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World J Gastroenterol. Sep 21, 2014; 20(35): 12391-12406
Published online Sep 21, 2014. doi: 10.3748/wjg.v20.i35.12391
Colorectal cancer with liver metastases: Neoadjuvant chemotherapy, surgical resection first or palliation alone?
Khurum Khan, Anita Wale, Gina Brown, Ian Chau
Khurum Khan, Ian Chau, Gastrointestinal Unit, the Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
Anita Wale, Gina Brown, Department of Radiology, the Royal Marsden NHS Foundation Trust, Sutton SM2 5PT, United Kingdom
Author contributions: Khan K, Wale A, Brown G and Chau I contributed equally to this work in designing and writing this review.
Supported by the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at the Royal Marsden NHS Foundation Trust and Institute of Cancer Research and the Robert McAlpine Charity (partly, for Khurum Khan)
Correspondence to: Dr. Ian Chau, MD, FRCP, Consultant in Medical Oncology, Gastrointestinal Unit, the Royal Marsden NHS Foundation Trust, Fulham Rd, Sutton SM2 5PT, United Kingdom. ian.chau@rmh.nhs.uk
Telephone: +44-20-86613582 Fax: +44-20-866613890
Received: December 5, 2013
Revised: January 30, 2014
Accepted: May 29, 2014
Published online: September 21, 2014
Processing time: 288 Days and 1.4 Hours
Abstract

Colorectal cancer (CRC) is one of the commonest cancers with 1.2 million new cases diagnosed each year in the world. It remains the fourth most common cause of cancer-related mortality in the world and accounts for > 600000 cancer-related deaths each year. There have been significant advances in treatment of metastatic CRC in last decade or so, due to availability of new active targeted agents and more aggressive approach towards the management of CRC, particularly with liver-only-metastases; however, these drugs work best when combined with conventional chemotherapy agents. Despite these advances, there is a lack of biomarkers to inform us about the accurate management of the patients with metastatic CRC. It is therefore imperative to carefully select the patients with comprehensive multi-disciplinary team input in order to optimise the management of these patients. In this review we will discuss various treatment options available in management of colorectal liver metastases with potential guidance on how and when to choose these options along with consideration on future directions in management of this disease.

Keywords: Colorectal cancer; Colorectal liver metastases; Surgical resection; Neo-adjuvant chemotherapy; Radiofrequency ablation; Disappearing liver metastases

Core tip: Colorectal cancer is one of the commonest cancers in the world. The management of metastatic colorectal cancer has changed significantly in last decade or so; primarily based on better understanding of the molecular complexity of colorectal cancer coupled with aggressive approach in management of colorectal liver metastases. Colorectal liver metastasises were once considered as incurable disease but with better treatment options and valuable input from multi-disciplinary teams, this disease can be cured in a proportion of patients. This review takes into account various clinical scenarios and their complexity that the clinicians may face during management of this disease.