Journal of Carcinogenesis & Mutagenesis

Abstract

Local and Systemic Treatment of Potentially Resectable Colorectal Liver Metastases

Raphael L. C. Araujo and Paulo Herman

Advances in surgical fields and chemotherapy regimens have been increasing long-term outcomes for patients with Colorectal Liver Metastases (CRLM). The liver resection remains the main treatment for resectable CRLM, but the progress of the chemotherapy regimens has been changing the oncologic approach for those patients who present unrespectable liver disease treated with chemotherapy who reach tumor shrinkage allowing hepatic resection. Looking for potentially resectable CRLM, it seems that chemotherapy should always be offered as additional treatment to curative-intention liver resections, increasing Recurrence Free Survival (RFS), but not affecting Overall Survival (OS). The optimal timing for each chemotherapy regimen has not been answered by Randomized Clinical Trials (RCT) yet. Retrospective series are biased on different patient selection for different chemo modalities. The best candidate for each regimen of chemotherapy could not yet be defined, but clearly patients with more aggressive disease were preferred to preoperative chemo regimens testing chemo responsiveness and selecting “good responders” before surgery. These patient selection criteria have not been standardized yet but the rational of additional chemotherapy, regardless the timing of administration, has been assumed as stand of care for patients who underwent curative-intent resection. The main objective of this review was to collect information to be taken in consideration for different approaches in the management of CRLM