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Colorectal Cancer — SCE Medical Oncology MCQ

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ModerateGI CancersColorectal CancerSCE Medical Oncology

A 58-year-old woman with left-sided colon cancer (RAS/BRAF wild-type, MSS) and potentially resectable liver metastases is started on FOLFOX + cetuximab with aim of conversion to surgery. After 4 cycles, CT shows excellent tumour shrinkage. The surgical team is ready. What is the optimal timing of hepatic surgery?

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Correct answer: E — Operate as soon as technically resectable — typically after 3-4 months of chemotherapy

For conversion chemotherapy targeting liver resection, surgery should be performed as soon as technically feasible (typically after 3-4 months/6-8 cycles). Prolonged pre-operative chemotherapy increases hepatic toxicity: oxaliplatin causes sinusoidal obstruction syndrome, irinotecan causes steatohepatitis, and cetuximab rarely causes hepatic steatosis. Earlier surgery also prevents disappearing metastases that become difficult to locate intraoperatively.

Reference: ESMO 2024 Metastatic Colorectal Cancer Guidelines; Adam et al Ann Surg 2004