Managing synchronous rectal cancer and liver metastases

Abstract

KEYWORDS • chemoradiotherapy • liver metastasis • radiotherapy • rectal cancer • resection • systemic therapy At presentation, 20% of patients with colorectal cancer have liver metastases [1]. Increasingly effective chemotherapy regi-mens and greater options for resection have improved survival. As a result, 5-year survival can reach 55% after radical resec-tion of all tumor sites [2]. Historically, the management strategy of colon carcinoma with liver metastases was resection of the primary tumor followed by treatment of the liver metastases. Now, despite a lack of data, a liver-first approach with synchronous colon carcinoma has been widely adopted because it results in more patients managing to complete the full treatment protocol [3]. There remains discussion regarding the treatment of patients with rectal carcinoma and synchronous (potentially) resectable liver metastases. Treatment options for these patients are systemic therapy, short-course radiotherapy, long-course chemo-radiotherapy and surgery of the primary tumor and metastases. The principal treat-ment goal should be radical resection of all lesions, but the optimal sequence and choice of the different treatment options remain unclear. Furthermore, when assess-ing management protocols, the risk of local or distant disease progression must be con-sidered as well as disease-free and overall survival outcomes.