Summary.-The results of using a standard combination of cytotoxic agents in 27 cases of secondary liver cancer are reported. A brief review of the methods available for treating hepatic metastases from solid tumours, as opposed to lymphomata, is included. The response rate depends on the site of the primary lesion. It is suggested that in patients with mammary or colorectal primary tumours, combination chemotherapy represents an advance in treatment with an objective response rate of 730/% and 66% respectively in the 2 groups. The method requires no specialized equipment as neither grossly deranged liver enzymes nor jaundice are contra-indications to treatment, and toxicity is easily monitored and readily controlled.
CHEMOTHERAPEUTIC REGIMENIn 1971 Hanham, Newton and Westbury reported on 75 cases treated with quadruple chemotherapy using a modification of the regimen devised by Costanzi and Coltman (1969). We have continued to use this regimen and this report concerns those patients in the first 150 treated by quadruple chemotherapy who had hepatic metastases.Liver biopsy is not performed as a routine on patients suspected of having metastases, thus antemortem histological confirmation of liver involvement was not always available. Hepatic metastases were therefore diagnosed when 3 or more of the following were present: (1) Hepatomegaly; (2) raised alkaline phosphatase level; (3) raised aspartate aminotransferase (SGOT) level; (4) evidence of hepatic metastases on gamma scan.Of the 150 patients reviewed, 27 had hepatic metastases on these criteria. This figure is lower than might be expected and this is largely explained by the high proportion of head and neck cancers.