The position of neoadjuvant treatment in livermetastatic colorectal carcinoma

A multimodal tretmant in patients with resectable liver-metastatic colorectal carcinoma is highly required. However, suitable treatment

combinations are not known yet as well as the position of neoadjuvant therapy.

Current data: A non-defined group of patients exists that might profit from the neoadjuvant therapy (elevated CEA, synchronous metastases,

metastases greater than 5 cm or with more than 2, patients with advanced stadium of primary tumours, with other molecular

markers, likelihood of a difficult surgery with a higher blood loss, small future liver remnant, previous treatment). The neoadjuvant setting

has not been proven superior to the adjuvant one. Duration of the neoadjuvance should not exceed 3 months or 6 cycles.

Basic patients´ stratification in relation to the neoadjuvant treatment: 1. primarily well resectable 2. primarily resectable with difficulties

3. primarily non-resectable 4. patients with high risk of the progression to local nonresectability. The above mentioned factors should

be reconned.

Conclusion: A multidisciplinary presentation of the patient is a must from the very beginning (surgeon + oncologist at least). Liver ultrasound

+ oncomarkers and physical examination each month on treatment can be recommended so as to prevent the progression to

the non-resectability and to perform the surgery well before the complete response.

Keywords: neoadjuvant, metastases, colorectal carcinoma, resection, liver