Introduction

The liver is a common site of metastatic disease, which occurs following initial spread to the lymph nodes. It is the most common site of metastatic disease from primary cancer within the abdomen because it is the first major organ reached by venous blood draining from the intestinal tract. For patients with systemic spread of metastases, curative treatment is generally not possible and general chemotherapeutic approaches for treatment are indicated. On the other hand, if the liver remains the only site of metastatic disease, surgical resection may represent the only means of cure. Unfortunately, the average survival of patients with untreated hepatic metastases is between 2 and 8 months [19].

Only about 30% of patients with hepatic metastases represent cases suitable for surgical resection, even when intervention is performed in centers with expertise in hepatic surgery. Thus, there has been growing interest in interstitial approaches aimed at destroying liver metastases in situ. Local ablative therapeutic approaches include ther-motherapy and chemotherapy and are alternatives to major surgery. Each of these has the advantage of being repeatable in cases of recurrent metastatic lesions [1].

Thermotherapeutic approaches to tumor reduction include the application of physical energy in radio-frequency (RF) ablation, laser-induced interstitial therapy (LITT) and cryotherapy. Chemotherapeutic approaches include the local instillation of drugs, alcohol injection, chemother-apeutic drug instillation and regional transarterial chemoembolization (TACE) [22].

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