A cytoreductive approach to treatment of multiple liver metastases

Modest benefits and extensive costs have occurred as a result of hepatic artery chemotherapy with fluorodeoxyuridine (FUDR). As a consequence, pump or port infusions of chemotherapy through the hepatic artery are rarely used today. A new cytoreductive approach to the treatment of multiple liver metastases isolated to the liver has been introduced. Induction chemotherapy is used to achieve a response or stabilize disease in the liver. Patients are then selected for surgery, at which time a complete response is achieved through the judicious use of a variety of cytoreductive techniques. In a limited number of patients treated to date the median survival greatly exceeds that reported for intraarterial chemotherapy alone. As experience accumulates, protocols are being modified to decrease the morbidity and maximize the number of complete responders.