Inclusion Criteria:

- Histologically proven diagnosis of colorectal adenocarcinoma

- Metastatic disease present in the liver only.

- Absence of extrahepatic metastases excluded by CT chest, abdomen and pelvis.
Indeterminate CT findings may require verification by FDG-PET scanning.

- Liver-only metastases determined to be unresectable at presentation on a
pre-treatment liver MRI with an appropriate liver specific contrast (eg. TESLA) by a
specialist multidisciplinary team (consisting of medical oncologist, hepatic surgeon
and radiologist). Guidelines for determining unresectability include:

- presence of >4 metastases;

- size >5cm;

- location and distribution of metastatic disease within the liver unsuitable for
resection with clear margins (eg. Involvement of both lobes of liver; invasion of
intrahepatic vascular structures);

- extent of liver involvement precluding resection with adequate post-resection
residual liver parenchyma volume for viable liver function in the immediate
post-operative period;

- inability to retain adequate vascular in flow and out flow to maintain viable liver
function.

- No previous treatment for metastatic colorectal cancer, including chemotherapy,
targeted or experimental therapies (e.g. anti-VEGF or anti-EGFR), radiotherapy to the
liver, or surgery or radiofrequency ablation to liver metastases.

- Feasibility of surgery with curative intent:

- If the primary colorectal tumour is in situ, the primary tumour must also be
resectable with curative intent

- Patients presenting with liver metastases only relapse after initially curative
resection of their primary colorectal cancer followed by treatment with adjuvant
chemotherapy may not be entered into the study if the relapse has occurred within 12
months of completion of adjuvant treatment

- Adequate medical fitness to undergo neoadjuvant treatment and surgery with curative
intent (hepatectomy +/- resection of primary tumour, if required)

- Absence of pre-existing liver dysfunction of Childs Pugh Grade B or greater. Patients
who are suspected of having pre-existing liver dysfunction due to clinical,
biochemical or radiological findings, should have significant liver disease excluded
by a liver biopsy prior to study entry.