[Recent management of metastatic colorectal cancer]

The most common metastatic sites in colorectal cancer are the lung, liver, and the pelvis in rectal cancer. Systemic chemotherapy for these metastases is not effective. Our principle of treatment for metastatic colorectal cancer is as follows. Radical resection is the first choice of treatment if the metastases are localized. Radiation therapy and intra-arterial infusion of 5-FU is adopted if radical resection is impossible. Five-year survival rates of curative resection at our hospital for pulmonary metastases, hepatic metastases and local recurrences of rectal cancer are 35.3% (n = 44), 28.4% (n = 72) and 34.1% (n = 32), respectively. Intra-arterial hepatic continuous infusion of 5-FU and weekly high-dose infusion of 5-FU (WHF) are effective chemotherapy for inoperable hepatic metastases. For inoperable pelvic recurrence of rectal cancer, intraoperative radiation therapy, 192 Ir brachytherapy, interstitial hyperthermia and intra-arterial chemotherapy have seemed to be effective treatment methods.