Nonsurgical methods for liver metastases including cryotherapy, radiofrequency ablation, and infusional treatment: what's new in 2001?

Abstract

Surgical resection is now well accepted as the standard treatment in 10 to 20% of patients with liver metastases. Tumor ablative techniques have been developed in recent years. The basic idea is to use them in patients with a limited number of intrahepatic deposits that are not totally resectable. Several papers published in 2001 have addressed cryotherapy. Cryotherapy can be considered an effective method for local destruction of liver metastases up to 3 to 4 cm in diameter but is also associated with a significant rate of complications. In many centers, cryoablation has now been replaced by radiofrequency ablation, the most widely used method for ablation of unresectable liver metastases. It can be performed during laparotomy, at laparoscopy, or percutaneously. Tumors less than 3 cm in their greatest diameter can be destroyed with one placement of the needle electrode. Metastases larger than 3 cm require several placements. Both cryotherapy and radiofrequency ablation are effective methods to induce necrosis of liver metastases. It is likely that in the near future, most patients with liver metastases will receive a multimodality treatment: a local treatment such as surgical resection or tumor ablation, and a general treatment such as hepatic infusional or systemic chemotherapy. Trials published in 2001 have shown that oral prodrugs of fluorouracil were probably equivalent to fluorouracil bolus administration. Regimens containing oxaliplatin or irinotecan have also been evaluated for efficacy and tolerance and by the intravenous route alone or in combination with hepatic artery infusion. Effective systemic chemotherapy regimens have resulted in increased survival rates and improved quality of life and in some cases have allowed resection of initially unresectable liver metastases.