New treatments with curative intent for metastatic colorectal liver cancer

Although surgical resection is the mainstay of therapy in metastatic colorectal liver cancer, < 10 - 15% of patients are suitable for resection. In addition, recurrence rates after resection may reach 75% in the first 2 years, of which 50% involve local recurrences in the liver. This has provided an impetus for the development of neoadjuvant and adjuvant protocols in the treatment of this malignancy, techniques concentrating on improving the residual liver functional reserve, as well as local tumour ablative therapies using radiofrequency and cryotherapy. A multimodal interdisciplinary approach is a pre-requisite when treating secondary liver tumours from colorectal cancer and should be concentrated in centres of reference. The development of such innovative modalities as preoperative downstaging in the absence of extrahepatic tumour disease, local tumour control and new adjuvant therapies has expanded the patient population thus providing the opportunity to treat patients with large or advanced stage colorectal liver tumours. The following is a review of some of the approaches currently being evaluated in the treatment of colorectal liver metastases.