Local and Systemic Treatment of Potentially Resectable Colorectal Liver Metastases
Raphael L. C. Araujo* and Paulo Herman
Liver Surgery Unit, Department of Gastroenterology, University of São Paulo Medical School, São Paulo, SP, Brazil.
- *Corresponding Author:
- Raphael L.C. Araujo
Liver Surgery Unit, Department of Gastroenterology
University of São Paulo Medical School, São Paulo, SP
Brazil. Rua Dr. Enéas de Carvalho Aguiar, 255 - 9º andar - sala 9025
CEP 05403-900 - São Paulo - SP, Brazil
E-mail: [email protected]
Received date: March 20, 2014; Accepted date: May 24, 2014; Published date: May 31, 2014
Citation: Araujo RLC, Herman P (2014) Local and Systemic Treatment of Potentially Resectable Colorectal Liver Metastases. J Carcinog Mutagen S10:005. doi: 10.4172/2157-2518.S10-005
Copyright: © 2014 Araujo RLC, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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