Multimodal Treatment of Colorectal Cancer Liver Metastases Dr

Multimodal Treatment of Colorectal Cancer Liver Metastases Dr. Efraim Idelevich MD, Ph. D, Gastrointestinal Oncology Unit Kaplan Medical Center Rehovot Israel June 2011

COLORECTAL CANCER Worldwide incidence* Western Europe Male Female 39. 8 29. 0 Eastern Europe Male Female 25. 3 18. 5 Japan Male Female 39. 5 24. 6 Australia/ Male New Zealand Female 45. 8 34. 8 South Central Male Asia Female 5. 0 3. 8 Northern Africa Male Female 44. 1 31. 0 6. 0 4. 2 Southern Africa Israel Male Female 11. 2 8. 5 Central America Male Female 8. 8 7. 9 North America Male Female 44. 3 32. 8 *Incidence per 100, 000 population. Parkin DM, et al. CA Cancer J Clin. 1999; 49: 33 -64.

COLORECTAL CANCER 1930 -1997 Age-adjusted death rate*, male, USA Rate per 100, 000 Male Population 80 Prostate Lung & Bronchus Colon & Rectum 70 60 Estimated incidence (% of all cancers in men): Prostate=31%; Lung & Bronchus=14%; Colon and rectum=10% 50 40 30 20 10 0 1930 1940 1950 1960 1970 1980 1997 Year *Adjusted to the age distribution of the 1970 census population. Greenlee RT, et al. CA Cancer J Clin. 2001; 51: 15 -36.

COLORECTAL CANCER 1930 -1997 Age-adjusted death rate*, female, USA Rate per 100, 000 Female Population 80 Breast Lung & Bronchus Colon & Rectum 70 Estimated 2001 incidence (% of all cancers in women): Breast=31%; Lung=13%; Colon and rectum=11% 60 50 40 30 20 10 0 1930 1940 1950 1960 1970 1980 1997 Year *Adjusted to the age distribution of the 1970 census population. Greenlee RT, et al. CA Cancer J Clin. 2001; 51: 15 -36.

COLORECTAL CANCER Disease Stage at Time of Diagnosis Stage I 15% Stage II 20%– 30% Stage III 30%– 40% Stage IV 20%– 25% Hamilton IM, Grem JL. Current Cancer Therapeutics. 3 rd ed. 1998; 157.

Polyp Carcinoma EGF Abnormal production of cytokines Angiogenic switch Mutations in growth control genes Mutations in apoptosis control genes Metastatic carcinoma

Stage IV Colon Cancer Group I Curable disease Group II ! Group III Group IV Potentially curable disease Symptomatic non curable disease Asymptomatic non curable disease Non curable

EORTC, ASCO 2007