1.1. Inclusion criteria
The trial seeks to include patients in whom liver resection is not considered standard of care.
All the following criteria must be present
- Verified adenocarcinoma in colon or rectum
- Liver metastases that are technically resectable (ablation can be used as an adjunct) without PVE, HVE or ALPPS, but judged in need of further (next line) chemotherapy based on insufficient response to at least one line of chemotherapy.
a. Six or more liver metastases, with extra-hepatic disease that exceeds
i. 3 pulmonary metastases and/or
ii. radiologically positive liver hilar lymph nodes.
b. Ten or more liver metastases with at least one of the following negative prognostic signs:
i. At least one lesion > 7 cm in diameter before chemotherapy
ii. CEA > 100 following chemotherapy
iii. KRAS and/or BRAF mutant primary tumour.
iv. Node positive primary tumour.
c. Fifteen or more liver metastases
3. ECOG 0/1
4. Informed consent
1.2. Exclusion criteria
Any of the following criteria will exclude participation in the trial:
- Previous or current bone or CNS metastatic disease
- Peritoneal deposits/metastases that is not amenable to resection
- Any other reason why, in the opinion of the investigators, the patient should not participate.