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Schietroma F, Bensi M, Calegari MA, Pozzo C, Basso M, Valente G, Caira G, Trovato G, Spring A, Beccia V, Ceccarelli A, Perazzo S, Chiofalo L, Barbaro B, Tatulli G, Alfieri S, De Sio D, Lorenzon L, Persiani R, Lococo F, Nachira D, Giuliante F, Ardito F, Cellini F, Panza G, Cozza V, Giovinazzo F, Pafundi DP, Sofo L, Santullo F, Tondolo V, Tortora G, Salvatore L. The Impact of a Multidisciplinary Tumor Board (MDTB) in the Management of Colorectal Cancer (CRC). Clin Colorectal Cancer 2025; 24:231-238. [PMID: 39893137 DOI: 10.1016/j.clcc.2025.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 01/05/2025] [Accepted: 01/07/2025] [Indexed: 02/04/2025]
Abstract
BACKGROUND The management of colorectal cancer (CRC) is a complex process. Defining the disease burden, assessing the radiological response and identifying the right time for surgery or other locoregional treatments are crucial factors which can require the involvement of a multidisciplinary tumor board (MDTB) comprising several specialists. This study investigates the impact of MDTB on management of CRC in our institution. METHODS We retrospectively assessed all cases discussed by our MDTB between September 2019 and April 2023. In particular, we collected data concerning radiology, surgery and radiotherapy indication before and after MDTB meetings. The primary endpoint was the overall rate of discrepancy between pre- and post-discussion evaluations. RESULTS Our analysis involved 1150 cases. Median age was 64 years (16-90), 629 patients (54.7%) were male and 915 (79.5%) had metastatic disease at the time of the relevant MDTB discussion. After the meetings, 325 treatment decisions were modified, producing an overall discrepancy rate of 28.3%. In particular: (1) of 648 cases discussed for radiological assessment, 156 decisions (24.1%) were altered after a central imaging review; (2) of 327 cases considered for surgical approach, treatment strategy changed in 118 (36.1%); and (3) of the 160 cases discussed regarding radiotherapy, the treatment strategy changed in 51 of them (31.9%). CONCLUSIONS Our analysis shows significant discrepancies between the radiology and locoregional evaluations from both before and after the MDTB meetings. Our results highlight that the discussions of a MDTB can considerably change the management of CRC, maximizing the treatment strategy.
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Affiliation(s)
- Francesco Schietroma
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Bensi
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Alessandra Calegari
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmelo Pozzo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Michele Basso
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giustina Valente
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Caira
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Trovato
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alexia Spring
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Viria Beccia
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Ceccarelli
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Serena Perazzo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Chiofalo
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Brunella Barbaro
- Radiologia Diagnostica e Interventistica Generale, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Tatulli
- Radiologia Diagnostica e Interventistica Generale, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sergio Alfieri
- Chirurgia Digestiva, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide De Sio
- Chirurgia Digestiva, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Laura Lorenzon
- Chirurgia Generale, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Roberto Persiani
- Chirurgia Generale, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Lococo
- Chirurgia Toracica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dania Nachira
- Chirurgia Toracica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Felice Giuliante
- Chirurgia Generale ed Epato-Biliare, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ardito
- Chirurgia Generale ed Epato-Biliare, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Cellini
- Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulia Panza
- Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Valerio Cozza
- Chirurgia d'Urgenza e del Trauma, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Francesco Giovinazzo
- Chirurgia Generale e dei Trapianti di Organo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Donato Paolo Pafundi
- Chirurgia Generale 2, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Luigi Sofo
- Chirurgia Addominale, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Santullo
- Chirurgia del Peritoneo e Retroperitone, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Tondolo
- Chirurgia Digestiva e del Colon Retto, Ospedale Isola Tiberina Gemelli Isola, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Tortora
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lisa Salvatore
- Oncologia Medica, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Oncologia Medica, Università Cattolica del Sacro Cuore, Rome, Italy.
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Xue JS, Maimaitiming N, Zhang BL, Xu BW, Yin X, Huang Z, Che X, Zhao H, Cai JQ. Prognostic analysis of patients with CRLM based on CRS score: a single-center retrospective study. BMC Cancer 2025; 25:718. [PMID: 40247181 PMCID: PMC12004860 DOI: 10.1186/s12885-025-14135-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/10/2025] [Indexed: 04/19/2025] Open
Abstract
BACKGROUND To improve prognosis of patients with synchronous colorectal liver metastasis (CRLM), we constructed a nomogram model to improve outcome through risk stratification and decision support. METHODS The 389 CRLM patients (273 training set and 116 validation set at a ratio of 7: 3) receiving systematic chemotherapy and synchronously resection with/without radiofrequency ablation (RFA) were retrospectively investigated. Overall survival (OS) and recurrence free survival (RFS) were mainly endpoint. A normo-gram model was conduct. The receiver operating characteristic (ROC) curve, decision curve analysis (DCA), C-index and calibration curve were performed to assess stablity and efficacy of model. The prognosis was evaluated based on Kaplan-Meier (KM) curve. RESULTS A total of 389 CRLM patients were included. The median OS and RFS times were 70.20 months (95% CIs: 57.73, 82.68) and 11.70 months (95% CIs: 9.75, 13.65), respectively. These patients were divided into training set and validation set at a ratio of 7: 3. In training set, 1, 3, and 5-year survival rate of OS was 97.38%, 71.18%, and 54.56% as well as RFS was 52.57%, 22.65%, and 21.12%, respectively. Cox model showed that hospital day, R0 resection, RFA, only neoadjuvant chemotherapy and CRS score were independent prognostic factors for CRLM patients. The patients were divided into high-risk group and low-risk group based on cut-off value of score calculated by model. The KM curves were statistically different between two groups (P < 0.01). The ROC curve, DCA and calibration curve showed a good prediction efficacy. the C-index of OS and RFS were 0.72 and 0.68, respectively, which were also verified in the validation set (OS, 0.71; RFS, 0.65). CONCLUSIONS A good prediction model was developed and validated to assess the prognoses of CRLM patients. Systematic chemotherapy and R0 resection could benefit patients' survival and improve prognosis.
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Affiliation(s)
- Jun-Shuai Xue
- Department of Hepatobiliary Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Nuersimanguli Maimaitiming
- Department of Hepatobiliary Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Bo-Lun Zhang
- Department of Hepatobiliary Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Bo-Wen Xu
- Department of Hepatobiliary Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xin Yin
- Department of Hepatobiliary Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhen Huang
- Department of Hepatobiliary Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xu Che
- Department of Hepatobiliary Surgery, Shenzhen Center, Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen, 518000, China
| | - Hong Zhao
- Department of Hepatobiliary Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jian-Qiang Cai
- Department of Hepatobiliary Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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VandenHeuvel SN, Nash LL, Raghavan SA. Dormancy in Metastatic Colorectal Cancer: Tissue Engineering Opportunities for In Vitro Modeling. TISSUE ENGINEERING. PART B, REVIEWS 2025. [PMID: 40195931 DOI: 10.1089/ten.teb.2025.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2025]
Abstract
Colorectal cancer (CRC) recurs at a striking rate, specifically in patients with liver metastasis. Dormant CRC cells disseminated following initial primary tumor resection or treatment often resurface years later to form aggressive, therapy-resistant tumors that result in high patient mortality. Routine imaging-based screenings often fail to detect dormant cancer cell clusters, and there are no overt symptomatic presentations, making dormant CRC a major clinical challenge to diagnose and treat. Tissue engineering approaches are ideally suited to model dormant cancer cells and enable the discovery of therapeutic vulnerabilities or unique mechanistic dependencies of dormant CRC. Emerging evidence suggests that tissue-engineered approaches have been successfully used to model dormant breast and lung cancer. With CRC responsible for the second most cancer-related deaths worldwide and CRC patients commonly experiencing recurrence, it is essential to expand dormancy models to understand this phenomenon in the context of CRC. Most published in vitro models of CRC dormancy simplify the complex tumor microenvironment with two-dimensional culture systems to elucidate dormancy-driving mechanisms. Building on this foundation, future research should apply tissue engineering methods to this growing field to generate competent three-dimensional models and increase mechanistic knowledge. This review summarizes the current state of in vitro CRC dormancy models, highlighting the techniques utilized to give rise to dormant CRC cells: nutrient depletion, anticancer drugs, physical extracellular matrix interactions, and genetic manipulation. The metrics used to validate dormancy within each model are also consolidated to demonstrate the lack of established standards and the ambiguity around comparing studies that have been validated differently. The methods of these studies are organized in this review to increase comprehensibility and identify needs and opportunities for future bioengineered in vitro models to address dormancy-driven mortality in patients with CRC liver metastasis. Impact Statement Dormant cancer drives high patient mortality, especially in metastatic colorectal cancer, owing to the clinical inability to identify dormant cells prior to their overt recurrence. Lacking clinical insights, in vitro modeling for mechanistic and therapeutic discovery is hindered. Here, we review models and methods of inducing colorectal cancer dormancy with the goal of consolidating findings for reference. We also highlight the need for advanced, tissue-engineered models to better mimic the organ-specific 3D microenvironment of metastatic colorectal cancer. New models would enable breakthroughs in understanding mechanisms driving dormancy progression and reversal, thereby providing context for therapeutic advances to improve patient survival.
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Affiliation(s)
| | - Lucia L Nash
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
| | - Shreya A Raghavan
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
- Regional Excellence Center in Cancer, Texas A&M University, College Station, Texas, USA
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Nakagawa M, Sumitani D, Matubara K, Ota H, Yano M. Ileal metastasis of colorectal cancer diagnosed by double-balloon endoscopy and resected via laparoscopy: A case report. Int J Surg Case Rep 2025; 129:111072. [PMID: 40106946 PMCID: PMC11964571 DOI: 10.1016/j.ijscr.2025.111072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 02/14/2025] [Accepted: 02/17/2025] [Indexed: 03/22/2025] Open
Abstract
INTRODUCTION Small bowel metastasis of colorectal cancer (CRC) is rare, with a 3.8 % occurrence. Preoperative diagnosis was considered challenging; however, with the development of various endoscopes, diagnosis may now be possible. Most small bowel metastases of CRC are systemic metastatic events, such as direct invasion or disseminated metastasis. Therefore, R0 surgery is difficult to achieve, and local treatment is infrequent. PRESENTATION OF CASE A 70-year-old woman underwent laparoscopic left hemicolectomy for transverse colon cancer in 2022 and her final staging was pT4a, N1b, M0, pStage IIIb. One year after surgery, her carcinoembryonic antigen (CEA) level was elevated, and computed tomography (CT) showed no evidence of neoplastic lesions; however, positron emission tomography (PET) showed a 1 cm nodule with a high SUVmax:9.1 concentration near the uterus, suggesting the possibility of a small bowel tumor. Double-balloon endoscopy (DBE) revealed a submucosal tumor in the ileum. A biopsy could not be performed; however, the lesion was marked with ink dots and clips near the lesion. The lesion was diagnosed as solitary, and the patient underwent laparoscopic partial ileal resection. The tumor was located approximately 60 cm from the end of the ileum on the mesenteric side of the mouth, and it was impossible to determine whether it was an extramural or intraluminal lesion. The patient had a good postoperative course, and histopathologic examination revealed small bowel metastasis of transverse colon cancer, with tumor cells infiltrating from the subserosal layer to the intrinsic muscularis propria. The patient has been under observation for 1 year and 4 months after surgery without recurrence. DISCUSSION Small bowel metastases of CRC are very rare and have a poor prognosis; DBE can be used to identify neoplastic lesions in the ileum that could not be determined as extraintestinal or small bowel lesions by CT or PET alone. By marking the lesion with dots of ink and a clip, the lesion was determined to be solitary and amenable to R0 surgery. Laparoscopic surgery was chosen because of the ease of confirming the markings near the lesion and because it was minimally invasive. Furthermore, laparoscopic surgery allowed observation of the subdiaphragm, pelvic floor, and entire abdominal cavity. This report is the only case in which ink dots and clips were employed during DBE and subsequently utilized when laparoscopic surgery was performed. CONCLUSION We report a case involving a single site of small bowel metastasis after CRC surgery in which the patient underwent laparoscopic resection of the small intestine after locating the metastatic site with DBE and was successfully treated without recurrence. We conclude that if R0 surgery is possible for a single site of small bowel metastasis, it may contribute to an improved prognosis. Endoscopy is useful for detecting small intestinal tumors, and a single site of small bowel metastasis is a good indication for laparoscopic resection.
