Non-surgical treatment for liver metastases

The liver is a common site for developing metastatic disease. Although any malignancy can spread to the liver, the direct passage of blood from the gastrointestinal tract to the liver via the portal circulation results in a high rate of liver metastasis from gastrointestinal tract tumours. Various radiographical tests including computed tomography and magnetic resonance imaging can detect the majority of liver metastases. Surgical resection if feasible is the treatment of choice since it produces a 5-year survival rate of about 30%. However, the majority of the patients relapse after hepatic resection, 50% relapsing in the liver. Systemic chemotherapy produces response rates of 15–30% with a median survival of 10–12 months. It is estimated that 30 000 patients each year in the USA are candidates for regional hepatic therapy. Hepatic arterial chemotherapy, hepatic artery embolization, chemoembolization, cryosurgery, ethanol injection of the tumour and radiation therapy are being investigated as potential treatment options for such patients.