Oligometastic colorectal cancer

 

Surgical resection in hepatic mets mCRC: with 4 or less mets, relapse free survival 5 yr =30%

Resection in non-hepatic mets mCRC: 5 yr RFS 27% to 68%

Goal is achieving R0 resection

Patients with CRC metastases to the liver and/or lungs should be evaluated to determine the feasibility of complete removal of the known tumor (R0 resection). The likely benefit of such an approach should be evaluated according to the following criteria.

• Probability of complete resection of known disease, with negative margins
• For liver resection, retention of an adequate postoperative hepatic reserve, potentially achieved through preoperative portal vein embolization to enlarge the postoperative hepatic remnant
• Potential for preoperative chemotherapy to cause sufficient regression to convert disease from “unresectable” to “resectable” (unlikely for most metastatic disease cases) ( Ref Clinical Care options).

Role of PET scan:

• Select cases - surgical curable M1 disease 
• Potential for embolization

MRI of liver for potentially resectable hepatic mets preferred over PET

Initial chemotherapy in oligometastic disease is called "conversion" therapy, not NACT.

Optimal chemo regimen is not known.

FOLFOXIRI in patients who are otherwise fit.