Multimodal therapy and precision-imaging extends the limits of treatment for a patient with initially unresectable synchronous colorectal liver metastases.

The cancer journey of a young patient who presented with an obstructing metastatic (Stage 4) colon cancer is described. The addition of bevacizumab to an established chemotherapy regimen of 5-fluorouracil, folinic acid and oxaliplatin (FOLFOX) ameliorated their chemotherapy-associated liver injury (CALI). This improvement in liver quality was demonstrated non-invasively with multi-parametric magnetic resonance imaging (mpMRI). Both the response to chemotherapy and the improvement in liver quality provided by additional bevacizumab allowed this patient with initially unresectable synchronous colorectal liver metastases to undergo resection of their bowel primary, followed by an extended liver resection, uncomplicated by post-hepatectomy liver failure (PHLF). They had subsequent planned ablative therapy with stereotactic ablative radiotherapy (SABR) to a residual central metastasis, and are currently disease free. This case illlustrates the importance of a multi-modal, multidisciplinary and individualised approach to patients' cancer care.