New technologies complement liver cancer surgery in treatment of metastatic colon cancer. What is selective internal radiation therapy, SIRT? Transarterial chemoembolization using drug eluting irinotecan beads DEBIRI is called TACE-DEBIRI. IRE is tumor irreversible electrophoresis. It is irreversible electroporation of colon cancer metastases in the liver. “Multidisciplinary team is key to make correct treatment plan for each colon cancer patient.” Stage 4 colon cancer treatment options beyond surgery. Dr. Graeme Poston, MD. Chemoembolization and Arterial pump therapy for the metastatic cancer treatment in the liver. Dr. Anton Titov, MD. Video interview with leading British liver cancer surgeon specializing in colorectal cancer metastases resection. Advanced stage 4 colon cancer surgery by selective internal radiation therapy, SIRT, for liver metastases. selective internal radiation therapy clinical trials SIRFLOX and FOXFIRE showed effectiveness of SIRT in stage 4 colorectal cancer patients. Transarterial chemoembolization (TACE) using irinotecan beads fro stage 4 colon cancer. Transarterial chemoembolization using DEBIRI is called TACE-DEBIRI for metastatic advanced colorectal cancer. IRE is tumor irreversible electrophoresis (irreversible electroporation) of colon cancer metastases in the liver. Medical second opinion confirms stage 4 colorectal cancer diagnosis. Dr. Graeme Poston, MD. Medical second opinion also confirms that liver metastases chemoembolization, selective internal radiation therapy or TACE DEBIRI is possible in stage 4 colon cancer. Best treatment for advanced stage 4 colon cancer with liver metastatic lesions. Dr. Anton Titov, MD. Medical second opinion helps to choose the best treatment for stage 4 colorectal cancer with liver metastases, including irreversible electroporation of metastatic lesions. Get medical second opinion on advanced colorectal cancer and be confident that your multimodality treatment is the best. Best colorectal cancer treatment center for liver metastases. Video interview with leading expert in colorectal cancer liver metastases treatment surgery. Stage 4 colon cancer treatment options. SIRT, TACE DEBIRI, IRE. Dr. Anton Titov, MD. You are leading liver cancer surgeon. You have experience with the surgical resection of the liver metastatic disease. Stage 4 colon cancer. You also use a variety of new technologies to treat liver metastases in advanced colon cancer. Dr. Graeme Poston, MD. Stage 4 colon cancer. Could you please talk about the additional technology and liver-specific treatments that you use in your practice to treat advanced stage 4 colon cancer patients? Dr. Graeme Poston, MD. Leading liver cancer surgeon. Yes. There are several new technologies to treat stage 4 colon cancer with metastases to the liver. Chemoembolization for the liver metastatic stage 4 cancer lesions has been used for a long time. Arterial pump therapy to treat liver metastases has also been used for long time. The team at Memorial Sloan Kettering Cancer Center under Professor Kemeny have really pushed arterial pump therapy experience over the last 20-odd years. They are getting very good results. But arterial pump therapy is very demanding therapy. It is demanding both for the patient and for the physician. Dr. Graeme Poston, MD. Placing the arterial pumps requires meticulous surgery. Maintaining the pumps requires meticulous attention to detail. It is very difficult to be able to continue to do aerial pump cancer therapy. It is tough to get the results that Professor Kemeny has obviously achieved. Dr. Anton Titov, MD. Now there are other treatment methods for advanced metastatic colon cancer treatment that have come in the last 10 years. Dr. Graeme Poston, MD. Leading liver cancer surgeon. The first is selective internal radiation therapy, or SIRT. In SIRT microspheres are injected into the hepatic artery that goes into the liver. They carry yttrium-90. It has a half-life of four days. The liver is selectively internally radiated. There have just been two clinical trials in Australia (the SIRFLOX clinical trial) and in Europe (FOXFIRE) on use of liver internal radiation therapy in stage 4 metastatic colon cancer treatment. SIRFLOX reported to ASCO in June results of treatment of stage 4 colon cancer patients with liver-dominant metastatic disease. Dr. Graeme Poston, MD. These stage 4 colon cancer patients had systemic chemotherapy with or without selective