Transcatheter treatment of hepatic metastases

After successful removal of a primary tumor, the exclusive or dominant site of metastatic spread is often the liver. Existing palliative treatments, particularly chemotherapy, have low success rates. Fortuitous physiologic circumstances allow the use of regional treatments, such as hepatic artery infusion therapy, for both primary and secondary malignant tumors in the liver. Despite encouraging results in early uncontrolled trials, subsequent randomized studies have failed to show survival benefit with regional infusion therapy via surgically implanted pumps in patients who have colorectal metastases, the most common tumor studied. Dissatisfaction with current treatments has led to a host of novel therapies, including embolization of liver tumors and the combined infusion of embolic particles and chemotherapeutic agents (i.e., chemoembolization).