[Management of metastatic colorectal cancer]

Prognosis of metastatic colorectal cancer has dramatically improved during these two last decades, through a better understanding of therapeutic goals and the development of news drugs such as biologics. The character resectable, potentially resectable or not resectable of colorectal cancer liver metastasis should be considered at baseline because it determines the systemic chemotherapy which will be conducted. Considering resectable metastasis, 6 courses of FOLFOX (5 fluoro-uracil + oxaliplatin) will be administered before and after surgery in the goal of "cleaning" the body from the potential micrometastasis. In potentially resectable liver metastasis, the objective of the chemotherapy will be to get a tumor shrinkage, enabling microscopically complete resection while leaving enough functional hepatic parenchyma. In case of unresectable metastasis, obtaining a tumor response with an intensive induction chemotherapy is the guarantee of a good disease control, and authorizes to light treatment during a maintenance period, or a therapeutic break in selected patients, without altering the prognosis.