CRLMConfigurable Role Limiting Methods
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In the past, 5-fluorouracil (5-FU) with folinic acid (leucovorin) was the only chemotherapeutic option available for patients with unresectable CRLM.
Bevacizumab, a monoclonal antibody directed against vascular endothelial growth factor (VEGF), and cetuximab, which is directed against epidermal growth factor receptor, provide hope that even more patients with initially unresectable CRLM may respond to treatment with combinations of systemic treatments in the future [28].
There is clearly a difference between true neoadjuvant chemotherapy, having determined that the patient is resectable with curative intent at the outset, and the administration of chemotherapy to patients with unresectable CRLM, with the intention of rendering this disease resectable.
It should be stressed that in order to exploit every opportunity to achieve cure, the management of CRLM should be undertaken in a multidisciplinary setting, with a medical and surgical oncologist involved in the care of every patient.
The key recent advance in the management of CRLM has been the availability of new, more effective chemotherapy, with the ability to make inoperable liver disease resectable.
In tandem, surgery for patients with CRLM has been applied in a wider range of clinical circumstances.
With this combined modality approach, the key contemporary developments in surgery and chemotherapy for CRLM are brought together into an integrated framework to create a significantly expanded population of patients who can be treated with curative intent.
While hepatic resection is potentially curative, most CRLM patients are inoperable and therefore radiofrequency ablation (RFA) is the most frequently used local treatment modality for CRLM.