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19 - Medical Management of Colorectal Liver Metastasis

from PART III - ORGAN-SPECIFIC CANCERS

Published online by Cambridge University Press:  18 May 2010

By
Wen W. Ma  and
Wells A. Messersmith
Edited by
Jean-François H. Geschwind  and
Michael C. Soulen
Wen W. Ma
Affiliation:
Clinical Fellow Gastrointestinal Oncology Program, Division of Medical Oncology Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine Baltimore, MD
Wells A. Messersmith
Affiliation:
Assistant Professor Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine Baltimore, MD
Jean-François H. Geschwind
Affiliation:
The Johns Hopkins University School of Medicine
Michael C. Soulen
Affiliation:
University of Pennsylvania School of Medicine
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Summary

Colorectal cancer is the third most common cancer in the United States, and about 145,000 new cases are expected each year (1). Approximately 15% to 30% of all colorectal cancer patients have synchronous liver metastases at initial diagnosis, and up to 60% will develop hepatic metastases at some point during their disease course (2–4). Therefore, liver metastases from colorectal cancer are a common oncologic problem. Because management of patients with colorectal liver metastases frequently involves medical oncologists, surgical oncologists, interventional radiologists and other specialists, a multidisciplinary setting is optimal.

Palliative chemotherapy remains the mainstay of treatment for patients with widely metastatic colorectal cancer, and survival has increased significantly with the introduction of novel agents. However, 5-year survival of such patients remains anecdotal. Advances in surgical and interventional techniques, however, have made cure a possibility for some colorectal cancer patients with liver-only metastases. Patients with initially resectable colorectal liver metastases have achieved impressive 5-year survival rates of 30% to 70% following metastatectomy (4–6). Unfortunately, only 20% to 30% of patients with colorectal liver metastases are candidates for resection at initial presentation (7, 8).

Preoperative or neoadjuvant chemotherapy may improve the rate of successful metastatectomy, limit the extent of hepatectomy and improve postoperative recovery in this group of patients. In patients with unresectable liver metastases, neoadjuvant chemotherapy can potentially render previously unresectable liver metastases amenable to surgery. The 5-year survival rate of those who subsequently undergo hepatic metastatectomy has been reported to be 20% to 40% (9).

Type
Chapter
Information
Interventional Oncology
Principles and Practice
 , pp. 222 - 242
Publisher: Cambridge University Press
Print publication year: 2008

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  • Medical Management of Colorectal Liver Metastasis
    • By Wen W. Ma, Clinical Fellow Gastrointestinal Oncology Program, Division of Medical Oncology Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine Baltimore, MD, Wells A. Messersmith, Assistant Professor Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine Baltimore, MD
  • Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
  • Book: Interventional Oncology
  • Online publication: 18 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722226.020
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  • Medical Management of Colorectal Liver Metastasis
    • By Wen W. Ma, Clinical Fellow Gastrointestinal Oncology Program, Division of Medical Oncology Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine Baltimore, MD, Wells A. Messersmith, Assistant Professor Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine Baltimore, MD
  • Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
  • Book: Interventional Oncology
  • Online publication: 18 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722226.020
Available formats
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Medical Management of Colorectal Liver Metastasis
    • By Wen W. Ma, Clinical Fellow Gastrointestinal Oncology Program, Division of Medical Oncology Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine Baltimore, MD, Wells A. Messersmith, Assistant Professor Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine Baltimore, MD
  • Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
  • Book: Interventional Oncology
  • Online publication: 18 May 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511722226.020
Available formats
×