Non-surgical management of liver metastases

The liver represents the most common site of visceral metastasis for primary gastrointestinal neoplasms, but it is also a common site of metastasis for extra-abdominal tumours including breast cancer, lung cancer as well as other cancers. Metastatic liver disease is often the cause of death for cancer patients. Metastatic liver disease is a heterogenous entity depending upon histologic type, site of primary tumour and other extrahepatic involvement. Surgical resection is feasible only in highly selected patients with no extrahepatic metastasis. The nonsurgical modalities of management of liver metastases include radiotherapy, chemotherapy, biologicals or a combination of these modalities. Hepatic irradiation can produce satisfactory palliation but has dose limiting toxicity of radiation hepatitis. The systemic chemotherapy of liver metastases has evolved over the past decades from single agent systemic treatment to regional infusion chemotherapy. The drugs employed in treatment depend on the site of primary tumour. 5-fluorouracil remains the mainstay of chemotherapy in most gastrointestinal cancers. Recent technological advances in drug delivery system and genetic engineering have given new vistas to nonsurgical management of liver metastases. Ambulatory or implantable pumps have enabled drugs to be delivered by continuous infusion via an implantable vascular access system. Monoclonal antibodies conjugated to toxins or radioisotopes offer exciting prospects for targeted therapy.