Regional intra-arterial chemotherapy of metastatic liver cancer

The rationale of regional intra-arterial chemotherapy of metastatic liver cancer is based on the possibility of providing higher levels and longer exposure time of the tumor to drugs. The recent availability of a totally implantable portable pump (Infusaid) had greatly reduced the catheter-related complications with very good patient compliance. An extensive review of the published results in colorectal carcinoma does not allow us to reach any firm conclusion on the validity of regional treatment: many authors report high response rates and satisfactory long term control of liver disease, but impact on survival is questionable because of extrahepatic tumor progression. Prospective randomized trials comparing systemic versus regional plus systemic chemotherapy are needed. Finally, our personal experience in colorectal and breast cancer is presented.