Nancy Kemeny, MD

The liver is a frequent site of metastatic colorectal disease. Over the past 20 years, improvements in systemic chemotherapy and surgical techniques have improved the survival of patients with hepatic metastases. For 4 decades, fluorouracil and leucovorin were the only drugs available to treat metastatic colorectal cancer, but several new drugs and a variety of novel regimens are now available. Further improvements in results have been seen with the delivery of chemotherapy via the hepatic artery. Surgical resection of liver metastases has been encouraged when possible, and recent advances in surgery such as portal vein embolization, have made liver resection a possibility for more patients. This review considers the timing and sequence of chemotherapy and surgery in this setting, as well as the roles of cryoablation, radiofrequency ablation, and radiation therapy.

Drs. Whisenant and Venookhave provided us with a summaryof the role of hepaticarterial infusion (HAI) chemotherapyfor patients with metastatic colorectalcancer. In their abstract they state thatthere is confusion about whether HAIfor unresectable liver metastases isuseful, because European studies havebeen negative; they go on to say thatthe work in adjuvant therapy hasmixed results. I would like to offersome different interpretations.

Colorectal carcinoma is a common problem in the United States, and the liver is the most frequent site of metastatic disease. Because there is a good pharmacologic rationale for the use of hepatic intra-arterial (HIA) therapy, and because of the disappointing survival observed with systemic chemotherapy, studies of hepatic arterial infusion have been conducted.