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Can TACE be used instead of chemotherapy for metastatic colon cancer?

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Posted on Wed, 20 May 2015
Question: If chemotherapy fails for metastic colon cancer with mets to liver n peritoneal , can TACE be used ?
doctor
Answered by Dr. Indranil Ghosh (28 minutes later)
Brief Answer:
yes, it can be

Detailed Answer:
Hi
Thanks for your query.

TACE can be done but the disease should be preferably be limited to the liver or minimal disease outside the liver. If there is too much disease outside the liver, like peritoneum, then it won't help.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Indranil Ghosh (8 minutes later)
Problem
Is my father was resistant to irinitecan and also
Xeloda .
Now they tried oxyplatin and raltitrexed .

Cea was 65 before start of chemo . However, after 1 round it jumped to 80! Plus his ALP is now
175 and was 75 before .

Does this mean this regime also not working ? As cea reduce right ?
doctor
Answered by Dr. Indranil Ghosh (1 hour later)
Brief Answer:
Need some more time

Detailed Answer:
Ok, I understand.

But CEA takes 2-3 cycles at least to show response. Sometimes, after cycle 1 CEA rises to some extent then start falling. So we need some more time to draw any conclusions.

ALP rise may be due to progression of metastases, biliary obstruction or even effect of oxaliplatin on liver. However, if bilirubin is not rising I would just continue with same chemo for another 1-2 cycles and then decide.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh (18 minutes later)
But this jump is quite steep
Right ? If chemo
Works islt should reduce I thought .

Is about 9 liver mets a lot , 2 are large at 9cm.

Also the ALP has risen from 75 to 175
doctor
Answered by Dr. Indranil Ghosh (5 minutes later)
Brief Answer:
Not really a big jump

Detailed Answer:
65 to 80 is not a big rise. It may come down after 1-2 cycles.

Yes, the ALP rise is steep but it can be drug induced also. What I mean to say is that these are lab markers and not 100% sensitive or specific. We can't do CT scans after every cycle so we need to exercise some clinical judgement.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Indranil Ghosh (8 minutes later)
Ok I am concerned as cea gone up .

Is cea of 80 very high in a patient ?

If there are peritoneal nodes , about 4 and a aortocaval node and poss sub pleural nodule , can TACE b done ?

doctor
Answered by Dr. Indranil Ghosh (4 minutes later)
Brief Answer:
No CEA is not very high by itself

Detailed Answer:
It depends upon the exact size and total burden of disease outside the liver. going by your statement, TACE may be possible. But one needs to ensure that the disease outside liver is small
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Indranil Ghosh (2 minutes later)
Here In uk no one willing to do that or SIRT, but Germany may be willing to once viewed images .

If Germnay does , should
We
Go for it if chemo fails or should
We try avastin first ?
doctor
Answered by Dr. Indranil Ghosh (19 minutes later)
Brief Answer:
very difficult decision without seeing the scans

Detailed Answer:
If german doctors agree to do it then I assume that it will be worth doing. Avastin can be tried even after that. But avastin needs some chemo along with it to work. Chemo options are getting exhausted slowly. So TACE may be better.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh (24 minutes later)
U think this chemo regime will work ? Usually before even every time cea rises he had progression .

Is TACE or SIRT better ?
doctor
Answered by Dr. Indranil Ghosh (1 hour later)
Brief Answer:
It may work still

Detailed Answer:
There is still chance that it may work. If it doesn't then after 3rd cycle you may consider TACE
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Indranil Ghosh (2 hours later)
U think avastin worth to try or proceed with tace ?
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Answered by Dr. Indranil Ghosh (7 hours later)
Brief Answer:
yes you can try avastin

Detailed Answer:
If avastin is considered, then now is the best time. If this chemo fails, getting a suitable chemo partner for avastin will be difficult.
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Indranil Ghosh (1 hour later)
Ok so does TACE have a good success rate ?

Prob is tace will only treat liver right it won't prevent other metastases from forming in body ?
doctor
Answered by Dr. Indranil Ghosh (6 hours later)
Brief Answer:
TACE has good success

Detailed Answer:
But only if it is liver localized or minimal disease outside the liver. It will not affect the peritoneal or lymph nodal disease. They will continue to grow as per their course.

hence TACE is usually reserved when standard chemo options fail.

Regards
Above answer was peer-reviewed by : Dr. Pradeep Vitta
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Follow up: Dr. Indranil Ghosh (9 hours later)
Ok . So what can be done re the peri nodules and 1 lymph node if we did tace for liver ?

Is liver the main organ that can actually kill ?
doctor
Answered by Dr. Indranil Ghosh (6 hours later)
Brief Answer:
for those chemo and avastin to be used

Detailed Answer:
Liver is a vital organ and for your dad it appears to be the chief site of metastasis. Hence it needs attention. But we can't ignore the other sites. Over time they may increase significantly.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Indranil Ghosh

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Practicing since :2004

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Can TACE be used instead of chemotherapy for metastatic colon cancer?

Brief Answer: yes, it can be Detailed Answer: Hi Thanks for your query. TACE can be done but the disease should be preferably be limited to the liver or minimal disease outside the liver. If there is too much disease outside the liver, like peritoneum, then it won't help. Regards