Targeted Therapy, Surgery Offers Cancer Patients New Hope

More than a year ago, Ethel Shumway was told to get her affairs in order because there was nothing more doctors could do to treat the colorectal cancer that had spread to her liver.

Unwilling to give up, the 57-year-old northwestern Ohio woman sought a second opinion " and treatment " at the James Cancer Hospital and Solove Research Institute at Ohio State University, where a personalized targeted treatment approach is extending the lives of some colorectal cancer patients with metastases only to the liver.

In many cases, these patients " including Shumway " have had tumors that most modern medical textbooks define as inoperable. But major advances in chemotherapy, local ablative approaches and surgical techniques over the last five years have greatly improved the possibility of cure for 5 to 10 percent of these patients, says Dr. Mark Bloomston, surgical oncologist at The James who specializes in liver and pancreas malignancies.

Shumway underwent six months of aggressive weekly chemotherapy treatments to shrink her liver tumors. In August 2006, Bloomston removed 75 percent of Shumway ,, s liver during a surgery that lasted four hours. He found no lingering signs of cancer when he saw Shumway at a follow-up visit eight months later.

"The traditional dogma of who shouldn ,, t get liver surgery is now being debunked, Bloomston says. "This, of course, means that it ,, s critical for physicians to correctly identify which patients may qualify for additional treatment.

Bloomston works closely with colleagues including Dr. Tanios Bekaii-Saab, a medical oncologist at The James who specializes in gastrointestinal cancer, to determine the best treatment plan for each patient. Both physicians " who are also researchers at the Ohio State University Comprehensive Cancer Center " stress the importance of multidisciplinary patient care. Each patient is seen by a team that includes a medical oncologist, a surgical oncologist, an interventional radiologist and, when needed, a radiation oncologist, says Bekaii-Saab.

Colorectal cancer is the third most common kind of cancer in men and women in the United States and the third overall leading cancer killer in both sexes. Roughly half of the 150,000 newly diagnosed colorectal cancer cases this year will spread to the liver.

"We almost always think of metastatic cancer as a death sentence, says Bekaii-Saab. "But colorectal cancer that has spread to the liver only is one of the very few instances of metastatic disease with the potential for cure.

The liver is one of the few solid organs capable of regenerating. Surgeons can remove up to 80 percent of the liver, and within one year the organ will have restored itself to nearly normal size, Bloomston says.

Not every patient with colorectal cancer that has spread only to the liver is a candidate for liver surgery, however. At The James, patients go through a rigorous screening process to make sure that their heart, lungs and kidneys can withstand the treatments.

Bloomston, Bekaii-Saab and their colleagues are treating an increasing number of patients with surgery, noting that there is about a 30 percent chance that patients who initially arrive with this disease will be eligible for surgery.

"We have some very effective chemotherapy and targeted agents that can shrink these tumors prior to surgery, Bekaii-Saab says. "We can actually downstage the disease in a lot of patients who are deemed incurable, and give them a shot at a possible cure.

Those improvements in chemotherapy, along with new surgical techniques that allow surgeons to manipulate the liver, are giving oncologists an arsenal of tools to potentially cure some patients and achieve long-term, disease-free survival for others.

Advances in surgical techniques make it possible to manipulate the liver. In some cases, Bloomston employs portal vein embolization, a technique that restricts blood flow to the portion of the liver to be removed and increases it to the healthy areas of the liver.

"We essentially block blood flow to the tumor-bearing portions of the liver, which then shrink, Bloomston says. "We wait four to six weeks to operate, letting the part of the liver that wasn ,, t embolized to enlarge, which significantly improves the chances of a good recovery.

This multidisciplinary approach and the improved therapies seem to be paying off for this unique group of people with metastatic disease.

"In the year 2000, patients with metastatic colorectal cancer survived an average of one year after diagnosis, Saab says. "Today it ,, s an average of three years. That ,, s something we ,, ve never seen before with metastatic disease. It ,, s revolutionary.