Alternative techniques for the treatment of colon carcinoma metastases in the liver: current status in The Netherlands

Alternative techniques for the treatment of colon carcinoma metastases in the liver: current status in The Netherlands.Greve JW.Dept. of Surgery, University Hospital Maastricht, The Netherlands. JW.Greve@Surgery.azm.nlBACKGROUND: Review of current treatment modalities for liver metastases resulting from colorectal cancer. METHODS: Literature review. RESULTS: An increasing number of techniques are available for the treatment of colorectal liver metastases. When it is not possible to use the current gold standard, radical surgical resection, many patients can be treated with alternative techniques. Chemotherapy in its present form must be considered as purely palliative, perhaps with the exclusion of isolated liver perfusion: however, this therapy should still be considered as experimental. Most other possible treatments focus on local destruction of the metastases. This can be achieved using either immuno-guided techniques (tumor antibodies which carry a local active agent), direct local application of a toxic agent (injection) or thermo therapy, which has been applied in patients on a large scale. Thermo therapy involves either localized heating, by means or laser photocoagulation or radiofrequency or microwave ablation, or localized freezing using cryo probes. CONCLUSIONS: Local destruction of liver metastases, especially by means of thermo therapy, is feasible and safe. Currently, cryotherapy is most frequently used in patients. New treatment modalities, such as radiofrequency ablation, arc very promising but their true clinical value should be determined in a randomized clinical tria