Interventional radiology in the treatment of hepatic metastases.

Recent technical developments have enabled the development of a range of non-surgical interventions for liver metastases. These include cryotherapy, chemoembolisation, and radiofrequency, laser or microwave ablation. These techniques are reviewed and their role in the management of liver metastases discussed. Chemoembolization does not reliably achieve destruction of hepatic metastases. Cryotherapy and radiofrequency treatment can ablate metastases in 50-90% of cases and are relatively safe compared to hepatic resection. There has been no randomised comparison to show that either cryotherapy or radiofrequency treatment alter long-term survival compared with chemotherapy alone. However, this may be related to the fact that most patients being referred for ablative treatment are considered unsuitable for hepatic resection. Randomised trials to accurately define the place of these innovative techniques are needed.