metastatic stage 4 colon cancer prognosis update. dr. anton titov, md: metastatic stage 4 colorectal cancer is now treated by combination chemotherapy and extensive surgical treatment. often there is multi stage surgical treatment of advanced colon cancer. what are the overall expectations for survival of patients with metastatic colorectal cancer? what is prognosis when liver metastases are present in colon cancer? dr. graeme poston, md (leading liver cancer surgeon, uk): sometimes the patient has completely unresectable liver metastases from colorectal cancer. and such stage 4 colon cancer patient with liver metastases never might never convert to resectable liver lesions. but we are still looking at median survival now in excess of 30 months, if patients are fit enough to receive treatment for stage 4 metastatic colon cancer. for those colon cancer patients that have resectable liver metastases upfront. or for those stage 4 colon cancer patients whose liver metastases convert to resection. five-year survival of such patients is 50% now. half of those who survive 5 years, or 25% of stage 4 colon cancer patients with resectable liver metastases are disease free at 5 years. and 10-year survival for stage 4 colon cancer patients in whom we can resect liver metastases is now approaching 30%. dr. graeme poston, md (leading liver cancer surgeon, uk): and the longer patients with stage 4 colorectal cancer live after liver metastases resection, the chance of cancer recurrence diminishes. and if, after treatment for stage 4 colorectal cancer with liver metastases, the patient is disease-free at 10 years, this patient is cured from cancer. and we know from survival data from memorial hospital in new york, once the patient gets to 10 years disease-free survival from metastatic colorectal cancer, the survival line is flat out to 20 years.
dr. anton titov, md: so it's possible, essentially, even with the liver metastatic disease in stage 4 colorectal cancer, to have a 10-year survival in a significant percentage of patients? dr. graeme poston, md (leading liver cancer surgeon, uk): i have 20-year survivors from metastatic stage 4 colorectal cancer with liver metastases resected. they die of old age. but i have now have got 20-year survivors from metastatic colon cancer. dr. anton titov, md: that is, i think, an amazing progress of metastatic colon cancer treatment. this underscores the value of multimodality therapies for colon cancer. dr. graeme poston, md (leading liver cancer surgeon, uk): yeah, absolutely, absolutely. and that's the key to metastatic colon cancer treatment and improved prognosis. it is multimodal therapy. it's absolutely essential that metastatic colon cancer patients are managed by multidisciplinary teams that can work together. and that in my group we have not just the medical oncologist and radiation oncologist. but we have the liver surgeon, the colorectal surgeon, and the chest surgeon all in the same room at the same time discussing colon cancer patient's treatment options. we are frequently looking at patients who present in stage 4 rectal cancer with a big rectal tumor and several liver metastases and possibly two or three lung metastases. and we have to work out a stage 4 colorectal cancer treatment strategy for the next 12 months for that patient. because oftentimes, these metastatic colorectal cancer patients will need a long course of neoadjuvant chemotherapy for the primary tumor in the rectum. in the interim we should we treat colorectal cancer metastases in the liver and in the lungs whilst they are receiving the neoadjuvant chemotherapy.
and it may well be that the last treatment such stage 4 colorectal cancer patients get is the primary tumor being removed. and in the meantime, they have had the liver metastases removed and the lung metastases removed. and patient had a long course of neoadjuvant radiotherapy with chemotherapy. dr. graeme poston, md (leading liver cancer surgeon, uk): so you have to tell that metastatic stage 4 colon cancer patient: "it's going to be hard work for the next 12 months." "you are going to have probably three surgical operations. and you are going to have a lot of radiation and systemic colon cancer chemotherapy." but hopefully this time next year, you will be disease-free from stage 4 metastatic colorectal cancer. dr. anton titov, md: and the primary colorectal cancer tumor will be removed at the later stage. dr. graeme poston, md (leading liver cancer surgeon, uk): primary colorectal cancer tumor may be the last thing to come out, yes. dr. anton titov, md: that is very impressive progress in metastatic stage 4 colorectal cancer treatment. especially when liver metastases or lung metastases are present.
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