Background and study aims Bowel cancer is the third most common cancer in the United Kingdom and the liver is the most common site to which bowel cancer spreads. About a third of patients with bowel cancer will already have secondary tumours in the liver called metastases at the time that the bowel cancer is diagnosed. In this situation, the standard treatment is to remove the bowel cancer first by surgery, give chemotherapy and then about three to four months later, remove the liver tumours.
This is known as the classic approach. The limitation with this is that the liver tumours are untreated during the period of bowel cancer surgery and the patient may have to wait several months for chemotherapy.
The reasoning behind this approach is that chemotherapy treats the whole body and tumours in both the liver and the bowel.
The liver tumours are thought to be responsible for spread of bowel cancer Professor siriwardena manchester royal infirmary sexual health other sites so the reason for operating on these first is to reduce the chance of spread. Finally, it is the bowel surgery which is associated with unpleasant side effects such as the possibility of requiring a colostomy stoma bag and for men the possibility of impaired sexual function, and in some patients treated with the reverse approach the chemotherapy means that if the bowel tumour responds completely, surgical removal may not be necessary.
Patients over the age of 18 presenting with bowel cancer that has spread to the liver.
What does the study involve? Participants will be randomly allocated to receive either the standard treatment or the newer reverse approach. In both options, both the bowel cancer and the liver tumour are treated; the difference lies in the sequence of treatment.
What are the possible benefits and risks of participating? Both strategies are known to be safe but it is not known whether one is better than the other.
The benefits are that we may establish that one strategy is better than the other. There is no additional risk from participation. Where is the study run from? When is the study starting and how long is it expected to run for?
It is anticipated that recruitment will start in midfor two years. The study observation period will be for a year after enrolment in the study. Who is funding the study? Who is the main contact? Professor Ajith K Siriwardena ajith. Systemic chemotherapy and the liver-first approach compared to index colorectal resection for colorectal cancer presenting with synchronous liver metastases: In patients with colorectal cancer with synchronous liver-only metastases, a "reverse" or liver-first sequence of best-evidenced neoadjuvant chemotherapy, liver resection and bowel resection preceded by adjuvant chemo radio therapy for rectal tumours Professor siriwardena manchester royal infirmary sexual health the risk of cancer progression compared to the current standard management sequence of bowel resection with chemoradiotherapy for rectal lesionsneoadjuvant chemotherapy followed by Professor siriwardena manchester royal infirmary sexual health resection with adjuvant chemotherapy as the final step.
Not available in web format, please use the contact details below to request a patient information sheet. For patients with colorectal cancer with synchronous hepatic metastases, the study compares the classic approach of bowel cancer surgery first, followed by neoadjuvant chemtoherapy and then liver resection to the reverse approach of systemic chemotherapy first, followed by liver resection as the first surgical intervention, adjuvant chemotherapy and then colorectal resection as the final surgical intervention.