Treatment of metastatic stage 4 colon cancer to the liver frequently involves starting with systemic chemotherapy. Surgery to resect primary colorectal tumor may be last in the treatment plan. “Because response of metastatic colon cancer to systemic chemotherapy is the best tumor behavior test we have at the moment.” Comprehensive treatment strategy for colorectal cancer liver metastases. “Chip and Burn”, ALPPS procedure, chemo-embolization. Colon cancer with liver metastases. Long-term survival and cure possible? Dr. Graeme Poston, MD. Colorectal cancer liver metastases treatment by multidisciplinary team. Cure of stage 4 colorectal cancer with liver metastatic lesion is possible. Advanced stage 4 colon cancer surgery for liver metastases systemic chemotherapy tests biology of colorectal cancer. ALPPS procedure for liver metastases resection. Dr. Anton Titov, MD. Video interview with leading British liver cancer surgeon specializing in colorectal cancer metastases resection. 5-year survival in stage 4 colon cancer with liver metastases 40% . Liver metastases were resection and microwave ablation. Dr. Anton Titov, MD. Medical second opinion confirms that stage 4 colorectal cancer diagnosis is correct and complete. Medical second opinion also confirms that liver metastases surgery is possible in stage 4 colon cancer. Best treatment for advanced stage 4 colon cancer with liver metastatic lesions. Medical second opinion helps to choose the best treatment for stage 4 colorectal cancer with liver metastases. Dr. Anton Titov, MD. Get medical second opinion on advanced colorectal cancer and be confident that your treatment is the best. Best colorectal cancer treatment center for liver metastases. Video interview with leading expert in colorectal cancer liver metastases treatment surgery. 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. Sometimes 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. Sometimes metastases are present in liver and sometimes even in lungs. Dr. Graeme Poston, MD. 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. This is really where multidisciplinary team working has to be done. The data shows this. 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. Dr. Anton Titov, MD. 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. Dr. Graeme Poston, MD. Although it will be superseded by genetic tumor testing in the next five years. But the systemic chemotherapy allows us to see the result. We can get a response from metastatic stage 4 colon cancer tumor. We know even with traditional cytotoxic chemotherapy, only 6% of patients will have metastatic stage 4 colon cancer tumor progress in the first six cycles. This is a treatment with Oxaliplatin. FOLFOX is the name of chemotherapy regimen. Dr. Graeme Poston, MD. Leading liver cancer surgeon. The majority of patients with metastatic stage 4 colon cancer will either stabilize or respond to systemic chemotherapy. First, we test the biology of the tumor. At that point, we hope we converted patients with liver metastatses from stage 4 colon cancer. Unresectable liver lesions became resectable liver metastatic lesions. Dr. Graeme Poston, MD. 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. Then we remove colon cancer metastases from the other half of the liver. That has risks, that is a two-step strategy. Because unfortunately in 25% of patients, colon cancer progresses between the two stages of surgery. Dr. Anton Titov, MD. There is 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 time. It is only about six or seven days. Dr. Graeme Poston, MD. Leading liver cancer surgeon. ALPPS procedure carries a significant risk of operative mortality. It is 10% mortality rates. We have adopted another operation to remove liver metastases. We call it "Chip and Burn". Dr. Graeme Poston, MD. We resect liver metastatic lesions from stage 4 colon cancer. We also ablate the tumors in the liver. We have now moved on from the old-fashioned radiofrequency ablation method. That would take 20 minutes to ablate liver tumors. We now use microwave ablation of cancer. This takes two minutes per tumor to destroy colorectal cancer metastases in the liver. We could take a patient with 15 metastases in the liver. In one operation we can purify 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 ablation. Dr. Anton Titov, MD. Microwave ablation. [Dr. Poston] Yes. Yes. Dr. Anton Titov, MD. Some metastatic stage 4 colon cancer patients have the "wild" KRAS and NRAS tumor type. As you discussed, they can basically stay disease-free for a long time? Dr. Graeme Poston, MD. Leading liver cancer surgeon. Yes, their prognosis will be very good. We have 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 had these characteristics. Dr. Anton Titov, MD. 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 operated on these patients to remove their liver metastatic lesions. Dr. Graeme Poston, MD. We resected and ablated liver metastases. Our five-year survival rate 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. Dr. Graeme Poston, MD. We do multi-modal therapy to treat advanced stage 4 colon cancer and we do repeat lines of therapy. Then we can keep these patients alive on average three to four years. Stage 4 colon cancer liver metastases. Treatment starts with systemic chemotherapy followed by surgery and tumor ablation. Dr. Anton Titov, MD. Long term survival or cure in colon cancer with liver metastases is possible.