Isolated Liver and Limb Perfusion in Preclinical and Clinical Studies: gene therapy and biochemotherapeutic strategies

Abstract

The liver is the major site of metastatic spread of primary colorectal cancer, whereas 3% of all patients with colorectal cancer will develop resectable liver metastases. If a resection with curative intent is done, a five year survival rate of 25-30% has been demonstrated in a large number of studies. The natural history of untreated patients with comparable liver involvement shows a five year survival rate of 0-3% (8). As noted above, the majority of patients with evidence of liver metastases are irresectable, because of extra-hepatic disease or excessive liver involvement. There is no standard treatment for unresectable hepatic metastases confined to the liver, so novel treatment modalities have to be developed. In order to achieve a better control of intrahepatic disease and to reduce systemic toxicity of the applied therapy, locoregional therapies have been developed. These therapies include hepatic arterial embolization (9), intratumoral injections of ethanol, acetic acid, biological agents, stereotactic or intra-arterial radiotherapy, intralesional laser therapy, cryotherapy, radiofrequency ablation and regional infusion or perfusion of chemotherapeutic drugs.