[Physical and chemical locoregional therapy in liver metastasis]

Close imaging follow-up of patients with known colorectal adenocarcinoma and other cancer can often detect hepatic metastases that are still small and potentially treatable. Unfortunately, many of these patients are poor surgical candidates, or refuse operation. This has stimulated the search for other minimally invasive means of tumor ablation. The first procedure suggested for this type of treatment was percutaneous ultrasound guided ethanol injection. Complete response is often obtained in lesions less than 2-3 cm, but only partial response in greater lesions. Usually a decrease of CEA values is observed, lasting for some months. Clearly, is difficult to establish whether, how much, and in which cases patient survival is lengthened. In the same time, because the procedure has proved safe, simple and cheap, when palliative purpose is requested it is hard to deny treatment to an inoperable patient with not advanced disease. Response in endocrine metastases in higher, because of their hypervascularity. Recently, encouraging results have been obtained inducing coagulation necrosis by means of thermal methods as laser or radiofrequency. In particular, new strategies of the latter obtained very promising results.