advanced colon cancer cure. surgical resection and radiofrequency ablation of liver metastatic stage 4 colon cancer. dr. anton titov, md: curative strategy for metastatic stage 4 colorectal cancer is possible today when metastases are present in the liver. several years ago curing patients with stage 4 metastatic colon cancer was not possible. it can still be possible to surgically resect the lesions when metastases are present in liver and sometimes even in lungs. more patients with stage 4 metastatic colorectal cancer have long-term survival. you are a leading surgeon for colorectal cancer and metastatic disease to the liver in particular. how do you make decisions about curative strategy for stage 4 metastatic colorectal cancer? what affects your surgical strategy at the time of operation to remove metastatic liver lesions from colon cancer spread to the liver? dr. graeme poston, md (leading liver cancer surgeon, uk): this is really where multidisciplinary team working has to be done. the data show, that for metastatic stage 4 colorectal cancer patients, the treatment strategy is not straightforward. the treatment of metastatic stage 4 colon cancer to the liver frequently involves starting with systemic chemotherapy. because how stage 4 metastatic colon cancer tumor responds to systemic chemotherapy is a good test of tumor biology. response of metastatic stage 4 colon cancer to systemic chemotherapy is the best tumor behavior test we have at the moment. although i think it will be superseded by genetic tumor testing in the next five years. but the systemic chemotherapy allows us to see if we can get a response from metastatic stage 4 colon cancer tumor. we know even with traditional cytotoxic chemotherapy, oxaliplatin, folfox (chemotherapy regimen), only 6% of patients will have metastatic stage 4 colon cancer tumor progress in the first six cycles. dr. graeme poston, md (leading liver cancer surgeon, uk): the majority of patients with metastatic stage 4 colon cancer will either stabilize or respond to systemic chemotherapy. so, first we test the biology of the tumor.
at that point, having tested the biology, we hope we converted patients with liver metastatses from stage 4 colon cancer from unresectable liver lesions to resectable liver metastatic lesions. so we would then consider the liver metastases resection strategy. we might do a single surgical operation. it might require two separate surgical operations. we call that two-stage operation. we resect liver metastases in one half of the liver first. and then we remove colon cancer metastases from the other half of the liver second. that has risks, that two-step strategy. because unfortunately in 25% of people metastatic stage 4 colon cancer progresses between the two stages of surgery. there's another operation to resect multiple liver metastases. it is called the alpps procedure. in alpps procedure we bring the gap between the two surgical operations to a very short period of only about six or seven days. dr. graeme poston, md (leading liver cancer surgeon, uk): well, alpps procedure carries quite a significant risk of operative mortality, 10% mortality rates. on the other hand, we have adopted another operation to remove liver metastases. we call it "chip and burn". we resect liver metastatic lesions from stage 4 colon cancer and we also ablate the tumors in the liver. we have now moved on from the old fashioned radio frequency ablation method, which would take 20 minutes to ablate liver tumors. we now use microwave ablation, which takes two minutes per tumor to destroy colorectal cancer metastases in the liver. so, we could take a patient with 15 metastases in the liver and in one operation we can clear that liver out of metastatic lesions in two hours. the metastases must be reduced in size to less than three centimeters.
dr. anton titov, md: 15 metastatic lesions in the liver from stage 4 colorectal cancer can be removed in two hours by new microwave ablation method? [dr. poston] microwave ablator. - [dr. titov] microwave ablation. - [dr. poston] yes. yes. dr. anton titov, md: and therefore, the metastatic stage 4 colon cancer patients who have the "wild" kras and nras tumor type, as you discussed, can basically stay disease-free for a long time? dr. graeme poston, md (leading liver cancer surgeon, uk): yes, their prognosis will be very good. we've published the data. we published the data this year from my center and from memorial sloan kettering, from bordeaux in france and aarhus in denmark. 300 patients with liver metastases from colorectal cancer like this. and these are patients who are completely inoperable, completely incurable at the start. these advanced stage 4 colon cancer patients had a very good response to chemotherapy first. then we went in and operated on these patients to remove their liver metastatic lesions. we resected and ablated liver metastases and our five year survival for those patients was 40%. the disease-free survival was a lot lower because these advanced stage 4 colon cancer patients have a poor prognosis. with multi-modal therapy to treat advanced stage 4 colon cancer and with repeat lines of therapy, we can keep these people alive on average three to four years.
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