepatic metastases is very poor and mainly determined by the extent of hepatic disease at presentation. In these patients, the goal of any treatment is to obtain a complete tumour remission in the liver; this is the only way to obtain a significant survival benefit. In this overview, we summarise data from (i) studies comparing survival of patients after primary resection of liver metastases with survival after repeat liver resections, (ii) studies comparing hepatic arterial infusion of fluoropyrimidines with systemic delivery of these anticancer drugs, and (iii) phase I/II studies on isolated liver perfusion (ILP) with alkylating compounds. Furthermore, we discuss alternative strategies to combat liver metastases, including those taking advantage of an ILP setting.