The role of chemotherapy in the treatment and prophylaxis of colorectal liver metastases

Although colorectal liver metastases are a common occurrence, the role of chemotherapy in the management of this condition remains controversial. This article reviews the value of chemotherapy in the treatment and prevention of colorectal liver metastases. Systemic chemotherapy is of no proven benefit in terms of patient survival. Regional approaches to therapy are only a little more encouraging, although an objective view is difficult due to the lack of suitable randomized controlled trials and the difficulty in comparing results of different studies. More recent attempts to enhance regional therapy with degradable starch microspheres have theoretical advantages but need further clinical evaluation. Ultimately, more effective means of controlling overt or occult extrahepatic disease are also required when treating established liver metastases. The use of adjuvant intraportal chemotherapy for the prevention of liver metastases is more encouraging, however, and appears likely to have an important role.