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Review
. 2014 Sep 21;20(35):12391-406.
doi: 10.3748/wjg.v20.i35.12391.

Colorectal cancer with liver metastases: neoadjuvant chemotherapy, surgical resection first or palliation alone?

Khurum Khan  1 , Anita Wale  1 , Gina Brown  1 , Ian Chau  1
Affiliations
Review

Colorectal cancer with liver metastases: neoadjuvant chemotherapy, surgical resection first or palliation alone?

Khurum Khan et al. World J Gastroenterol. .

Abstract

Colorectal cancer (CRC) is one of the commonest cancers with 1.2 million new cases diagnosed each year in the world. It remains the fourth most common cause of cancer-related mortality in the world and accounts for > 600000 cancer-related deaths each year. There have been significant advances in treatment of metastatic CRC in last decade or so, due to availability of new active targeted agents and more aggressive approach towards the management of CRC, particularly with liver-only-metastases; however, these drugs work best when combined with conventional chemotherapy agents. Despite these advances, there is a lack of biomarkers to inform us about the accurate management of the patients with metastatic CRC. It is therefore imperative to carefully select the patients with comprehensive multi-disciplinary team input in order to optimise the management of these patients. In this review we will discuss various treatment options available in management of colorectal liver metastases with potential guidance on how and when to choose these options along with consideration on future directions in management of this disease.

Keywords: Colorectal cancer; Colorectal liver metastases; Disappearing liver metastases; Neo-adjuvant chemotherapy; Radiofrequency ablation; Surgical resection.

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Figures

Figure 1
Figure 1
The treatment options for colorectal liver-only metastases. MDT: Multi-disciplinary team; CT: Computed tomography; PET: Positron emission tomography; MRI: Magnetic resonance imaging; VEGF: Vascular endothelial growth factor; EGFR: Epidermal growth factor receptor; PD: Progressive disease; SD: Stable disease; PR: Partial response.
Figure 2
Figure 2
Computed tomography images. A: Computed tomography (CT) scan of a patient showing extensive liver metastatic disease prior to systemic therapy; B: CT scan after 4 cycles of neo-adjuvant chemotherapy demonstrating excellent partial response to the treatment along with intra-tumoural calcification; C: CT scan following left hepatectomy.
See this image and copyright information in PMC

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