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Affiliation(s)
- Masataka Nakagawa
- Department of Surgery, Medical Corporation Hiroshima Hospital, 3-1-36 Hutabanosato, Higashi-ku, Hiroshima 732-0057, Japan
| | - Daisuke Sumitani
- Department of Surgery, Medical Corporation Hiroshima Hospital, 3-1-36 Hutabanosato, Higashi-ku, Hiroshima 732-0057, Japan.
| | - Keiso Matubara
- Department of Surgery, Medical Corporation Hiroshima Hospital, 3-1-36 Hutabanosato, Higashi-ku, Hiroshima 732-0057, Japan
| | - Hiroshi Ota
- Department of Surgery, Medical Corporation Hiroshima Hospital, 3-1-36 Hutabanosato, Higashi-ku, Hiroshima 732-0057, Japan
| | - Masatsugu Yano
- Department of Surgery, Medical Corporation Hiroshima Hospital, 3-1-36 Hutabanosato, Higashi-ku, Hiroshima 732-0057, Japan
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Papakonstantinou M, Fantakis A, Torzilli G, Donadon M, Chatzikomnitsa P, Giakoustidis D, Papadopoulos VN, Giakoustidis A. A Systematic Review of Disappearing Colorectal Liver Metastases: Resection or No Resection? J Clin Med 2025; 14:1147. [PMID: 40004679 PMCID: PMC11856073 DOI: 10.3390/jcm14041147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2025] [Revised: 01/29/2025] [Accepted: 02/07/2025] [Indexed: 02/27/2025] Open
Abstract
Background: Colorectal cancer is the second most common type of cancer and a leading cause of cancer-related deaths worldwide. Approximately 15% of the patients with colorectal cancer will already have liver metastases (CRLMs) at diagnosis. Luckily, the advances in chemotherapy regimens during the past few decades have led to increased rates of disease regression that could even render an originally unresectable disease resectable. In certain patients with CRLMs, the hepatic lesions are missing on preoperative imaging after neoadjuvant chemotherapy. These patients can undergo surgery with or without resection of the sites of the disappearing liver metastases (DLMs). In this systematic review, we assess the recurrence rate of the DLMs that were left unresected as well as the complete pathologic response of those resected. Methods: A literature search was conducted in PubMed for studies including patients with CRLMs who received neoadjuvant chemotherapy and had DLMs in preoperative imaging. Two independent reviewers completed the search according to the PRISMA checklist. Results: Three hundred and twenty-six patients with 1134 DLMs were included in our review. A total of 47 out of 480 DLMs (72.29%) that were removed had viable tumor cells in postoperative histology. One hundred and forty-five tumors could not be identified intraoperatively and were removed based on previous imaging, with thirty (20.69%) of them presenting viable cancer cells. Four hundred and sixty-five lesions could not be identified and were left in place. Of them, 152 (32.69%) developed local recurrence within 5 years. Of note, 34 DLMs could not be categorized as viable or non-viable tumors. Finally, DLMs that were identifiable intraoperatively had a higher possibility of viable tumors compared to non-identifiable ones (72.29% vs. 20.69%, respectively). Conclusions: Disappearing liver metastases that are left unresected have an increased possibility of recurrence. Patients receiving neoadjuvant treatment for CRLMs may have better survival chances after resecting all the DLM sites, either identifiable intraoperatively or not.
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Affiliation(s)
- Menelaos Papakonstantinou
- Aristotle University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (M.P.); (A.F.); (P.C.); (D.G.); (V.N.P.)
| | - Antonios Fantakis
- Aristotle University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (M.P.); (A.F.); (P.C.); (D.G.); (V.N.P.)
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary Surgery & General Surgery, Humanitas Research Hospital, 20089 Rozzano, Italy;
| | - Matteo Donadon
- Surgical Oncology Program, University Maggiore Hospital, University of Piemonte Orientale, 28100 Novara, Italy;
| | - Paraskevi Chatzikomnitsa
- Aristotle University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (M.P.); (A.F.); (P.C.); (D.G.); (V.N.P.)
| | - Dimitrios Giakoustidis
- Aristotle University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (M.P.); (A.F.); (P.C.); (D.G.); (V.N.P.)
| | - Vasileios N. Papadopoulos
- Aristotle University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (M.P.); (A.F.); (P.C.); (D.G.); (V.N.P.)
| | - Alexandros Giakoustidis
- Aristotle University Surgery Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (M.P.); (A.F.); (P.C.); (D.G.); (V.N.P.)
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Li H, Shi M, Long X, Huang P, Peng C, He W, Li Y, Li B, Yuan Y, Qiu J, Zou R. Contrast-enhanced intraoperative ultrasound improved hepatic recurrence-free survival in initially unresectable colorectal cancer liver metastases. Dig Liver Dis 2025; 57:467-476. [PMID: 39343654 DOI: 10.1016/j.dld.2024.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 09/14/2024] [Accepted: 09/16/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND We aimed to evaluate the role of Contrast-enhanced intraoperative ultrasound (CE-IOUS) with perfluorobutane microbubbles (Sonazoid) in improving the prognosis of patients with unresectable colorectal cancer liver metastases (CRLM). METHODS A total of 130 Patients with unresectable CRLM who underwent curative hepatic resection at our institute were retrospectively analyzed. Of these 130 enrolled patients, 67 underwent intraoperative ultrasound alone (IOUS group); 63 underwent additional CE-IOUS and IOUS (CE-IOUS group). Normalized inverse probability treatment weighting (IPTW) was employed to balance baseline characteristics between groups. Hepatic recurrence-free survival (HRFS) and overall survival (OS) were compared. RESULTS The treatment strategy was altered in 25 patients (25/63, 39.9%) due to the additional use of CE-IOUS. After applying IPTW, the CE-IOUS group exhibited a significantly lower rate of hepatic recurrence (hazard ratio [HR], 0.55; 95% confidence interval [CI] 0.32-0.95; P = 0.032). Subgroup analysis showed that CE-IOUS provided a significant benefit over IOUS in patients with bilobar liver metastases (P = 0.007), or with a number of live tumors < 3 (P = 0.021), or without DLM (P = 0.018), or with extrahepatic metastasis (P = 0.034), or with a minimum of 6 cycles of systemic therapy (P = 0.03). CONCLUSIONS CE-IOUS is necessary for unresectable CRLM after preoperative chemotherapy, as it enhances detection accuracy and improves the prognosis of unresectable CRLM patients.
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Affiliation(s)
- HuiFang Li
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China; Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China
| | - Ming Shi
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China; Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China
| | - Xingzhang Long
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China; Department of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China
| | - Pinzhu Huang
- Department of Colorectal Surgery, the Sixth affiliated hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510060, PR China
| | - Chuan Peng
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China; Department of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China
| | - Wei He
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China; Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China
| | - Yuhong Li
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China; Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China
| | - Binkui Li
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China; Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China
| | - Yunfei Yuan
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China; Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China
| | - JiLiang Qiu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China; Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China.
| | - Ruhai Zou
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, PR China; Department of Ultrasound, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China.
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Bitterer F, Bauer A, Glehr G, Brunner S, Schmidt K, Schlitt HJ, Jung EM, Hackl C. Intraoperative contrast-enhanced ultrasound has an outcome-relevant impact on surgery of primary and metastatic liver lesions. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2025; 46:49-56. [PMID: 38335990 DOI: 10.1055/a-2249-6791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
PURPOSE Complete resection of the affected tissue remains the best curative treatment option for liver-derived tumors and colorectal liver metastases. In addition to preoperative cross-sectional imaging, contrast-enhanced intraoperative ultrasound (CE-IOUS) plays a crucial role in the detection and localization of all liver lesions. However, its exact role is unclear. This study was designed to evaluate the clinical and oncological impact of using CE-IOUS in the surgical treatment of these diseases. MATERIALS AND METHODS Over the three-year study period, 206 patients with primary liver tumors and hepatic metastases were enrolled in this prospective, monocentric study to evaluate the impact of CE-IOUS in liver surgery. Secondary outcomes included comparing the sensitivity and specificity of CE-IOUS with existing preoperative imaging modalities and identifying preoperative parameters that could predict a strategic impact of CE-IOUS. In addition, the oncological significance of CE-IOUS was evaluated using a case-cohort design with a minimum follow-up of 18 months. RESULTS CE-IOUS findings led to a change in surgical strategy in 34% of cases (n=70/206). The accuracy in cases with a major change could be confirmed histopathologically in 71.4% of cases (n=25/35). The impact could not be predicted using parameters assumed to be clinically relevant. An oncological benefit of a CE-IOUS adapted surgical approach was demonstrated in patients suffering from HCC and colorectal liver metastases. CONCLUSION CE-IOUS may significantly increase R0 resection rates and should therefore be used routinely as an additional staging method, especially in complex liver surgery.
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Affiliation(s)
- Florian Bitterer
- Department of Surgery, University Hospital Regensburg Clinic and Polyclinic for Surgery, Regensburg, Germany
| | - Andreas Bauer
- Department of Surgery, University Hospital Regensburg Clinic and Polyclinic for Surgery, Regensburg, Germany
| | - Gunther Glehr
- Department of Surgery, University Hospital Regensburg Clinic and Polyclinic for Surgery, Regensburg, Germany
| | - Stefan Brunner
- Department of Surgery, University Hospital Regensburg Clinic and Polyclinic for Surgery, Regensburg, Germany
| | - Katharina Schmidt
- Department of Surgery, University Hospital Regensburg Clinic and Polyclinic for Surgery, Regensburg, Germany
| | - Hans Jürgen Schlitt
- Department of Surgery, University Hospital Regensburg Clinic and Polyclinic for Surgery, Regensburg, Germany
| | - Ernst Michael Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Christina Hackl
- Department of Surgery, University Hospital Regensburg Clinic and Polyclinic for Surgery, Regensburg, Germany
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8
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Nakagawa M, Sumitani D, Matsubara K, Ota H, Yano M. A long-term recurrence-free case of colorectal cancer with 13 simultaneous liver metastases: A case report. Int J Surg Case Rep 2024; 125:110600. [PMID: 39547031 PMCID: PMC11607655 DOI: 10.1016/j.ijscr.2024.110600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 11/06/2024] [Accepted: 11/09/2024] [Indexed: 11/17/2024] Open
Abstract
INTRODUCTION Metastatic liver tumors result from distant metastasis of a primary tumor. While chemotherapy is the treatment of choice, liver resection is aggressively performed for metastatic liver cancer derived from colorectal cancer. However, during chemotherapy, some disappearing liver metastases (DLMs) can be undetectable on computed tomography (CT), and surgical treatment remains challenging. PRESENTATION OF CASE A 48-year-old woman with abdominal pain and constipation was diagnosed with multiple liver metastases of colorectal cancer (CRLM) origin after a thorough examination involving CT and ethoxybenzyl-magnetic resonance imaging. Thirteen simultaneous CRLM were observed (largest metastasis diameter, 37 mm). Resection of the primary tumor (laparoscopy-assisted left colon resection + D3 dissection) was performed. Following eight courses of chemotherapy with mFOLFOX6 + panitumumab, only two CRLM and 11 DLMs were detectable on CT. With no new lesions identified, the patient underwent anterior segment resection and segment 3 and segment 7 partial hepatectomies. Contrast-enhanced intraoperative ultrasonography was performed, and all detectable lesions were resected. However, pathology results showed three CRLM in the anterior segment and no tumor cells in the segment 3 and segment 7 specimens. Postoperatively, the patient received eight courses of adjuvant chemotherapy with capecitabine and oxaliplatin (with capecitabine as a single agent beginning mid-course). The patient is currently alive and recurrence-free 3.5 years post-hepatic resection. DISCUSSION The utility of EOB-MRI in the detection of DLMs has been demonstrated. The incidence of residual disease and subsequent early recurrence at sites diagnosed as DLMs on CT is reported to be approximately 80 %. Although aggressive resection of resectable DLMs is desirable to the extent that residual liver function can be preserved, recurrence is frequent and long-term careful follow-up is considered important. CONCLUSION Our patient, with multiple CRLM, responded to chemotherapy and underwent conversion surgery following resection of the primary tumor. Surgeons should consider possible surgical resection and DLM management when selecting the primary treatment.
