40IN - Integrating liver directed therapies such as embolization and IMRT into systemic treatment

Date 30 September 2012
Event ESMO Congress 2012
Session Pursuing the NED condition in stage IV colorectal cancer
Topics Anticancer Agents
Colon and Rectal Cancer
Biological Therapy
Presenter Dirk Arnold
Authors D. Arnold, A. Stein
  • Medical Oncology, Hubertus Wald Tumor Center, University Cancer Center Hamburg (UCCH), 20246 - Hamburg/DE


Metastatic colorectal cancer confined to the liver is a distinct entity characterized by different prognosis and a broad variety of available local treatment approaches. Beneath the classical, albeit continuously developed approaches like surgery, radio frequency ablation (RFA) and transarterial chemoembolization (TACE), local radiotherapy (delivered either by conventional, intensity modulated (IMRT) or stereotactic techniques (SBRT)) or selective intraarterial radiotherapy (SIRT) have been established in the last years. However, spread to the liver - even without extrahepatic manifestation - is the expression of systemic disease and thus urges for systemic control besides local ablation of existing metastases. For example, in liver metastases of mCRC, combination of systemic therapy and surgery or RFA has demonstrated beneficial impact. The sequence of systemic and local treatment is not well defined yet. Although individual patients tumour characteristics will strongly impact the choice of upfront treatment approach (e.g. single small metastases after a long disease free interval versus “upfront” large manifestations with high tumour burden), upfront systemic treatment followed by local treatment and postprocedural systemic treatment if feasible may generally bear several benefits: beside prompt control of systemic disease and potential extrahepatic spread, an interval with systemic chemotherapy will provide information about biology of metastatic cancer (e.g. rapid progression during chemotherapy) and will furthermore enable a more tailored approach for remaining lesions after treatment induced tumour shrinkage. Therefore, current treatment approaches for localized liver metastases are using sequential either neoadjuvant or periprocedural systemic and local treatment (e.g. RFA or surgery) or a concomitant approach with systemic treatment and local ablation in given intervals (e.g. TACE). Some local treatment approaches (e.g. SIRT or TACE) have demonstrated efficacy in malignant disease refractory to chemotherapy, but the possibly greater impact in earlier disease settings combined with or after systemic treatment have not been elucidated yet. Further research will need to determine the optimal combination and timing of local and systemic treatment approaches.


D. Arnold: has received honoraria from Roche, sanofi-aventis, Merck Serono and Amgen, and research support from Roche and sanofi-aventis.

A. Stein: received honoraria from Roche and Merck Serono