[Colorectal cancers: management of metastatic cancers]

Close to half of patients suffering from colorectal cancer develop metastases. Their natural prognosis is grim with a median survival of 6 to 7 months. Current treatment options rest on surgery and (or) chemotherapy. Complete surgical excision of the metastates is the treatment of choice as it permits cure rates and levels of long-term survival never attained with chemotherapy. It is only justified if it is complete; it must be systematically discussed with a specialised multidisciplinary team. However, it is possible only in a maximum of 10% of patients. More than half of the patients operated on finish by having a recurrence; post-operative chemotherapy seems to diminish this risk. Furthermore, so-called "palliative" chemotherapy consists of protocols that are by and large well tolerated, based on 5-FU-folic acid and more recent cytotoxics such as oxaliplatin and irinotecan. When a surgical solution cannot be offered (such is the case in the majority of patients), these active treatment plans permit an amelioration in survival (going from a median of 6 months to more that 20 months) without a deterioration in the quality of life. Thus, if the general state of the patient allows, and in the absence of serious organ failure, palliative chemotherapy is most often indicated. Several cycles can be given: tolerance and efficacity must be regularly evaluated so that it is only re-administered in cases of benefit. Sometimes the tumoral reduction is such that metastases that weren't initially resectable become so. The combination of the different therapeutic options has permited significant advances; multidisciplinary discussion of all cases of patients suffering from metastatic colorectal cancer is an indispensable pre-requisite for a well-adapted and efficacious management.