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Affiliation(s)
- Masataka Nakagawa
- Department of Surgery, JR Hiroshima Hospital, 3-1-36 Hutabanosato, Higashi-ku, Hiroshima 732-0057, Japan
| | - Daisuke Sumitani
- Department of Surgery, JR Hiroshima Hospital, 3-1-36 Hutabanosato, Higashi-ku, Hiroshima 732-0057, Japan.
| | - Keiso Matsubara
- Department of Surgery, JR Hiroshima Hospital, 3-1-36 Hutabanosato, Higashi-ku, Hiroshima 732-0057, Japan
| | - Hiroshi Ota
- Department of Surgery, JR Hiroshima Hospital, 3-1-36 Hutabanosato, Higashi-ku, Hiroshima 732-0057, Japan
| | - Masatsugu Yano
- Department of Surgery, JR Hiroshima Hospital, 3-1-36 Hutabanosato, Higashi-ku, Hiroshima 732-0057, Japan
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9
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Dempsey PJ, Farrelly C, Cronin CG, Fenlon HM. Preoperative imaging of colorectal liver metastases: what the radiologist and the multidisciplinary team need to know. Br J Radiol 2024; 97:1602-1618. [PMID: 39078288 PMCID: PMC11417391 DOI: 10.1093/bjr/tqae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/13/2024] [Accepted: 07/29/2024] [Indexed: 07/31/2024] Open
Abstract
The management of patients with colorectal liver metastases (CRLM) has transformed over the past 2 decades. Advances in surgical techniques, systemic therapies, and local treatments have resulted in a paradigm shift. Disease that would once have been considered terminal is now frequently treated aggressively with both a disease-free and overall survival benefit. In line with the expanding range of treatment options, there has been an increase in the volume and complexity of imaging required in the management of these patients to ensure optimal patient selection and outcome. The radiologist plays a pivotal role in interpreting these studies, conveying the relevant information and informing the discussion at multidisciplinary team meetings. The purpose of this review is to provide an update for radiologists on the current surgical management of patients with CRLM highlighting specific imaging information that is required by the multidisciplinary team when assessing resectability and/or the need for additional liver-directed therapies.
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Affiliation(s)
- Philip J Dempsey
- Department of Radiology, Mater Misericordiae University Hospital, Dublin D07, Ireland
| | - Cormac Farrelly
- Department of Radiology, Mater Misericordiae University Hospital, Dublin D07, Ireland
| | - Carmel G Cronin
- Department of Radiology, Mater Misericordiae University Hospital, Dublin D07, Ireland
| | - Helen M Fenlon
- Department of Radiology, Mater Misericordiae University Hospital, Dublin D07, Ireland
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10
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Sheriff NJ, Thomas M, Bunck AC, Peterhans M, Datta RR, Hellmich M, Bruns CJ, Stippel DL, Wahba R. Registration accuracy comparing different rendering techniques on local vs external virtual 3D liver model reconstruction for vascular landmark setting by intraoperative ultrasound in augmented reality navigated liver resection. Langenbecks Arch Surg 2024; 409:268. [PMID: 39225933 PMCID: PMC11371850 DOI: 10.1007/s00423-024-03456-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Augmented reality navigation in liver surgery still faces technical challenges like insufficient registration accuracy. This study compared registration accuracy between local and external virtual 3D liver models (vir3DLivers) generated with different rendering techniques and the use of the left vs right main portal vein branch (LPV vs RPV) for landmark setting. The study should further examine how registration accuracy behaves with increasing distance from the ROI. METHODS Retrospective registration accuracy analysis of an optical intraoperative 3D navigation system, used in 13 liver tumor patients undergoing liver resection/thermal ablation. RESULTS 109 measurements in 13 patients were performed. Registration accuracy with local and external vir3DLivers was comparable (8.76 ± 0.9 mm vs 7.85 ± 0.9 mm; 95% CI = -0.73 to 2.55 mm; p = 0.272). Registrations via the LPV demonstrated significantly higher accuracy than via the RPV (6.2 ± 0.85 mm vs 10.41 ± 0.99 mm, 95% CI = 2.39 to 6.03 mm, p < 0.001). There was a statistically significant positive but weak correlation between the accuracy (dFeature) and the distance from the ROI (dROI) (r = 0.298; p = 0.002). CONCLUSION Despite basing on different rendering techniques both local and external vir3DLivers have comparable registration accuracy, while LPV-based registrations significantly outperform RPV-based ones in accuracy. Higher accuracy can be assumed within distances of up to a few centimeters around the ROI.
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Affiliation(s)
- Nonkoh J Sheriff
- Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
- Department of General, Visceral and Oncological Surgery, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Michael Thomas
- Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Alexander C Bunck
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | | | - Rabi Raj Datta
- Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Christiane J Bruns
- Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Dirk Ludger Stippel
- Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
| | - Roger Wahba
- Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany.
- Department of General, Visceral and Oncological Surgery, Helios Hospital Berlin-Buch, Berlin, Germany.
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11
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Pei Y, Wang Z, Hao S, Tong Y, Wu R, Qiao X, Liu Y, Zhang G. Analyzing the value of delayed 18 F-FDG PET/CT images in diagnosing small colorectal cancer liver metastases in patients with hypothyroidism based on diagnostic accuracy and image standardized uptake value. Nucl Med Commun 2024; 45:396-405. [PMID: 38372033 DOI: 10.1097/mnm.0000000000001825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
PURPOSE The objective of this study was to investigate the value of delayed 18F fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) images in patients with small colorectal cancer liver metastases (CRLMs) with hypothyroidism. METHOD We performed a retrospective analysis of 66 small-CRLM patients with hypothyroidism and 66 small-CRLM patients with euthyroidism, all of whom underwent dual-time-point 18 F-FDG PET/CT imaging. First, the diagnostic accuracy of PET/CT early imaging and PET/CT delayed imaging on lesions was analyzed. Next, the correlation of metabolic parameters between PET/CT early imaging and PET/CT delayed imaging was analyzed according to the grouping of all lesions. Finally, PET/CT parameters were analyzed for correlation with thyroid hormones. RESULTS The diagnostic accuracy of delayed imaging in small-CRLM patients with hypothyroidism is not as good as that in small-CRLM patients with euthyroidism; PET/CT metabolic parameters are also unfavorable for the diagnosis of small-CRLM. For small-CRLM patients with hypothyroidism, the greater the thyroid-stimulating hormone level, the greater the uptake of 18 F-FDG in normal liver tissue, and the smaller the ratio of tumor lesion uptake to normal liver tissue uptake. CONCLUSION PET/CT-delayed imaging has better performance than early imaging in small-CRLM patients with euthyroidism. However, the more severe the hypothyroidism, the worse the diagnostic delayed imaging performance. The scan time can be extended appropriately to optimize the imaging efficacy.
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Affiliation(s)
- Yusong Pei
- Department of Nuclear Medicine, General Hospital of Northern Theater Command and
| | - Zhiguo Wang
- Department of Nuclear Medicine, General Hospital of Northern Theater Command and
| | - Shanhu Hao
- Department of Nuclear Medicine, General Hospital of Northern Theater Command and
| | - Yanan Tong
- Department of Nuclear Medicine, General Hospital of Northern Theater Command and
| | - Ruixian Wu
- Department of Nuclear Medicine, General Hospital of Northern Theater Command and
| | - Xinxin Qiao
- Department of Radiology, The Peoples Hospital of China Medical University, Shenyang, China
| | - Yanqing Liu
- Department of Nuclear Medicine, General Hospital of Northern Theater Command and
| | - Guoxu Zhang
- Department of Nuclear Medicine, General Hospital of Northern Theater Command and
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12
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Li B, Wang C, He W, Qiu J, Zheng Y, Zou R, Lin Z, Shi Y, Yuan Y, Zhang R, Zhang C, Chen M, Lau WY, Yuan Y. Watch-and-wait strategy vs. resection in patients with radiologic complete response after conversion therapy for initially unresectable hepatocellular carcinoma: a propensity score-matching comparative study. Int J Surg 2024; 110:2545-2555. [PMID: 38329081 DOI: 10.1097/js9.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The optimal subsequent management for patients with initially unresectable hepatocellular carcinoma (uHCC) who have achieved complete response (CR) following conversion therapy remains unclear. This study aims to evaluate the feasibility and outcomes of the watch-and-wait (W-W) strategy versus surgical resection (SR) for these patients. MATERIALS AND METHODS This retrospective study reviewed patients with initially uHCC who underwent conversion therapy employing transarterial therapies combined with or without systemic therapies. Radiologic CR (rCR), clinical CR (cCR), and pathologic CR (pCR) were evaluated. Overall survival (OS) and progression-free survival (PFS) were compared between the W-W and SR groups. RESULTS Among 1880 patients with uHCC who underwent conversion therapy, 207 (11.0%) achieved rCR. Finally, we enrolled 149 patients meeting the inclusion criteria, including 74 receiving W-W strategy and 75 undergoing SR. Among the 149 patients with rCR, the W-W group demonstrated comparable 3-year OS rates to the SR group (80.9 vs 83.1%, P =0.77), but demonstrated inferior PFS rates (14.4 vs 46.5%, P =0.002). These results remained consistent after propensity score matching. For the 57 patients who achieved cCR, the W-W group exhibited comparable 3-year OS (88.1 vs 87.9%, P =0.89) and PFS rates (27.8 vs 40.8%, P =0.34) compared to SR group. Among the 75 patients in the SR group, 31 (41.3%) achieved pCR and 44 (58.7%) reached non-pCR. When compared with patients with pCR, those who achieved rCR in the W-W group showed comparable OS but inferior PFS rates. Moreover, patients who achieved rCR in the W-W group displayed both comparable OS and PFS rates to those with non-pCR. CONCLUSION The W-W strategy offered comparable survival outcomes to SR in patients with initially uHCC who achieved rCR or cCR after conversion therapy. For these patients, the W-W strategy could be offered as an alternative treatment option.
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Affiliation(s)
- Binkui Li
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery
| | - Chenwei Wang
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery
| | - Wei He
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery
| | - Jiliang Qiu
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery
| | - Yun Zheng
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery
| | - Ruhai Zou
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Ultrasound
| | - Zhu Lin
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery
| | - Yunxing Shi
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery
| | - Yichuan Yuan
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery
| | - Rong Zhang
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Medical Imaging
| | - Chao Zhang
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou
| | - Minshan Chen
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, People's Republic of China
| | - Yunfei Yuan
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine
- Department of Liver Surgery
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13
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Nassar A, Tzedakis S, Marchese U, Naveendran G, Sindayigaya R, Gaillard M, Cauchy F, Lesurtel M, Gayet B, Soubrane O, Fuks D. Factors of oncological failure in two stage hepatectomy for colorectal liver metastases. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107267. [PMID: 37988785 DOI: 10.1016/j.ejso.2023.107267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Two-stage hepatectomy (TSH) has increased the chance of surgical resections for bilobar colorectal liver metastases (CRLM). Nevertheless, drop-out between stages and early recurrence rates raise the question of surgical futility in some situations. This study aimed to identify factors of TSH oncological failure. METHODS Patients with bilobar CRLM eligible for TSH in three tertiary centers between 2010 and 2021 were included, and divided in Failure and Success groups. Oncological failure was defined as failure of the second stage hepatectomy for tumor progression or recurrence within 6 months after resection. RESULTS Among 95 patients, 18 (18.9%) had hepatic progression between the two stages, and 7 (7.4%) failed to complete the second stage hepatectomy. After TSH, 31 (32.6%) patients experienced early recurrence. Overall, 38 (40.0%) patients experienced oncological failure (Failure group). The Failure group had lower median DFS (3 vs. 32 months, p < 0.001) and median OS (29 vs. 70 months, p = 0.045) than the Success group. On multivariable analysis, progression between the two stages in the future liver remnant (OR = 15.0 (3.22-113.0), p = 0.002), and maximal tumor size ≥40 mm in the future liver remnant (OR = 13.1 (2.12-117.0), p = 0.009) were independent factors of oncological failure. CONCLUSION Recurrence between the two stages and maximal tumor size ≥40 mm in the future liver remnant were associated with TSH failure for patients with bilobar CRLM.
