Systemic or regional chemotherapy for liver metastases from colorectal cancer: has the wheel stopped spinning?

The optimal management of patients with liver metastases from colorectal cancer is confounded by the large number of options available. In addition to ablative therapy (surgery, cryosurgery, radiofrequency ablation, etc.), chemotherapy plays a key role in the management of these patients. With more effective systemic therapy, some commentators have questioned the role of intra-arterial chemotherapy. However, a careful review of the literature,as well as ongoing research efforts, suggest that this approach remains an important option for patients and physicians to consider in appropriately selected patients for both first- and second-line therapy in advanced disease as well as for adjuvant therapy following resection of liver metastases.