ABSTRACT

This chapter analyzes some of the methods by which chemotherapy can be directed towards the liver. Colorectal metastases usually occur via hematogenous spread, initially via the portal circulation to the liver, then to the lungs and then to other organs. Patients with portal vein thrombosis who therefore rely on the hepatic artery to supply the normal liver parenchyma are not candidates for hepatic arterial infusion (HAI). Early complications from HAI occur due to technical difficulties with the insertion of the pump or the pump itself but are rare. Nonrandomized studies have shown markedly superior outcomes for patients who have complete surgical resection of their liver metastases, and it is rare for patients to survive beyond three years without the use of surgery. The effectiveness of HAI therapy will be enhanced by more experience in the administration of HAI therapy, improvements in agents used for HAI, and further progress in the development of systemic therapies to complement HAI.