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Affiliation(s)
- Alexandra Nassar
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Stylianos Tzedakis
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ugo Marchese
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gaanan Naveendran
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Remy Sindayigaya
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Martin Gaillard
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Cauchy
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Mickael Lesurtel
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Brice Gayet
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris Cité, 42 Boulevard Jourdan, 75014, Paris, France
| | - Olivier Soubrane
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris Cité, 42 Boulevard Jourdan, 75014, Paris, France
| | - David Fuks
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, University of Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
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14
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Yokoi R, Tajima JY, Fukada M, Hayashi H, Kuno M, Asai R, Sato Y, Yasufuku I, Kiyama S, Tanaka Y, Murase K, Matsuhashi N. Optimizing Treatment Strategy for Oligometastases/Oligo-Recurrence of Colorectal Cancer. Cancers (Basel) 2023; 16:142. [PMID: 38201569 PMCID: PMC10777959 DOI: 10.3390/cancers16010142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer, and nearly half of CRC patients experience metastases. Oligometastatic CRC represents a distinct clinical state characterized by limited metastatic involvement, demonstrating a less aggressive nature and potentially improved survival with multidisciplinary treatment. However, the varied clinical scenarios giving rise to oligometastases necessitate a precise definition, considering primary tumor status and oncological factors, to optimize treatment strategies. This review delineates the concepts of oligometastatic CRC, encompassing oligo-recurrence, where the primary tumor is under control, resulting in a more favorable prognosis. A comprehensive examination of multidisciplinary treatment with local treatments and systemic therapy is provided. The overarching objective in managing oligometastatic CRC is the complete eradication of metastases, offering prospects of a cure. Essential to this management approach are local treatments, with surgical resection serving as the standard of care. Percutaneous ablation and stereotactic body radiotherapy present less invasive alternatives for lesions unsuitable for surgery, demonstrating efficacy in select cases. Perioperative systemic therapy, aiming to control micrometastatic disease and enhance local treatment effectiveness, has shown improvements in progression-free survival through clinical trials. However, the extension of overall survival remains variable. The review emphasizes the need for further prospective trials to establish a cohesive definition and an optimized treatment strategy for oligometastatic CRC.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City 501-1194, Gifu, Japan; (R.Y.); (K.M.)
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15
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Marcellinaro R, Spoletini D, Grieco M, Avella P, Cappuccio M, Troiano R, Lisi G, Garbarino GM, Carlini M. Colorectal Cancer: Current Updates and Future Perspectives. J Clin Med 2023; 13:40. [PMID: 38202047 PMCID: PMC10780254 DOI: 10.3390/jcm13010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Colorectal cancer is a frequent neoplasm in western countries, mainly due to dietary and behavioral factors. Its incidence is growing in developing countries for the westernization of foods and lifestyles. An increased incidence rate is observed in patients under 45 years of age. In recent years, the mortality for CRC is decreased, but this trend is slowing. The mortality rate is reducing in those countries where prevention and treatments have been implemented. The survival is increased to over 65%. This trend reflects earlier detection of CRC through routine clinical examinations and screening, more accurate staging through advances in imaging, improvements in surgical techniques, and advances in chemotherapy and radiation. The most important predictor of survival is the stage at diagnosis. The screening programs are able to reduce incidence and mortality rates of CRC. The aim of this paper is to provide a comprehensive overview of incidence, mortality, and survival rate for CRC.
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Affiliation(s)
- Rosa Marcellinaro
- Department of General Surgery, S. Eugenio Hospital, 00144 Rome, Italy; (D.S.); (M.G.); (R.T.); (G.L.); (M.C.)
| | - Domenico Spoletini
- Department of General Surgery, S. Eugenio Hospital, 00144 Rome, Italy; (D.S.); (M.G.); (R.T.); (G.L.); (M.C.)
| | - Michele Grieco
- Department of General Surgery, S. Eugenio Hospital, 00144 Rome, Italy; (D.S.); (M.G.); (R.T.); (G.L.); (M.C.)
| | - Pasquale Avella
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (P.A.); (M.C.)
- Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, 81030 Caserta, Italy
| | - Micaela Cappuccio
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, Italy; (P.A.); (M.C.)
| | - Raffaele Troiano
- Department of General Surgery, S. Eugenio Hospital, 00144 Rome, Italy; (D.S.); (M.G.); (R.T.); (G.L.); (M.C.)
| | - Giorgio Lisi
- Department of General Surgery, S. Eugenio Hospital, 00144 Rome, Italy; (D.S.); (M.G.); (R.T.); (G.L.); (M.C.)
| | - Giovanni M. Garbarino
- Department of General Surgery, S. Eugenio Hospital, 00144 Rome, Italy; (D.S.); (M.G.); (R.T.); (G.L.); (M.C.)
| | - Massimo Carlini
- Department of General Surgery, S. Eugenio Hospital, 00144 Rome, Italy; (D.S.); (M.G.); (R.T.); (G.L.); (M.C.)
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16
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Marolleau P, Tougeron D, Allignet B, Cohen R, Sefrioui D, Gallet B, Dumont F, Guimbaud R, Alouani E, Passot G, Desolneux G, Ghiringhelli F, Marchal F, Mourthadhoi F, Coriat R, Desgrippes R, Locher C, Goujon G, Des Guetz G, Aparicio T, Paubelle E, Dupré A, de la Fouchardière C. Complete pathological response after chemotherapy or immune checkpoint inhibitors in deficient MMR metastatic colorectal cancer: Results of a retrospective multicenter study. Int J Cancer 2023; 153:1376-1385. [PMID: 37403609 DOI: 10.1002/ijc.34636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/31/2023] [Accepted: 05/03/2023] [Indexed: 07/06/2023]
Abstract
About 5% of the patients with metastatic colorectal cancers (mCRC) present microsatellite instability (MSI)/deficient mismatch repair system (dMMR). While metastasectomy is known to improve overall and progression-free survival in mCRC, specific results in selected patients with dMMR/MSI mCRC are lacking. Our study aimed to describe metastasectomy results, characterize histological response and evaluate pathological complete response (pCR) rate in patients with dMMR/MSI mCRC. We retrospectively reviewed data from all consecutive patients with dMMR/MSI mCRC who underwent surgical metastasectomy between January 2010 and June 2021 in 17 French centers. Primary outcome was to assess the pCR rate defined by tumor regression grade (TRG) 0. Secondary endpoints included relapse-free survival (RFS) and overall survival (OS), and explored TRG as predictive factor for RFS and OS. Among the 88 patients operated, 109 metastasectomies were performed in 81 patients after neoadjuvant treatment [chemotherapy ± targeted therapy (CTT): 69, 85.2%; immunotherapy (ICI): 12, 14.8%], and pCR was achieved in 13 (16.1%) patients. Among the latter, pCR rate were 10.2% in the patients having received CTT (N = 7) and 50.0% in the patients treated with ICI (N = 6). Radiological response did not predict TRG. With a median follow-up of 57.9 (IQR 34.2-81.6) months, median RFS was 20.2 (15.4-not reached) months, median OS was not reached. Major pathological responses (TRG0 + TRG1) were significantly associated with longer RFS (HR 0.12, 95% CI 0.03-0.55; P = .006). The pCR rate of 16.1% achieved with neoadjuvant treatment in patients with dMMR/MSI mCRC is consistent with previously reported rates in pMMR/MSS mCRC. Immunotherapy showed better pCR rate than chemotherapy ± targeted therapy. Further prospective trials are needed to validate immunotherapy as neoadjuvant treatment in resectable/potentially resectable dMMR/MSI mCRC and identify predictive factors for pCR.
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Affiliation(s)
| | - David Tougeron
- Gastroenterology and Hepatology Department, Poitiers University Hospital, University of Poitiers, Poitiers, France
| | - Benoit Allignet
- Department of Radiation Oncology, Leon Berard Center, Lyon, France
| | - Romain Cohen
- Department of Medical Oncology, Saint-Antoine Hospital, Sorbonne Université, AP-HP, and INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Paris, France
| | - David Sefrioui
- Normandy Centre for Genomic and Personalized Medicine and Department of Hepatogastroenterology, Normandie Univ, UNIROUEN, Inserm U1245, IRON group, Rouen University Hospital, Rouen, France
| | - Blandine Gallet
- Department of Medical Oncology, Val d'Aurelle Center, Montpellier, France
| | - Frédéric Dumont
- Department of Surgical Oncology, Comprehensive Cancer Center, Institut de Cancérologie de l'Ouest, France
| | - Rosine Guimbaud
- Digestive Oncology Department, Rangueil Hospital, University Hospital of Toulouse, France
| | - Emily Alouani
- Digestive Oncology Department, Rangueil Hospital, University Hospital of Toulouse, France
| | - Guillaume Passot
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | | | | | - Frédéric Marchal
- Department of Surgical Oncology, Lorraine Cancer Center, Vandoeuvre les Nancy, France
| | - Farouk Mourthadhoi
- Department of General Surgery, Saint Etienne University Hospital, Jean Monnet University, Saint Etienne, France
| | - Romain Coriat
- Gastroenterology Department, Cochin University Hospital, Université de Paris, APHP, Paris, France
| | - Romain Desgrippes
- Gastroenterology Department, Saint Malo General Hospital, Saint Malo, France
| | - Christophe Locher
- Gastroenterology and Digestive Oncology Department, Meaux Hospital, Meaux, France
| | - Gaël Goujon
- Gastroenterology Department, Bichat Hospital, Paris, France
| | | | - Thomas Aparicio
- Gastroenterology Department, Saint Louis Hospital, Paris, France
| | - Etienne Paubelle
- Hematology Department, Amiens University Hospital, Amiens, France
| | | | - Christelle de la Fouchardière
- Medical Oncology Department, Leon Berard Center, Lyon, France
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, France
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17
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Wehrle CJ, Raj R, Aykun N, Orabi D, Stackhouse K, Chang J, Estfan B, Kamath S, Krishnamurthi S, Walsh RM, Kwon DCH, Aucejo F. Circulating Tumor DNA in Colorectal Cancer Liver Metastasis: Analysis of Patients Receiving Liver Resection and Transplant. JCO Clin Cancer Inform 2023; 7:e2300111. [PMID: 37820293 DOI: 10.1200/cci.23.00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/13/2023] [Accepted: 08/29/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Liver metastases occur in about 50% of colorectal cancer cases and drive patient outcomes. Circulating tumor DNA (ctDNA) is emerging as a diagnostic, surveillance, and tumor mutational information tool. METHODS Patients with colorectal cancer liver metastasis (CCLM) seen in a multidisciplinary liver tumor clinic from January to August 2022 received ctDNA testing on each visit. ctDNA was obtained using the Guardant360 platform. Tumor mutational burden (TMB) is defined as the number of identified mutations per megabase of genome analyzed. RESULTS Fifty-two patients had available ctDNA, with 34 (65%) tested preoperatively and 18 (35%) postoperatively; nine patients had sequential pre- and postoperative testing. The median time to test result was 12 days (IQR, 10-13.5). There were a greater number of somatic mutations identified preoperatively (n = 29 v n = 11) and a greater genomic heterogeneity (P = .0069). The mean TMB score was 12.77 in those without pathologic response to cytotoxic therapy and 6.0 in those with pathologic response (P = .10). All nine patients with sequential testing were positive preoperatively, compared with just three (33.3%) postoperatively (P = .0090). Positive postoperative ctDNA was associated with the increased likelihood of disease recurrence after resection (57%) versus negative ctDNA (0%, P = .0419). CONCLUSION Routine ctDNA screening in patients with CCLM is logistically feasible. Liver resection and/or transplant may be associated with clearance of detectable ctDNA and a reduction in TMB or genomic heterogeneity. Persistence of ctDNA alterations postresection appears predictive of disease recurrence. Further studies are necessary to confirm these findings, and longitudinal ctDNA testing is needed to monitor changing tumor biology.
