[Therapy concepts in colorectal liver metastases. What is proven, what is open to discussion?]

Isolated liver metastases of colorectal carcinomas principally can be treated by surgical intervention or cytostatic chemotherapy. Unquestionable indications for resection therapy are either solitary metastases or metastases limited to one liver lobe, since resection provides the best long-time results. In multilocular metastases or non-resectable liver metastases systemic monochemotherapy with 5-Fluorouracil (5-FU) presents respondance rates of about 20 percent with remissions lasting 3 to 6 months. Thereby a prolongation of life could not be proven statistically. Initial studies with a combination therapy of 5-FU/Folinic acid promise higher remission rates due to an increased cytotoxicity caused by a synergistic effect. Because of the mainly arterial supply of liver metastases the different procedures of regional chemotherapy-intraarterial infusion, isolated liver perfusion, chemoembolisation-provide the tumor with high drug concentrations without provoking systemic side effects. This advantage of a regional application of cytostatic drugs is reduced by the high percentage (2 to 87 percent) of extrahepatic tumor manifestations occurring after an average of 6 to 8 months.