May 25, 2016 7:00 AM

Treatment of Colorectal Liver Metastases: An Important Paradigm Shift

A multidisciplinary treatment approach to colorectal liver metastases has changed the treatment landscape for patients.

Traditionally, the treatment of colorectal liver metastases has begun with chemotherapy and included liver resection as a later option.

Now, however, at experienced surgical centers, patients have greatly expanded options.

Improving outcomes

A review shows the ability of a multidisciplinary treatment approach — with the involvement of medical oncologists and surgical oncologists from the beginning of treatment — to extend survival in colorectal liver metastases.

The researchers, who published their results in the January 2016 Journal of Oncology Practice, found that untreated individuals lived an average of six to 12 months. In contrast, patients treated with a combination of systemic chemotherapy and surgical resection achieved a five-year survival rate of 40 to 60 percent.

Studies have shown that no single negative prognostic feature precludes durable long-term survival for patients with resectable colorectal liver metastases. Many of the traditional selection criteria for resection of colorectal liver metastases, therefore, are now considered obsolete.

In combination with effective modern chemotherapy, surgical treatment of colorectal liver metastases can achieve durable long-term survival and even cure in patients who were thought to be ineligible for surgery just a few years ago. A thorough evaluation by a surgeon familiar with the modern multidisciplinary management of colorectal liver metastases can be a valuable addition to the care of these patients.

A modern take on treatment

Ideally, oncologists treating these individuals would consider early consultation at a large medical center with a robust, multidisciplinary oncology team, where the patient can be seen prior to therapy’s start.

Treatment plans in these settings should consider:

  • Sequencing of systemic therapy and liver surgery in order to optimize the safety of liver resection

  • Surgical management of the primary tumor and the patient’s suitability for a combined surgical approach

  • Salvage surgical therapy for patients with recurrent disease

As more patients gain access to potentially curative therapy for metastasized colorectal cancer, you can expect to see the medical and surgical advances incorporated into a new standard of care that includes early multidisciplinary evaluation.

The author, Hari Nathan, M.D., Ph.D., also co-authored a commentary on the evolution of treatment for colorectal cancer liver metastases, “Treatment of colorectal liver metastases: None of us is as smart as all of us,” published in the January 2016  Journal of Oncology Practice.