5
Treatment
Clinical Question 5.
➤ What are selected liver-directed therapy options for patients with
late-stage colorectal cancer and liver metastases?
• In maximal settings only, for patients with liver-metastases, options are presented.
Recommendations should be implemented in centers of expertise in the specific
technique after multidisciplinary review, or in the context of a clinical trial.
• See Table 8 for full list of recommendations.
Clinical Question 6.
➤ What is a summary of the optimal treatments for patients with late-
stage colorectal cancer?
• In basic and limited settings, if high risk of obstruction, significant bleeding,
perforation or tumor related symptoms: resection of primary tumor OR if
obstruction from primary tumor or from peritoneal metastases: diverting ostomy.
• In enhanced and maximal settings, the guideline adds option of colon or rectal
stenting.
• In enhanced and maximal settings only, if patients with metastatic rectal cancer
have a symptomatic primary rectal tumor, radiation therapy (± chemotherapy)
should be discussed.
• Patients who have received surgery/ablation may receive systemic therapy if
available (enhanced-maximal).
• See Table 9 for full list of recommendations by modality.
Clinical Question 7.
➤ What are the optimal on-treatment surveillance and follow-up
strategies for patients treated for mCRC?
• On-treatment surveillance includes a combination of taking the medical history,
performing physical examinations, blood work and imaging ; specifics including
frequency, depend on resource-based setting.
• See Table 10 for full list of recommendations.
