Hepatic metastases are a major cause of mortality in patients with colorectal carcinoma. The rationale for regional therapy is presented. The randomized studies are reviewed and they demonstrated a significantly higher response rate with hepatic arterial therapy versus systemic therapy. Survival information is difficult to evaluate because some of the studies are small and some had a crossover design, but two studies demonstrate a significant improvement in 2-year survival after hepatic arterial therapy versus systemic therapy. New modalities to increase response rate and decrease toxicity are presented.