Chemotherapy and Rfa to Treat Crc Metastases

Of the estimated 23,800 Canadians diagnosed with colorectal cancer (crc) annually, approximately 9200 (40%) will die from their disease, most with distant metastatic spread1. When feasible, hepatic resection offers the greatest probability of cure for patients with isolated liver metastases2. However, even for those with disease that is largely liver-limited, there are barriers to curative resection such as the extent and distribution of lesions within the liver, extrahepatic disease, comorbidities, and age3. The maldistribution of lesions within the liver, making complete excision of all disease impossible without the risk of subsequent liver insufficiency, is one barrier that has received considerable attention. Strategies include serial resection, portal vein embolization, and the adjuvant use of radiofrequency ablation (rfa). The rfa procedure uses heat derived from radiofrequency waves at the end of a probe inserted into a metastasis to induce tumour necrosis. The use of rfa as an adjunct to hepatic resection is gaining acceptance. However, its efficacy in comparison with resection is controversial because of high rates of recurrence at the ablation site in some studies4. Despite the increasing opportunity for potentially curative hepatic resection, recurrence in resected patients is the most frequent outcome. Chemotherapy, ABSTRACT