Chemotherapy and surgery: new perspectives on the treatment of unresectable liver metastases.

Liver metastases concern half of patients with colorectal cancer, and are frequently unresectable, jeopardizing patient outcome. Owing to increased efficacy, chemotherapy can render initially inoperable patients amenable to potentially curative resection. The 34% 5-year and 20% 10-year survival of patients resected following neoadjuvant chronomodulated chemotherapy with 5-fluorouracil, folinic acid and oxaliplatin is similar to that of patients whose disease was operable at diagnosis. Recently, a group of 16 patients were treated with irinotecan and became resectable after treatment. Their survival (56% at 3 years) matches that of patients treated with other forms of chemotherapy. The poor prognosis of patients with non-resectable hepatic metastases might now be improved by the combination of chemotherapy and surgery.