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Affiliation(s)
- Chase J Wehrle
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Roma Raj
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Nihal Aykun
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Danny Orabi
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Kathryn Stackhouse
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Jenny Chang
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Bassam Estfan
- Cleveland Clinic Foundation, Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland, OH
| | - Suneel Kamath
- Cleveland Clinic Foundation, Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland, OH
| | - Smitha Krishnamurthi
- Cleveland Clinic Foundation, Taussig Cancer Institute, Department of Hematology and Oncology, Cleveland, OH
| | - R Matthew Walsh
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - David Choon Hyuck Kwon
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
| | - Federico Aucejo
- Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland, OH
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18
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Manabe T, Takii Y, Oyanagi H, Nogami H, Maruyama S. Prognosis for Metastatic Colorectal Cancer Patients Achieving Complete Response After Systemic Chemotherapy. J Gastrointest Cancer 2023; 54:501-505. [PMID: 35488111 DOI: 10.1007/s12029-022-00829-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Despite marked recent advances in chemotherapy, few reports have focused on the prognosis for patients with metastatic colorectal cancer (mCRC) achieving complete response (CR) after systemic chemotherapy. This study investigated the clinical course of mCRC patients achieving CR and evaluated the role of chemotherapy in CR. METHODS This retrospective study searched a prospectively maintained database at the author's institute to identify medical records for mCRC patients achieving CR after systematic chemotherapy from January 2007 to March 2020. RESULTS The search yielded 23 patients with confirmed CR to systemic chemotherapy. Median time to CR from treatment initiation was 6.8 months. Maintenance chemotherapy was continued for 22 of 23 patients. Median duration of maintenance chemotherapy was 11.1 months. Disease progression occurred for 17 (73.9%) patients at a median 48.1-month follow-up. Median progression-free survival was 26.6 months. Median overall survival was 91.7 months. CONCLUSIONS Patients with CR to chemotherapy had a high probability of disease progression, but a relatively long-term prognosis. Treatment strategies after achievement of CR should be based an understanding of the high potential that tumor cells will remain. Use of maintenance chemotherapy after achievement of CR is still unclear, and the recent data do not demonstrate a negative impact for continuing maintenance chemotherapy after CR.
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Affiliation(s)
- Takahiro Manabe
- Department of Digestive Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishicho, Niigata, 951-8566, Japan.
| | - Yasumasa Takii
- Department of Digestive Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishicho, Niigata, 951-8566, Japan
| | - Hidehito Oyanagi
- Department of Digestive Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishicho, Niigata, 951-8566, Japan
| | - Hitoshi Nogami
- Department of Digestive Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishicho, Niigata, 951-8566, Japan
| | - Satoshi Maruyama
- Department of Digestive Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishicho, Niigata, 951-8566, Japan
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19
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Boraschi P, Moretto R, Donati F, Borelli B, Mercogliano G, Giugliano L, Boccaccino A, Della Pina MC, Colombatto P, Signori S, Masi G, Cremolini C, Urbani L. Exploring the Outcome of Disappearance or Small Remnants of Colorectal Liver Metastases during First-Line Chemotherapy on Hepatobiliary Contrast-Enhanced and Diffusion-Weighted MR Imaging. Cancers (Basel) 2023; 15:cancers15082200. [PMID: 37190129 DOI: 10.3390/cancers15082200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/01/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
We aimed to evaluate the outcome of the disappearance or small remnants of colorectal liver metastases during first-line chemotherapy assessed by hepatobiliary contrast-enhanced and diffusion-weighted MR imaging (DW-MRI). Consecutive patients with at least one disappearing liver metastasis (DLM) or small residual liver metastases (≤10 mm) assessed by hepatobiliary contrast-enhanced and DW-MRI during first-line chemotherapy were included. Liver lesions were categorized into three groups: DLM; residual tiny liver metastases (RTLM) when ≤5 mm; small residual liver metastases (SRLM) when >5mm and ≤10 mm. The outcome of resected liver metastases was assessed in terms of pathological response, whereas lesions left in situ were evaluated in terms of local relapse or progression. Fifty-two outpatients with 265 liver lesions were radiologically reviewed; 185 metastases fulfilled the inclusion criteria: 40 DLM, 82 RTLM and 60 SRLM. We observed a pCR rate of 75% (3/4) in resected DLM and 33% (12/36) of local relapse for DLM left in situ. We observed a risk of relapse of 29% and 57% for RTLM and SRLM left in situ, respectively, and a pCR rate of about 40% overall for resected lesions. DLM assessed via hepatobiliary contrast-enhanced and DW-MRI very probably indicates a complete response. The surgical removal of small remnants of liver metastases should always be advocated whenever technically possible.
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Affiliation(s)
- Piero Boraschi
- Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy
| | - Roberto Moretto
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Francescamaria Donati
- Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy
| | - Beatrice Borelli
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126 Pisa, Italy
| | - Giuseppe Mercogliano
- Department of Radiology, University of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Luigi Giugliano
- Department of Radiology, University of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Alessandra Boccaccino
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126 Pisa, Italy
| | - Maria Clotilde Della Pina
- Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy
| | - Piero Colombatto
- Hepatology Unit, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy
| | - Stefano Signori
- General Surgery, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy
| | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126 Pisa, Italy
| | - Chiara Cremolini
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Risorgimento 36, 56126 Pisa, Italy
| | - Lucio Urbani
- General Surgery, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa 2, 56124 Pisa, Italy
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20
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Ghazanfar MA, Abdelhamid A, Aldrighetti L, Sturesson C, Takemura N, Truant S, Fiorentini G, Teh C, Alikhanov R, Ahmed I, Hammond J, Ferrero A, Silva M, Pawlik T, Jones R, Bekheit M. The dilemma of the disappearing colorectal liver metastases: defining international trends in management. HPB (Oxford) 2023; 25:446-453. [PMID: 36775699 DOI: 10.1016/j.hpb.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/18/2022] [Accepted: 01/10/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVE This survey sought to appraise the degree of consistency in the management of disappeared colorectal liver metastases (dCRLM) among liver surgeons in different countries. BACKGROUND Colorectal liver metastases (CRLM) account for half of the deaths secondary to colorectal cancer. Due to the high utilization of chemotherapy before surgery, some or all CRLM can disappear (dCRLM) but management of dCRLMs remains unclear. METHODS Seven simulated scenarios of dCRLM were presented to experienced liver surgeons using an online platform. Treatment decisions were submitted and analysed using the multi-rater kappa method. The effect of the experience, complexity of scenarios, and location and number of dCRLM on treatment decision were analysed. RESULTS Sixty-seven liver surgeons from 25 countries completed the survey. There was no agreement about the therapeutic strategies of dCRLM in all scenarios (kappa 0.12, IQR 0.20-0.32). In scenarios with lower difficulty scores, surgeons tended to offer surgical resection for dCRLM alongside the visible CRLM (vCRLM), however, with poor agreement (kappa 0.32, IQR 0.19-0.51). No agreement was seen for clinical scenario in which all CRLM lesions disappeared (kappa 0.20). CONCLUSION There are clear inconsistencies in the management decisions of dCRLM. Better evidence is required to define optimal management strategies.
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Affiliation(s)
- Mudassar A Ghazanfar
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK; Department of HPB Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - Amir Abdelhamid
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK; Department of HPB Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy
| | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Nobuyuki Takemura
- Department of Surgery, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Stephanie Truant
- Department of Surgery, Centre Hospitalier Régional Universitaire de Lille: Lille, Nord-Pas-de-Calais, Lille, France
| | - Guido Fiorentini
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic Rochester, Rochester, USA
| | - Catherine Teh
- Department of Surgery, Makati Medical Center, Makati Metro Manila, Philippines; Department of Surgery, National Kidney & Transplant Institute, Quezon, Philippines; Department of Surgery, St Luke's Medical Center, Quezon, Philippines
| | - Ruslan Alikhanov
- Moscow Clinical Scientific Center, Department of Liver and Pancreatic Surgery and Transplantation, Russia
| | - Irfan Ahmed
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK; Department of HPB Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - John Hammond
- Department of HPB and Transplantation, Freeman Hospital, Newcastle Upon Tyne, Newcastle, UK
| | | | - Michael Silva
- Department of Surgery, Oxford University Hospital, Oxford, UK
| | - Timothy Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Ohio, USA
| | - Robert Jones
- Northwest Hepatobiliary Unit, Department of Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Mohamed Bekheit
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK; Department of HPB Surgery, NHS Grampian, Scotland, Aberdeen, UK; HPB Integrated Center of Care, Elite Integrated Centers of Excellence, Alexandria, Egypt.
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21
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Kuhlmann KF, Tufo A, Kok NF, Gordon-Weeks A, Poston GJ, Diaz Nieto R, Jones R, Fenwick SW, Malik HZ. Disappearing colorectal liver metastases in the era of state-of-the-art triple-modality diagnostic imaging. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1016-1022. [PMID: 36702715 DOI: 10.1016/j.ejso.2023.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/19/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Systemic therapy can result in disappearance of colorectal liver metastases in up to 40% of patients. This might be an overestimation caused by suboptimal imaging modalities. The aim of this study was to investigate the use of imaging modalities and the incidence, management and outcome of patients with disappearing liver metastases (DLMs). METHODS This was a retrospective study of consecutive patients treated for colorectal liver metastases at a high volume hepatobiliary centre between January 2013 and January 2015 after receiving induction or neoadjuvant systemic therapy. Main outcomes were use of imaging modalities, incidence, management and longterm outcome of patients with DLMs. RESULTS Of 158 patients included, 32 (20%) had 110 DLMs. Most patients (88%) had initial diagnostic imaging with contrast enhanced-CT, primovist-MR and FDG-PET and 94% of patients with DLMs were restaged using primovist-MR. Patients with DLMs had significantly smaller metastases and the median initial size of DLMs was 10 mm (range 5-61). In the per lesion analysis, recurrence after "watch & wait" for DLMs occurred in 36%, while in 19 of 20 resected DLMs no viable tumour cells were found. Median overall (51 vs. 28 months, p < 0.05) and progression free survival (10 vs. 3 months, p = 0.003) were significantly longer for patients with DLMs. CONCLUSION Even state-of-the-art imaging and restaging cannot solve problems associated with DLMs. Regrowth of these lesions occurs in approximately a third of the lesions. Patients with DLMs have better survival.
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Affiliation(s)
- K F Kuhlmann
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, the Netherlands; Liver Surgery Unit, Aintree University Hospital NHS Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - A Tufo
- Department of General Surgery, Ospedale del Mare, Via Enrico Russo, 80147, Naples, Italy; Liver Surgery Unit, Aintree University Hospital NHS Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - N F Kok
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, the Netherlands
| | - A Gordon-Weeks
- Nuffield Department of Surgical Sciences, University of Oxford, Old Road, OX3 7BN, United Kingdom
| | - G J Poston
- Liver Surgery Unit, Aintree University Hospital NHS Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - R Diaz Nieto
- Liver Surgery Unit, Aintree University Hospital NHS Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - R Jones
- Liver Surgery Unit, Aintree University Hospital NHS Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - S W Fenwick
- Liver Surgery Unit, Aintree University Hospital NHS Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom
| | - H Z Malik
- Liver Surgery Unit, Aintree University Hospital NHS Trust, Lower Lane, Liverpool, L9 7AL, United Kingdom.
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22
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Klemen ND, Court CM, Fernandes MC, Walch HS, Chatila WK, Saadat LV, Maron S, Crane C, Shia J, Cercek A, Gönen M, Schultz ND, Garcia Aguilar J, Jarnagin WR, D'Angelica MI. Local Therapy for Oligoprogression or Consolidation in High Mutational Burden Stage 4 Colorectal Cancer Treated With PD-1 or PD-L1 Blockade. Ann Surg Oncol 2022; 29:8373-8382. [PMID: 35930112 PMCID: PMC9649851 DOI: 10.1245/s10434-022-12095-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 06/12/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Immune checkpoint blockade (ICI) of programmed cell death protein 1 (PD-1) or PD-1 ligand (PD-L1) can induce durable responses in patients who have colorectal cancer (CRC) with a high tumor mutational burden (TMB). Two recurring clinical dilemmas show how to manage oligoprogressive disease and stable disease after ICI. METHODS A cohort study was conducted to analyze patients with metastatic CRC who underwent PD-1 or PD-L1 blockade. Tumors were mismatch repair (MMR) deficient or had more than 25 mutations per megabase. Patients were identified who had local therapy (surgery, ablation, or radiotherapy) for one to three sites of progressive disease (PD) or surgery to consolidate SD. The study evaluated clinical and biologic factors associated with patient selection, outcomes, and pathologic response rates. RESULTS From 2014 to 2020, treatment was administered to 111 patients with ICI. Of these 111 patients, 19 (17%) survived fewer than 6 months, whereas to date, 50 have not had progression of disease. The remaining 42 patients experienced PD, and 16 (38%) were treated with local therapy for oligoprogression. Selection for local therapy was associated with response to ICI. The 2-year progression-free survival (PFS) after local therapy was 62%. Finally, 6 of the 50 patients without PD had consolidation of SD, and 5 had complete or near complete pathologic responses. CONCLUSIONS Oligoprogression, a frequent pattern of failure after ICI, can be managed effectively with local therapy. In contrast, it may not be necessary to consolidate SD for selected patients. Further research is essential to define management algorithms better and to explore heterogeneity in response patterns.