internal radiation therapy. That clinical trial showed that the progression-free survival of stage 4 colon cancer with liver metastases was significantly better with internal radiation therapy (SIRT). Now we have got to wait for the overall stage 4 colon cancer survival data from these clinical trials (SIRT therapy). This data has to add results of SIRT therapy from the Australasian clinical trial. The UK clinical trial on use of internal radiation therapy (SIRT) in stage 4 colorectal cancer is coming through. Results should be out in the next year. Dr. Graeme Poston, MD. Then we are going to combine the dataset from two clinical trials on SIRT therapy for metastatic colon cancer into one big dataset. Dr. Anton Titov, MD. Data should show that there is clearly a benefit of adding internal radiation therapy to treatment protocols in stage 4 colon cancer patients with liver metastases. We would expect better overall survival in those stage 4 colon cancer patients who had SIRT therapy. Even though the progression-free survival between the two arms of the clinical trial was not different. The problem in SIRFLOX and FOXFIRE clinical trials was that most of the patients with stage 4 colon cancer had metastases outside the liver. That was in addition to liver metastases. Naturally their metastatic colon cancer lesions outside the liver were not being treated by the internal radiation therapy, SIRT. These stage 4 colon cancer patients progressed outside of liver at the same rate between two arms of clinical trial. Dr. Graeme Poston, MD. But it is the liver metastases in stage 4 colon cancer that are the cause of death.You must delay progression of liver metastatic disease in stage 4 colon cancer. Then there should be an improvement in overall survival of patients with advanced colon cancer. Dr. Graeme Poston, MD. Leading liver cancer surgeon. The second big change in treatment of metastases to the liver is this. We are now doing the transarterial chemoembolization (TACE) using irinotecan beads. Transarterial chemoembolization using DEBIRI is called TACE-DEBIRI. This treatment modality is a microsphere this is filled with irinotecan chemotherapy medication. In TACE-DEBIRI irinotecan beads are again injected into the hepatic artery. TACE DEBIRI is a localized radiation. It is also a localized chemotherapy. We published results of TACE DEBIRI in my group. Dr. Graeme Poston, MD. We have done clinical trials looking at transarterial chemoembolization using DEBIRI beads in stage 4 colon cancer patients. We were going to resect their liver metastases. Dr. Graeme Poston, MD. Leading liver cancer surgeon. We have seen a good response to one treatment of localized irinotecan beads within the liver tumors. The response to single TACE DEBIRI treatment was similar to six or more cycles of systemic irinotecan. Treatment of metastases resulted in tumor necrosis. Transarterial chemoembolization using DEBIRI (TACE DEBIRI) is another method for getting regional chemotherapy into the liver metastases in patients with stage 4 colon cancer. Another thing that is coming to treat stage 4 colon cancer patients is IRE. IRE is tumor irreversible electrophoresis (irreversible electroporation). In IRE needles are placed into the liver tumors and electrical current passed through the tumors. Dr. Anton Titov, MD. No heat is involved. But the electric current destroys the tumor cell membranes. Irreversible electroporation is difficult to do well. Dr. Graeme Poston, MD. But we have had some interesting results with irreversible electroporation in stage 4 colorectal cancer patients with liver metastases. Dr. Graeme Poston, MD. Leading liver cancer surgeon. New technologies to treat advanced colon cancer are coming to deliver liver-specific therapies. Dr. Anton Titov, MD. It is important to place an emphasis on multimodality treatment of metastatic colon cancer. Dr. Graeme Poston, MD. Leading liver cancer surgeon. Cancer therapy decisions have to be within the multidisciplinary team. Because to get the correct selection of treatment for advanced colon cancer patients everybody has to be there. Multidisciplinary team must discuss the rationale, the evidence for treatment. They have to discuss why particular combination of cancer treatment is chosen. Dr. Anton Titov, MD. Stage 4 colon cancer treatment options: Selective Internal Radiation (SIRT), Irreversible Tumor Electroporation (IRE), TACE DEBIRI, regional chemotherapy.