Metastatic Liver Cancer: Treatment: Radiation therapy
The liver is the most common site for blood-borne metastasis from colorectal cancers. Until the early 1980s, it was generally accepted that hepatic metastases from colorectal cancer represented just one site in a wide systemic dissemination of tumor, and hepatectomy was rarely used as treatment. Since then, numerous studies have shown that resection can prolong survival and potentially provide cure. Surgical excision for hepatic metastases from colorectal cancer is now considered standard therapy for patients with metastases isolated to the liver. In the next section, we will summarize the data supporting such therapies, as well as clinical parameters that infl uence outcome. Since acceptance of surgery as a local therapy for this disease, a number of other local therapies have emerged as effective treatment options for hepatic metastases. The data supporting use of radiotherapy will be presented, as well as recent data documenting outcome of treatment with ablative therapies such as radiofrequency ablation and cryoablation. These tissuesparing local treatments for hepatic colorectal metastases have further extended treatment possibilities. Recent advancements in chemotherapies and biologic therapies have also contributed to effective treatment for hepatic colorectal metastases and extended the possibility for cure. As many as 5% of patients previously beyond curative therapies are being converted by systemic therapies to resectable. Those not resectable for cure are effectively treated by systemic and regional therapies to achieve extension of life. In the following sections we will present the current approach of palliative and adjuvant chemotherapy. The use of systemic and regional chemotherapy as neoadjuvant therapy prior to hepatectomy will also be discussed. The combined advances in surgery, systemic therapies, and regional ablative therapies have transformed this disease from uniformly and immediately fatal to increasingly curable. © 2008 by Blackwell Publishing.
