Lung metastases and liver metastases happen in 50% of colorectal cancer patients. What are treatment options apart from surgical resection? Which patients benefit from selective internal radiation therapy (SIRT)? When to use transarterial chemoembolisation (TACE)? What is irreversible tumor electroporation (IRE)?

25% of colorectal cancer patients have liver metastasis at the time of colon cancer diagnosis. Dr. Anton Titov, MD. Over 50% of colorectal cancer patients develop liver metastases of during the course of the disease. We discussed with Dr. Graeme Poston the surgical resection of liver metastases in stage 4 colon cancer patients. Dr. Anton Titov, MD. But systemic chemotherapy of liver metastasis in stage 4 colorectal cancer is very, very important. Systemic chemotherapy can convert unresectable liver metastasis to resectable lesions. Chemotherapy can also prevent development of metastatic colorectal cancer. What are the best methods in systemic chemotherapy of the liver metastases in stage 4 colorectal cancer? Prof. Dr. Hans-Joachim Schmoll, MD. First of all I would like to add to liver metastases also lung metastases. both liver and lung metastases are the same biologic entity in stage 4 colorectal cancer. before I answer the question, elaborate on liver metastases and lung metastases in stage 4 colorectal cancer. Prof. Dr. Hans-Joachim Schmoll, MD. Because it is a unique situation in stage 4 colorectal cancer treatment. Colorectal cancer has an affinity to develop metastases in liver and lungs. Liver metastases happen more often than lung metastases in stage 4 colorectal cancer. Dr. Anton Titov, MD. But clinically liver and lung metastases in stage 4 colon cancer represent the same situation. These metastases in liver and metastases in lungs in colorectal cancer behave differently from metastases in other types of stage 4 cancer. Prof. Dr. Hans-Joachim Schmoll, MD. For example in colon cancer liver and lung metastases are different from bone metastases in other cancers. The advantage of liver and lung metastases in stage 4 colorectal cancer specifically is this. In "liver and lung only" metastatic colon cancer the cancer spread is limited to liver and lung ONLY for a longer time than in other cancers. "Limited" means that metastases in stage 4 colon cancer grow in liver or lungs. But they there are no metastases in other organs for a long time. Prof. Dr. Hans-Joachim Schmoll, MD. This gives us a chance to reduce the metastases by chemotherapy treatment. It is possible to completely eliminate colon cancer metastases from liver and lung by chemotherapy. Dr. Anton Titov, MD. This never happens in other types of cancer. We can reduce size of liver and lung metastases in colon cancer significantly. We then can resect metastases by surgical operation. There are also many additional therapies for liver and lung metastases in colorectal cancer. There is radio frequency ablation of liver metastases via needle insertion and heating up the tumor tissue. There is transarterial chemoembolization of liver metastases in colon cancer . There is also Selective Internal RadioTherapy . Small radioactive beads are injected into blood vessels feeding the tumor. They irradiate the tumor directly. This is transcutaneous radiotherapy. There is also radiosurgery of liver or lung metastases in colon cancer. Radiosurgery kills cancer metastases in 1 or 3 doses. Prof. Dr. Hans-Joachim Schmoll, MD. There is also regional chemotherapy with microsphere beads. [TACE DEBIRI and irreversible tumor electroporation, IRE] there are local and regional treatments for liver metastases. These methods are in addition to surgical operation. The same is with lung metastases. These combined therapies enable us to eliminate most or all colon cancer metastases to liver and lung. 30% of patients with liver and lung metastases in colorectal cancer have long-term survival. Or they have complete cure from metastatic stage 4 colon cancer. Doctor must have a lot of experience to decide what is the right treatment at the right time for metastatic stage 4 colon cancer. Dr. Anton Titov, MD. Surgery is only one of many treatment methods of stage 4 colon cancer with liver metastases or lung metastases. Not many oncologists in the world have large amount of knowledge. Prof. Dr. Hans-Joachim Schmoll, MD. A lot of knowledge is required to select the best treatment method at the right time. But only this combined method to treatment of stage 4 colon cancer with liver or lung metastases can give the maximum chance for survival and cure. But long term survival and cure in metastatic stage 4 colon cancer is possible. it is again, biology of liver and lung metastases in colon cancer is unique. Dr. Anton Titov, MD. But 40% of patients have stage 4 colon cancer with liver or lung metastases. it is not a minority of patients. It is a major part of the colorectal caner patient population. Prof. Dr. Hans-Joachim Schmoll, MD. Therefore it is very important for a colon cancer patient to be treated by expert in these advanced treatments. Sometimes treatment center only knows how to do chemotherapy, this is not enough for colon cancer treatment. Prof. Dr. Hans-Joachim Schmoll, MD. Experts must really know how to use local and regional therapies that we discussed today. Stage 4 colon cancer lung metastases and liver metastases – Locoregional therapy options: DEBIRI TACE, IRE, SIRT. 50% of colorectal cancer patients develop liver metastases of during the course of colon cancer or rectal cancer. Regional therapy of liver and lung metastases is very important. Liver metastases happen more often than lung metastases in stage 4 colorectal cancer. clinically liver and lung metastases in stage 4 colon cancer represent the same situation. Radio frequency ablation of liver metastases (RFA) can be very effective. transarterial chemoembolization of liver metastases with irinotecan beads in colon cancer (DEBIRI TACE) has high efficacy. There is also regional chemotherapy with microsphere beads TACE DEBIRI and irreversible tumor electroporation, IRE to destroy smaller liver and lung metastases in colorectal cancer. Selective internal radiation therapy for secondary bowel cancer with liver metastases has to be done by experts with a lot of experience. 30% of patients with liver and lung metastases in colorectal cancer have long-term survival. 40% of patients have stage 4 colon cancer with liver or lung metastases and can be treated with SIRT, IRE, DEBIRI TACE and transarterial chemoembolization. Leading colorectal cancer expert discusses local and regional treatment options for stage 4 colon cancer patients: tumor electrophoresis, transarterial chemoembolization and selective internal radiation therapy.