Advanced Locoregional Therapies for Metastatic Colorectal Cancer in the Liver and Lungs

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• Metastatic Colorectal Cancer Biology
• Systemic Chemotherapy Role
• Liver Metastases Treatment Options
• Lung Metastases Treatment Options
• Multimodal Treatment Approach
• Importance of Expert Care
• Full Transcript

Metastatic Colorectal Cancer Biology

Dr. Hans-Joachim Schmoll, MD, clarifies the unique biology of stage 4 colorectal cancer. Liver metastases and lung metastases are the most common sites of spread. Over 50% of colorectal cancer patients will develop liver metastases during their disease course. About 25% of patients already have liver metastasis at their initial colon cancer diagnosis.

Dr. Hans-Joachim Schmoll, MD, explains that liver and lung metastases in colorectal cancer behave as the same biologic entity. A key advantage is that metastatic spread is often limited to these two organs for a long time. This "liver and lung only" metastatic pattern is unique to colorectal cancer. It provides a critical therapeutic window not seen with cancers that spread to bone or other sites early.

Systemic Chemotherapy Role

Systemic chemotherapy is a cornerstone of treatment for metastatic colorectal cancer. Dr. Hans-Joachim Schmoll, MD, emphasizes its dual role. First, modern chemotherapy regimens can significantly reduce the size of liver and lung metastases. This tumor shrinkage can convert tumors that were initially unresectable into lesions that are operable.

Second, systemic chemotherapy helps prevent the development of new metastatic sites. By controlling microscopic disease, it supports the goal of achieving long-term remission. Dr. Anton Titov, MD, notes that this powerful effect is a hallmark of colorectal cancer treatment. It sets the stage for successful local interventions.

Liver Metastases Treatment Options

Several advanced locoregional therapies target colorectal cancer liver metastases. Surgical resection remains a primary option, but it is often part of a combined modality approach. Dr. Hans-Joachim Schmoll, MD, details several other highly effective techniques.

Radiofrequency ablation (RFA) involves inserting a needle into the metastasis and heating the tumor tissue to destroy it. Transarterial chemoembolization (TACE), specifically DEBIRI TACE, delivers chemotherapy-loaded beads directly into the blood vessels feeding the liver tumor. Selective Internal Radiation Therapy (SIRT), also known as radioembolization, involves injecting tiny radioactive beads into the hepatic arteries to irradiate the tumor from within.

Another advanced option is irreversible electroporation (IRE). This non-thermal technique uses electrical pulses to create irreparable nanoscale pores in cancer cell membranes, leading to cell death.

Lung Metastases Treatment Options

The treatment philosophy for lung metastases mirrors that for liver metastases. Dr. Hans-Joachim Schmoll, MD, confirms that lung metastases in colorectal cancer represent the same clinical situation. The goal is also elimination through a combination of systemic and local therapies.

Surgical resection of lung metastases is a common and effective procedure. For patients who are not surgical candidates, stereotactic body radiotherapy (SBRT), or radiosurgery, is a highly precise alternative. This advanced radiotherapy technique can destroy lung metastases in just one to three high-dose treatments, sparing surrounding healthy tissue.

Multimodal Treatment Approach

The integration of multiple treatment modalities is the key to success. Dr. Hans-Joachim Schmoll, MD, stresses that using these therapies in the right sequence is what leads to cure. This combined approach can eliminate most or all visible metastases in the liver and lungs.

The outcomes are significant. Dr. Hans-Joachim Schmoll, MD, states that 30% of patients with liver and lung metastases from colorectal cancer achieve long-term survival. For many, this equates to a complete cure from stage 4 disease. This potential for cure highlights the unique biology of colorectal cancer metastases and the power of modern oncology.

Importance of Expert Care

Selecting the optimal treatment strategy requires immense expertise. Dr. Hans-Joachim Schmoll, MD, notes that not all oncologists possess deep knowledge of every advanced locoregional option. A treatment center that only offers standard chemotherapy is not sufficient for optimal colon cancer care.

Dr. Anton Titov, MD, discusses the importance of seeking care from a multidisciplinary team of experts. These specialists must be proficient in all available local and regional therapies. This is crucial because these advanced treatments are relevant for a large patient population—approximately 40% of all stage 4 colon cancer patients present with liver or lung metastases. Expert guidance provides the maximum chance for survival and cure.

Full Transcript

Dr. Anton Titov, MD: 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 chemoembolization (TACE)? What is irreversible tumor electroporation (IRE)?

Twenty-five percent of colorectal cancer patients have liver metastasis at the time of colon cancer diagnosis. Over 50% of colorectal cancer patients develop liver metastases during the course of the disease.

We discussed with Dr. Graeme Poston the surgical resection of liver metastases in stage 4 colon cancer patients. But systemic chemotherapy of liver metastasis in stage 4 colorectal cancer is 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?

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, I will elaborate on liver metastases and lung metastases in stage 4 colorectal cancer. 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.

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 there are no metastases in other organs for a long time.

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 one or three doses.

Dr. Hans-Joachim Schmoll, MD: There is also regional chemotherapy with microsphere beads. TACE DEBIRI and irreversible tumor electroporation (IRE) 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.

Thirty percent 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.

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.

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 cancer patient population.

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.

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.

Fifty percent of colorectal cancer patients develop liver metastases 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. Thirty percent of patients with liver and lung metastases in colorectal cancer have long-term survival.

Forty percent 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.