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Affiliation(s)
- Nicholas D Klemen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Colin M Court
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | | | - Henry S Walch
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Walid K Chatila
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lily V Saadat
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Steven Maron
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chris Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nikolaus D Schultz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julio Garcia Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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23
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Chang GY, Fetzer DT, Porembka MR. Contrast-Enhanced Intraoperative Ultrasound of the Liver. Surg Oncol Clin N Am 2022; 31:707-719. [PMID: 36243503 DOI: 10.1016/j.soc.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Contrast-enhanced intraoperative ultrasound (CE-IOUS) is a relatively new but valuable tool that is increasingly used as an adjunct to computed tomography, MRI, and IOUS for patients undergoing liver surgery. CE-IOUS has an important role in 2 main settings: the discrimination of indeterminate lesions detected in cirrhotic livers by conventional IOUS and in the detection of colorectal liver metastasis that may be overlooked by other imaging modalities. The intraoperative nature of the imaging and interpretation allows for CE-IOUS to directly affect surgical decision-making that may importantly affect patient outcomes.
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Affiliation(s)
- Gloria Y Chang
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - David T Fetzer
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, E6-230-BF, Dallas, TX 75390-9316, USA
| | - Matthew R Porembka
- Division of Surgical Oncology, Department of Surgery, Dedman Family Scholar in Clinical Care, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, NB2.340, Dallas, TX 75390, USA.
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Anselmo A, Cascone C, Siragusa L, Sensi B, Materazzo M, Riccetti C, Bacchiocchi G, Ielpo B, Rosso E, Tisone G. Disappearing Colorectal Liver Metastases: Do We Really Need a Ghostbuster? Healthcare (Basel) 2022; 10:healthcare10101898. [PMID: 36292345 PMCID: PMC9602313 DOI: 10.3390/healthcare10101898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/06/2022] [Accepted: 09/22/2022] [Indexed: 11/24/2022] Open
Abstract
The development of new systemic treatment strategies has resulted in a significant increase in the response rates of colorectal liver metastases (CRLM) in the last few years. Although the radiological response is a favorable prognostic factor, complete shrinkage of CRLM, known as disappearing liver metastases (DLM), presents a therapeutic dilemma, and proper management is still debated in the literature. In fact, DLM is not necessarily equal to cure, and when resected, pathological examination reveals in more than 80% of patients a variable percentage of the tumor as residual disease or early recurrence in situ. Moreover, while a higher incidence of intrahepatic recurrence is documented in small series when surgery is avoided, its clinical significance for long-term OS is still under investigation. In light of this, a multidisciplinary approach and, in particular, radiologists’ role is needed to assist the surgeon in the management of DLM, thanks to emerging technology and strategy. Therefore, the aim of this review is to provide an overview of the DLM phenomenon and current management.
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Affiliation(s)
- Alessandro Anselmo
- Department of Surgical Science, University of Rome “Tor Vergata”, 00133 Roma, Italy
| | - Chiara Cascone
- Department of Surgery, University Campus Bio-Medico di Roma, 00128 Roma, Italy
- Correspondence: ; Tel.: +39-348-445-7000
| | - Leandro Siragusa
- Department of Surgical Science, University of Rome “Tor Vergata”, 00133 Roma, Italy
| | - Bruno Sensi
- Department of Surgical Science, University of Rome “Tor Vergata”, 00133 Roma, Italy
| | - Marco Materazzo
- Department of Surgical Science, University of Rome “Tor Vergata”, 00133 Roma, Italy
| | - Camilla Riccetti
- Department of Surgical Science, University of Rome “Tor Vergata”, 00133 Roma, Italy
| | - Giulia Bacchiocchi
- Department of Surgical Science, University of Rome “Tor Vergata”, 00133 Roma, Italy
| | - Benedetto Ielpo
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar. Universitat Pompeu Fabra Barcelona, 08003 Barcelona, Spain
| | - Edoardo Rosso
- Unité des Maladies de l’Appareil Digestif et Endocrine, Centre Hospitalier de Luxembourg, 1210 Luxembourg, Luxembourg
| | - Giuseppe Tisone
- Department of Surgical Science, University of Rome “Tor Vergata”, 00133 Roma, Italy
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Korenblik R, Olij B, Aldrighetti LA, Hilal MA, Ahle M, Arslan B, van Baardewijk LJ, Baclija I, Bent C, Bertrand CL, Björnsson B, de Boer MT, de Boer SW, Bokkers RPH, Rinkes IHMB, Breitenstein S, Bruijnen RCG, Bruners P, Büchler MW, Camacho JC, Cappelli A, Carling U, Chan BKY, Chang DH, Choi J, Font JC, Crawford M, Croagh D, Cugat E, Davis R, De Boo DW, De Cobelli F, De Wispelaere JF, van Delden OM, Delle M, Detry O, Díaz-Nieto R, Dili A, Erdmann JI, Fisher O, Fondevila C, Fretland Å, Borobia FG, Gelabert A, Gérard L, Giuliante F, Gobardhan PD, Gómez F, Grünberger T, Grünhagen DJ, Guitart J, Hagendoorn J, Heil J, Heise D, Herrero E, Hess GF, Hoffmann MH, Iezzi R, Imani F, Nguyen J, Jovine E, Kalff JC, Kazemier G, Kingham TP, Kleeff J, Kollmar O, Leclercq WKG, Ben SL, Lucidi V, MacDonald A, Madoff DC, Manekeller S, Martel G, Mehrabi A, Mehrzad H, Meijerink MR, Menon K, Metrakos P, Meyer C, Moelker A, Modi S, Montanari N, Navines J, Neumann UP, Peddu P, Primrose JN, Qu X, Raptis D, Ratti F, Ridouani F, Rogan C, Ronellenfitsch U, Ryan S, Sallemi C, Moragues JS, Sandström P, Sarriá L, Schnitzbauer A, Serenari M, Serrablo A, et alKorenblik R, Olij B, Aldrighetti LA, Hilal MA, Ahle M, Arslan B, van Baardewijk LJ, Baclija I, Bent C, Bertrand CL, Björnsson B, de Boer MT, de Boer SW, Bokkers RPH, Rinkes IHMB, Breitenstein S, Bruijnen RCG, Bruners P, Büchler MW, Camacho JC, Cappelli A, Carling U, Chan BKY, Chang DH, Choi J, Font JC, Crawford M, Croagh D, Cugat E, Davis R, De Boo DW, De Cobelli F, De Wispelaere JF, van Delden OM, Delle M, Detry O, Díaz-Nieto R, Dili A, Erdmann JI, Fisher O, Fondevila C, Fretland Å, Borobia FG, Gelabert A, Gérard L, Giuliante F, Gobardhan PD, Gómez F, Grünberger T, Grünhagen DJ, Guitart J, Hagendoorn J, Heil J, Heise D, Herrero E, Hess GF, Hoffmann MH, Iezzi R, Imani F, Nguyen J, Jovine E, Kalff JC, Kazemier G, Kingham TP, Kleeff J, Kollmar O, Leclercq WKG, Ben SL, Lucidi V, MacDonald A, Madoff DC, Manekeller S, Martel G, Mehrabi A, Mehrzad H, Meijerink MR, Menon K, Metrakos P, Meyer C, Moelker A, Modi S, Montanari N, Navines J, Neumann UP, Peddu P, Primrose JN, Qu X, Raptis D, Ratti F, Ridouani F, Rogan C, Ronellenfitsch U, Ryan S, Sallemi C, Moragues JS, Sandström P, Sarriá L, Schnitzbauer A, Serenari M, Serrablo A, Smits MLJ, Sparrelid E, Spüntrup E, Stavrou GA, Sutcliffe RP, Tancredi I, Tasse JC, Udupa V, Valenti D, Fundora Y, Vogl TJ, Wang X, White SA, Wohlgemuth WA, Yu D, Zijlstra IAJ, Binkert CA, Bemelmans MHA, van der Leij C, Schadde E, van Dam RM. Dragon 1 Protocol Manuscript: Training, Accreditation, Implementation and Safety Evaluation of Portal and Hepatic Vein Embolization (PVE/HVE) to Accelerate Future Liver Remnant (FLR) Hypertrophy. Cardiovasc Intervent Radiol 2022; 45:1391-1398. [PMID: 35790566 PMCID: PMC9458562 DOI: 10.1007/s00270-022-03176-1] [Show More Authors] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/08/2022] [Indexed: 12/02/2022]
Abstract
STUDY PURPOSE The DRAGON 1 trial aims to assess training, implementation, safety and feasibility of combined portal- and hepatic-vein embolization (PVE/HVE) to accelerate future liver remnant (FLR) hypertrophy in patients with borderline resectable colorectal cancer liver metastases. METHODS The DRAGON 1 trial is a worldwide multicenter prospective single arm trial. The primary endpoint is a composite of the safety of PVE/HVE, 90-day mortality, and one year accrual monitoring of each participating center. Secondary endpoints include: feasibility of resection, the used PVE and HVE techniques, FLR-hypertrophy, liver function (subset of centers), overall survival, and disease-free survival. All complications after the PVE/HVE procedure are documented. Liver volumes will be measured at week 1 and if applicable at week 3 and 6 after PVE/HVE and follow-up visits will be held at 1, 3, 6, and 12 months after the resection. RESULTS Not applicable. CONCLUSION DRAGON 1 is a prospective trial to assess the safety and feasibility of PVE/HVE. Participating study centers will be trained, and procedures standardized using Work Instructions (WI) to prepare for the DRAGON 2 randomized controlled trial. Outcomes should reveal the accrual potential of centers, safety profile of combined PVE/HVE and the effect of FLR-hypertrophy induction by PVE/HVE in patients with CRLM and a small FLR. TRIAL REGISTRATION Clinicaltrials.gov: NCT04272931 (February 17, 2020). Toestingonline.nl: NL71535.068.19 (September 20, 2019).
