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.
Charles A. Staley, MD
The authors have presented a
comprehensive review of rectal
cancer, challenging clinicians
to consider whether some patients
are being overtreated with any
modality including surgical resection,
chemotherapy, and/or radiotherapy.
Tables 2 and 3 provide an excellent
overview of suggested criteria for deciding
and radical resection for a cancer
confined to a rectal polyp.
As Drs. Nakakura and Choti point out, the incidence of hepatocellular carcinoma (HCC) is rising in many countries including the United States, mainly as the result of a steady increase in hepatitis C infections. Unfortunately, it now seems that the hepatitis C virus is more carcinogenic than the hepatitis B virus, judging from the frequency with which HCC develops among patients with hepatitis C- vs hepatitis B-induced cirrhosis. Numerous studies have demonstrated changes in various oncogenes and tumor suppressor genes, but no consistent sequence of genetic changes has emerged similar to the adenoma-carcinoma sequence in colon cancer.