Colorectal metastases to the liver: Present results and future strategies

Abstract

In recent years, wide agreement has been expressed on the value of surgical resection for liver metastases from colorectal cancer, while for unresectable patients different types of locoregional treatment have been attempted. One hundred seventy-one patients with hepatic metastases from colorectal cancer were treated by us over a period of 15 years. Sixty-four underwent hepatic resection, and 107 underwent various forms of locoregional treatment. Our experience confirms the opinion that hepatic resection can be performed with a "curative" aim in patients with colorectal liver metastases; a 5-year survival rate can be achieved in about 30% of resectable cases. Adjuvant chemotherapy after hepatic resection should be tested in prospective randomized trials. Patients with diffuse liver metastases can benefit from locoregional infusion chemotherapy. Symptoms improve in most patients and objective responses are higher than those reported for systemic chemotherapy. Survival benefit with respect to untreated patients, has not yet been demonstrated by prospective randomized studies. Future improvements may be achieved by using new treatment modalities, such as new drug combinations, repeat arterial ischemia, and local tumor destruction. As these types of treatment are still experimental they should be employed only in prospective clinical trials.

Fatores prognósticos na ressecção de metástases hepáticas de câncer colorretal

“…A sobrevida de pacientes com metástases hepáticas não ressecadas varia de 5 a 19 meses, com média inferior a 9 meses (29) . A quimioterapia isoladamente pode proporcionar sobrevida média de 15 meses (27,38) . A experiência de SCHEELE et al (35) , em 434 ressecções de metástases hepáticas de câncer colorretal em período de 32 anos (de 1960 a 1992), mostrou sobrevida de 32% em 10 anos e de 18% em 20, com mortalidade operatória inferior a 5%.…”

Early Events of Hepatic Metastasis Formation in Mice: Role of Kupffer and NK-Cells in Natural and Interferon-γ-Stimulated Defense

“…Injection protocol for GdCl 3 , anti-asGM 1 , and IFN-␥. To investigate the role of Kupffer cells in anti-tumor defense, mice were injected iv with GdCl 3 .…”

“…Surgical hepatic resection can be applied to only 10 -15% of patients with hepatic metastases and allows a 5-year survival rate in 25-30% of the cases [1].…”

EGFR signaling in colorectal cancer: a clinical perspective

“…3 By integrating systemic therapy and surgery in patients with limited liver metastases, 5-year OS ranges from 40% to 60%. [9][10][11] The contribution of other locoregional treatments (radioembolization, chemoembolization, or stereotactic radiotherapy) in the treatment of liver metastases has not been fully elucidated, although upfront radiofrequency ablation with or without liver surgery followed by chemotherapy has been shown to improve progression-free survival (PFS) compared to chemotherapy alone for unresectable liver metastases. 12 Therefore, these options may be considered in selected patients with chemorefractory liver disease.…”