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Affiliation(s)
- R Korenblik
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - B Olij
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - M Abu Hilal
- Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
| | - M Ahle
- Deparment of Radiology, University Hospital, Linköping, Sweden
| | - B Arslan
- Department of Radiology, Rush University Medical Center, Chicago, USA
| | - L J van Baardewijk
- Department of Radiology, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - I Baclija
- Department of Radiology, Clinic Favoriten, Vienna, Austria
| | - C Bent
- Department of Radiology, Bournemouth and Christuchurch, The Royal Bournemouth and Christchurch Hospitals, Bournemouth and Christuchurch, UK
| | - C L Bertrand
- Department of Surgery, CHU UCLouvain Namur, Namur, Belgium
| | - B Björnsson
- Department of Surgery, Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden
| | - M T de Boer
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - S W de Boer
- Deparment of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R P H Bokkers
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - I H M Borel Rinkes
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Breitenstein
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - R C G Bruijnen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Bruners
- Department of Radiology, University Hospital Aachen, Aachen, Germany
| | - M W Büchler
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - J C Camacho
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - U Carling
- Department of Radiology, University Hospital Oslo, Oslo, Norway
| | - B K Y Chan
- Department of Surgery, Aintree University Hospitals NHS, Liverpool, UK
| | - D H Chang
- Department of Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - J Choi
- Department of Surgery, Western Health Footscray, Footscray, Australia
| | - J Codina Font
- Department of Radiology, University Hospital Dr. Josep Trueta de Girona, Girona, Spain
| | - M Crawford
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - D Croagh
- Department of Surgery, Monash Health, Clayton, Australia
| | - E Cugat
- Department of Surgery, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - R Davis
- Department of Radiology, Aintree University Hospitals NHS, Liverpool, UK
| | - D W De Boo
- Department of Radiology, Monash Health, Clayton, Australia
| | - F De Cobelli
- Department of Radiology, Ospedale San Raffaele, Milan, Italy
| | | | - O M van Delden
- Department of Radiology, Amsterdam University Medical Centers Location AMC, Amsterdam, The Netherlands
| | - M Delle
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - O Detry
- Department of Surgery, CHU de Liège, Liège, Belgium
| | - R Díaz-Nieto
- Department of Surgery, Aintree University Hospitals NHS, Liverpool, UK
| | - A Dili
- Department of Surgery, CHU UCLouvain Namur, Namur, Belgium
| | - J I Erdmann
- Department of Surgery, Amsterdam University Medical Centers Location AMC, Amsterdam, The Netherlands
| | - O Fisher
- Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
| | - C Fondevila
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Å Fretland
- Department of Surgery, University Hospital Oslo, Oslo, Norway
| | - F Garcia Borobia
- Department of Surgery, Hospital Parc Taulí de Sabadell, Sabadell, Spain
| | - A Gelabert
- Department of Radiology, Hospital Parc Taulí de Sabadell, Sabadell, Spain
- Department of Radiology, University Hospital Mútua Terassa, Terassa, Spain
| | - L Gérard
- Department of Radiology, CHU de Liège, Liège, Belgium
| | - F Giuliante
- Department of Surgery, Gemelli University Hospital Rome, Rome, Italy
| | - P D Gobardhan
- Department of Surgery, Amphia, Breda, The Netherlands
| | - F Gómez
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T Grünberger
- Department of Surgery, HPB Center Vienna Health Network, Clinic Favoriten, Vienna, Austria
| | - D J Grünhagen
- Department of Surgery, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - J Guitart
- Department of Radiology, University Hospital Mútua Terassa, Terassa, Spain
| | - J Hagendoorn
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Heil
- Department of Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - D Heise
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - E Herrero
- Department of Surgery, University Hospital Mútua Terassa, Terassa, Spain
| | - G F Hess
- Department of Surgery, Clarunis University Hospital, Basel, Switzerland
| | - M H Hoffmann
- Department of Radiology, St. Clara Spital, Basel, Switzerland
| | - R Iezzi
- Department of Radiology, Gemelli University Hospital, Rome, Italy
| | - F Imani
- Department of Radiology, Amphia, Breda, The Netherlands
| | - J Nguyen
- Department of Radiology, Western Health Footscray, Footscray, Australia
| | - E Jovine
- Department of Surgery, Ospedale Maggiore di Bologna, Bologna, Italy
| | - J C Kalff
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - G Kazemier
- Department of Surgery, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - T P Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Kleeff
- Department of Surgery, University Hospital Halle (Saale), Halle, Germany
| | - O Kollmar
- Department of Surgery, Clarunis University Hospital, Basel, Switzerland
| | - W K G Leclercq
- Department of Surgery, Maxima Medisch Centrum, Eindhoven, The Netherlands
| | - S Lopez Ben
- Department of Surgery, University Hospital Dr. Josep Trueta de Girona, Girona, Spain
| | - V Lucidi
- Department of Surgery, Hôpital Erasme, Brussels, Belgium
| | - A MacDonald
- Department of Radiology, Oxford University Hospital NHS, Oxford, UK
| | - D C Madoff
- Department of Radiology, Yale School of Medicine, New Haven, USA
| | - S Manekeller
- Department of Surgery, University Hospital Bonn, Bonn, Germany
| | - G Martel
- Department of Surgery, The Ottawa Hospital, Ottawa, Canada
| | - A Mehrabi
- Department of Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - H Mehrzad
- Department of Radiology, Queen Elizabeth Hospital Birmingham NHS, Birmingham, UK
| | - M R Meijerink
- Department of Radiology, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - K Menon
- Department of Surgery, King's College Hospital NHS, London, UK
| | - P Metrakos
- Department of Surgery, McGill University Health Centre, Montréal, Canada
| | - C Meyer
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - A Moelker
- Department of Radiology and Nuclear Medicine, Erasmus Medisch Centrum, Rotterdam, The Netherlands
| | - S Modi
- Department of Radiology, University Hospital Southampton NHS, Southampton, UK
| | - N Montanari
- Department of Radiology, Ospedale Maggiore Di Bologna, Bologna, Italy
| | - J Navines
- Department of Surgery, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - U P Neumann
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - P Peddu
- Department of Radiology, King's College Hospital NHS, London, UK
| | - J N Primrose
- Department of Surgery, University Hospital Southampton NHS, Southampton, UK
| | - X Qu
- Department of Radiology, Zhongshan Hospital, Fundan University, Shanghai, China
| | - D Raptis
- Department of Surgery, Royal Free Hospital NHS, London, UK
| | - F Ratti
- Department of Surgery, Ospedale San Raffaele, Milan, Italy
| | - F Ridouani
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - C Rogan
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - U Ronellenfitsch
- Department of Surgery, University Hospital Halle (Saale), Halle, Germany
| | - S Ryan
- Department of Radiology, The Ottawa Hospital, Ottawa, Canada
| | - C Sallemi
- Department of Radiology, Fondazione Poliambulanza, Brescia, Italy
| | - J Sampere Moragues
- Department of Radiology, University Hospital Germans Trias I Pujol, Badalona, Spain
| | - P Sandström
- Department of Surgery, Biomedical and Clinical Sciences, Linköping University Hospital, Linköping, Sweden
| | - L Sarriá
- Department of Radiology, University Hospital Miguel Servet, Saragossa, Spain
| | - A Schnitzbauer
- Department of Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - M Serenari
- Department of Surgery, General Surgery and Transplant Unit, IRCCS Azienda Ospedaliero- Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - A Serrablo
- Department of Surgery, University Hospital Miguel Servet, Saragossa, Spain
| | - M L J Smits
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Sparrelid
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - E Spüntrup
- Department of Radiology, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | - G A Stavrou
- Department of Surgery, Klinikum Saarbrücken gGmbH, Saarbrücken, Germany
| | - R P Sutcliffe
- Department of Surgery, Queen Elizabeth Hospital Birmingham NHS, Birmingham, UK
| | - I Tancredi
- Department of Radiology, Hôpital Erasme, Brussels, Belgium
| | - J C Tasse
- Department of Radiology, Rush University Medical Center, Chicago, USA
| | - V Udupa
- Department of Surgery, Oxford University Hospital NHS, Oxford, UK
| | - D Valenti
- Department of Radiology, McGill University Health Centre, Montréal, Canada
| | - Y Fundora
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - T J Vogl
- Department of Radiology, University Hosptital Frankfurt, Frankfurt, Germany
| | - X Wang
- Department of Surgery, Zhongshan Hospital, Fundan University, Shanghai, China
| | - S A White
- Department of Surgery, Newcastle Upon Tyne Hospitals NHS, Newcastle upon Tyne, UK
| | - W A Wohlgemuth
- Department of Radiology, University Hospital Halle (Saale), Halle, Germany
| | - D Yu
- Department of Radiology, Royal Free Hospital NHS, London, UK
| | - I A J Zijlstra
- Department of Radiology, Amsterdam University Medical Centers Location VU, Amsterdam, The Netherlands
| | - C A Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - M H A Bemelmans
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany
| | - C van der Leij
- Deparment of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E Schadde
- Department of General and Visceral Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
- Department of Surgery, Rush University Medical Center Chicago, Chicago, USA
| | - R M van Dam
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht Universiteitssingel 40 room 5.452, 6229 ET, Maastricht, The Netherlands.
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of General, Visceral and Transplant Surgery, University Hospital Aachen, Aachen, Germany.
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26
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Sanuki N, Takeda A, Tsurugai Y, Eriguchi T. Role of stereotactic body radiotherapy in multidisciplinary management of liver metastases in patients with colorectal cancer. Jpn J Radiol 2022; 40:1009-1016. [PMID: 35857212 PMCID: PMC9529716 DOI: 10.1007/s11604-022-01307-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022]
Abstract
In the treatment of colorectal cancer patients with distant metastases, the development of new anticancer agents has considerably prolonged progression-free survival. Such survival benefits attributed to chemotherapy have increased the relative significance of local therapy in patients with limited metastases. The liver is recognized as the most common site of metastasis of colorectal cancer because of the intestinal mesenteric drainage to the portal veins. Hepatic resection of isolated liver metastases of colorectal cancer is the only option for a potential cure. However, hepatic metastases are resectable in only approximately 20% of the patients. For remaining patients with high-risk resectable liver metastases or those who are unfit for surgery, less invasive, local therapies including radiation therapy (stereotactic body radiation therapy, SBRT) may have a potential role in treatment. Although the local control rate of SBRT for colorectal liver metastases has room for improvement, its less-invasive nature and broad indications deserve consideration. Future research should include SBRT dose escalation or the selection of patients who benefit from local ablative therapies. SBRT may offer an alternative, non-invasive approach for the treatment of colorectal liver metastases in a multidisciplinary treatment strategy.
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Affiliation(s)
- Naoko Sanuki
- Department of Radiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, 510-8567, Japan.
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24, Ofuna, Kamakura, Kanagawa, 247-0056, Japan.
| | - Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24, Ofuna, Kamakura, Kanagawa, 247-0056, Japan
| | - Yuichiro Tsurugai
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24, Ofuna, Kamakura, Kanagawa, 247-0056, Japan
| | - Takahisa Eriguchi
- Radiation Oncology Center, Ofuna Chuo Hospital, 6-2-24, Ofuna, Kamakura, Kanagawa, 247-0056, Japan
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27
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Percutaneous microwave ablation of disappearing colorectal liver metastases using US-MR fusion imaging guidance with integration of pre-chemotherapy imaging: a case report. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2022. [DOI: 10.1016/j.cpccr.2022.100159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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28
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The Influence of Radiological “Disappearing Lesions” on the Efficacy and Prognosis of Patients with Colorectal Liver Metastases Undergoing Conversion Therapy. Gastroenterol Res Pract 2022; 2022:2200598. [PMID: 35242182 PMCID: PMC8888111 DOI: 10.1155/2022/2200598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/19/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose The purpose of the current study was to analyze the influence of radiological “disappearing liver metastasis” (DLM) on the efficacy and prognosis of patients with colorectal liver metastases (CRLM) undergoing conversion therapy. Methods Patients with CRLM by the multidisciplinary team (MDT) of the First Affiliated Hospital of Chongqing Medical University were retrospectively enrolled from January 2014 to January 2021. The relationship between the occurrence and recurrence of DLM and different clinical factors was analyzed. Results Thirty-five of the 113 patients (31.0%) with initially unresectable CRLM developed DLM, and of the 361 lesions, 177 disappeared (49.0%). Within 6 months, 6-12 months, and 12-24 months groups, the recurrence rate was 3.4%, 16.8%, and 34.8%, but there is no recurrence in after 24 months group. There was a statistical difference between chemotherapy alone and chemotherapy combined with the targeted therapy group on the occurrence of DLM (58.3% vs. 37.1%, P < 0.001). There were significant differences between <5 mm group and >10 mm group on occurrence of DLM（76.7% vs. 30.4%, P < 0.001) and between 5-10 mm group and >10 mm group also (70.0% vs. 30.4%, P < 0.001). Through univariate and multivariate analyses, it was concluded that age (P = 0.026, 95%CI = 3.690) and treatment regimens (P = 0.033, 95%CI = 2.703) had a significant influence on the progression-free survival (PFS) time of DLM. Conclusion Younger patients, who use chemotherapy alone to achieve a therapeutic effect, might have better survival benefits when the lesions do not progress within 2 years after the appearance of DLMs.
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Current Surgical Management Strategies for Colorectal Cancer Liver Metastases. Cancers (Basel) 2022; 14:cancers14041063. [PMID: 35205811 PMCID: PMC8870224 DOI: 10.3390/cancers14041063] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Colorectal cancer is one of the most common cancer diagnoses in the world. At least half of patients diagnosed with colorectal cancer will develop metastatic disease, with most being identified in the liver. Surgical resection of colorectal liver metastases (CRLM) is potentially curative. Surgical resection of CRLM, however, remains underutilized despite the continued expansion of operative strategies available. This is likely due to differing views on resectability. Resectability is a surgical assessment, and the classification of CRLM as unresectable should only be made by an experienced hepatobiliary surgeon. Obtaining a surgical evaluation at the time of liver metastasis discovery may help mitigate the challenge of assessing resectability and the determination of potential operative time windows within current multimodal management strategies. The aim of this review is to help facilitate discussions surrounding resectability as well as the timing and sequencing of both surgical and non-surgical therapies. Abstract Colorectal cancer is the third most common cancer diagnosis in the world, and the second most common cause of cancer-related deaths. Despite significant progress in management strategies for colorectal cancer over the last several decades, metastatic disease remains difficult to treat and is often considered incurable. However, for patients with colorectal liver metastases (CRLM), surgical resection offers the best opportunity for survival, can be curative, and remains the gold standard. Unfortunately, surgical treatment options are underutilized. Misperceptions regarding resectable and unresectable CRLM likely play a role in this. The assessment of factors that impact resectability status like medical fitness, technical considerations, and disease biology can be difficult, necessitating careful multidisciplinary input and discussion. The identification of ideal operative time windows that align with the multimodal management of these patients can also be perplexing. For all patients with CRLM it may therefore be advantageous to obtain surgical evaluation at the time of discovering liver metastases to mitigate these challenges and minimize the risk of undertreatment. In this review we summarize current surgical management strategies for CRLM and discuss factors to be considered when determining resectability.
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Freitas PS, Janicas C, Veiga J, Matos AP, Herédia V, Ramalho M. Imaging evaluation of the liver in oncology patients: A comparison of techniques. World J Hepatol 2021; 13:1936-1955. [PMID: 35069999 PMCID: PMC8727197 DOI: 10.4254/wjh.v13.i12.1936] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/26/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
The liver is commonly affected by metastatic disease. Therefore, it is essential to detect and characterize liver metastases, assuming that patient management and prognosis rely on it. The imaging techniques that allow non-invasive assessment of liver metastases include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, and PET/MRI. In this paper, we review the imaging findings of liver metastases, focusing on each imaging modality's advantages and potential limitations. We also assess the importance of different imaging modalities for the management, follow-up, and therapy response of liver metastases. To date, both CT and MRI are the most appropriate imaging methods for initial lesion detection, follow-up, and assessment of treatment response. Multiparametric MRI is frequently used as a problem-solving technique for liver lesions and has evolved substantially over the past decade, including hardware and software developments and specific intravenous contrast agents. Several studies have shown that MRI performs better in small-sized metastases and moderate to severe liver steatosis cases. Although state-of-the-art MRI shows a greater sensitivity for detecting and characterizing liver metastases, CT remains the chosen method. We also present the controversial subject of the "economic implication" to use CT over MRI.
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Affiliation(s)
- Patrícia S Freitas
- Department of Radiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon 1150-199, Portugal
| | - Catarina Janicas
- Department of Radiology, Centro Hospitalar de Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - José Veiga
- Department of Radiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon 1150-199, Portugal
| | - António P Matos
- Department of Radiology, Hospital Garcia de Orta, EPE, Almada 2805-267, Portugal
- Department of Radiology, Hospital CUF Tejo, Lisbon 1350-352, Portugal
| | - Vasco Herédia
- Department of Radiology, Hospital Garcia de Orta, EPE, Almada 2805-267, Portugal
- Department of Radiology, Hospital Espírito Santo de Évora-EPE, Évora 7000-811, Portugal
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, EPE, Almada 2805-267, Portugal
- Department of Radiology, Hospital da Luz, Lisbon 1500-650, Portugal.
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Eigeliene N, Saarenheimo J, Wichmann V, Österlund P, Jekunen A. Metastatic Rectal Carcinoma with Long-Term Remission due to Modern Multimodality Treatment. Case Rep Oncol 2021; 14:1475-1482. [PMID: 34899239 PMCID: PMC8613627 DOI: 10.1159/000519044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/14/2021] [Indexed: 12/24/2022] Open
Abstract
In the era of personalized medicine, systemic treatment with chemotherapy in combination with targeted drugs, tailored according to RAS and BRAF status, has improved the survival of patients with metastatic colorectal cancer (mCRC), but curative resection of metastases provides the only chance of cure. Here, we present a 40-year-old male with rectal adenocarcinoma and multiple bilateral synchronous liver metastases who has achieved long-term remission with multimodal treatment without resection of all metastatic lesions. This case emphasizes the need of repeated multidisciplinary team assessments and change of treatment intent if extraordinary responses are seen. The initial therapy consisted of short-course radiotherapy and surgery of the primary tumor followed by oxaliplatin-based combination chemotherapy and panitumumab with disease control intent. A complete radiologic response in >20 liver metastases in segments II–VIII was obtained. A biopsy-verified relapse of 3 liver metastases occurred at 9 months of treatment pause. Subsequently, major liver resection of 8 lesions was performed (4 with adenocarcinoma and 4 with cicatrix showing the challenge of disappearing lesions), followed by 6 months of adjuvant-like therapy. No relapse in MRI, PET, or CT has been noted since liver resection 6 years ago. Comprehensive genomic profiling of the primary tumor and liver metastases had similar driver mutations representing a low level of gene alteration and low diversity, possibly explaining the exceptional treatment response.
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Affiliation(s)
- Natalja Eigeliene
- Department of Oncology, Vaasa Central Hospital, Vaasa, Finland.,University of Turku, Department of Oncology and Radiotherapy, Turku, Finland
| | - Jatta Saarenheimo
- Department of Oncology, Vaasa Central Hospital, Vaasa, Finland.,Department of Pathology, Vaasa Central Hospital, Vaasa, Finland
| | - Viktor Wichmann
- Department of Oncology, Vaasa Central Hospital, Vaasa, Finland.,University of Turku, Department of Oncology and Radiotherapy, Turku, Finland
| | - Pia Österlund
- Department of Oncology, Tampere University Hospital and University of Tampere, Tampere, Finland.,Department of Oncology & Pathology, Karolinska Institutet and Karolinska Comprehensive, Cancer Centre, Stockholm, Sweden
| | - Antti Jekunen
- Department of Oncology, Vaasa Central Hospital, Vaasa, Finland.,University of Turku, Department of Oncology and Radiotherapy, Turku, Finland
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Stavrou GA, Stang A, Raptis DA, Schadde E, Zeile M, Brüning R, Wagner KC, Huber TM, Oldhafer KJ. Intraoperative (Contrast-Enhanced) Ultrasound Has the Highest Diagnostic Accuracy of Any Imaging Modality in Resection of Colorectal Liver Metastases. J Gastrointest Surg 2021; 25:3160-3169. [PMID: 34159555 DOI: 10.1007/s11605-021-04925-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/14/2021] [Indexed: 01/31/2023]
Abstract
AIM Defining sensitivity, specificity, diagnostic accuracy for detection of colorectal liver metastases in imaging compared to intraoperative assessment. Defining a cutoff, where accuracy of detection is impaired. METHODS Prospective single-institution clinical trial (clinicaltrials.gov: NCT01522209). Patients underwent CEUS, MDCT, and 3 Tesla EOB-MRI within 2 weeks preoperatively. Intraoperative palpation, IOUS, and CEIOUS were performed. A patient and lesion-based database was analyzed for accuracy of detection of CEUS, CT, MRI, and Palp/IOUS/CEIOUS combined read. Histology was standard of reference. RESULTS Forty-seven high tumor load (mean 5, 4 lesions) patients were analyzed. Histopathology confirmed 264 lesions (245 malignant: 19 benign). Accuracy for detection of all lesions: CEUS 63%, CT 71%, MRI 92%, and PALP/IOUS/CEIOUS 98%. ROC analysis for lesion size showed severe impairment of accuracy in lesion detection smaller than 5mm. Intraoperative imaging was not impaired by lesion size. Patient-based analysis revealed a change of resection plan after IOUS/CEIOUS in 35% of patients. CONCLUSION At 5-mm lesion size, preoperative imaging shows a drop in accuracy of detection. In patients with multiple lesions, addition of MRI to MDCT seems useful. Accuracy of intraoperative ultrasound is not impacted by lesion size and should be mandatory. CEIOUS can improve intraoperative decision-making. TRIAL REGISTRATION Study registered with clinicaltrials.gov : NCT01522209.
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Affiliation(s)
- Gregor A Stavrou
- Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbruecken General Hospital, Saarbruecken, Germany. .,Semmelweis Medical Faculty, Asklepios Campus Hamburg, Hamburg, Germany.
| | - Axel Stang
- Semmelweis Medical Faculty, Asklepios Campus Hamburg, Hamburg, Germany.,Department of Medical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Dimitri A Raptis
- Department of Surgery and Liver Transplantation, Royal Free Hospital, London, UK
| | - Erik Schadde
- Department of Surgery, Division of Surgical Oncology and Division of Transplant Surgery, Rush University Medical Center, Chicago, IL, USA.,Institute of Physiology, University of Zürich Campus Irchel, Zürich, Switzerland.,Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Martin Zeile
- Department of Radiology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | - Roland Brüning
- Department of Radiology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Kim C Wagner
- Department of General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Tessa M Huber
- Department of General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Karl J Oldhafer
- Semmelweis Medical Faculty, Asklepios Campus Hamburg, Hamburg, Germany.,Department of General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany
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Moslim MA, Jeyarajah DR. Narrative review of the role of yttrium-90 selective internal radiation therapy in the surgical management of colorectal liver metastases. J Gastrointest Oncol 2021; 12:2438-2446. [PMID: 34790404 DOI: 10.21037/jgo-21-96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/08/2021] [Indexed: 11/06/2022] Open
Abstract
The management of colorectal liver metastasis (CRLM) is complicated and benefits from a multidisciplinary team approach. Liver-directed therapy has been emerging as a modality for better progression-free control. In its early years, selective internal radiation therapy (SIRT) with yttrium-90 (Y-90) was confined as an end-of-line therapy. However, literature has supported other roles including: a first-line treatment for CRLM alone or in combination with systemic chemotherapy; an adjunct to second or third-line chemotherapy; and a salvage treatment for chemo-refractory disease. Although future liver remnant (FLR) hypertrophy may take 3-12 months, the SIRT effect on loco-regional disease control has rendered it to be a useful tool in some pathologies with certain strategic goals. This paper reviews the use of SIRT with Y-90 in a surgical treatment pathway. This includes: (I) an element of multidisciplinary treatment of low-volume CRLMs, (II) convert an R1 to R0 resection by sterilizing the margins of tumor near critical structures, and (III) radiation lobectomy to induce contralateral hypertrophy in order to aid in a safer resection. There are many opportunities to validate the role of SIRT as a first-line therapy along with surgical resection including an umbrella clinical trial design.
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Missing colorectal liver metastases: the surgical challenge. Langenbecks Arch Surg 2021; 406:2163-2175. [PMID: 34590190 DOI: 10.1007/s00423-021-02297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND New chemotherapy schemes have allowed for a better radiological response of unresectable colorectal liver metastases, leading to an interesting scenario known as a complete radiological response. The aim of this study was to review the current management of missing liver metastases (MLM) from the liver surgeon's point of view. METHODS A systematic search was conducted on all publications of PubMed and Embase between 2003 and 2018. Meta-analysis was performed on MLM resected/unresected. Residual tumor or regrowth and relapse-free survival were used as evaluation indices. RESULTS After literature search, 18 original articles were included for analysis. The predictive factors for MLM are type and duration of chemotherapy and size and number of lesions. Magnetic resonance is the most sensitive preoperative technique. Regarding clinical management, liver surgery is deemed the fundamental pillar in the therapeutic strategy of these patients. Meta-analysis due to data heterogeneity was inconclusive. CONCLUSIONS Depending on the clinical context, MLM monitoring appears to be a valid therapeutic alternative. Nevertheless, prospective randomized clinical studies are needed.
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Guo M, Jin N, Pawlik T, Cloyd JM. Neoadjuvant chemotherapy for colorectal liver metastases: A contemporary review of the literature. World J Gastrointest Oncol 2021; 13:1043-1061. [PMID: 34616511 PMCID: PMC8465453 DOI: 10.4251/wjgo.v13.i9.1043] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/17/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Colorectal carcinoma (CRC) is one of the leading causes of cancer-related deaths worldwide, and up to 50% of patients with CRC develop colorectal liver metastases (CRLM). For these patients, surgical resection remains the only opportunity for cure and long-term survival. Over the past few decades, outcomes of patients with metastatic CRC have improved significantly due to advances in systemic therapy, as well as improvements in operative technique and perioperative care. Chemotherapy in the modern era of oxaliplatin- and irinotecan-containing regimens has been augmented by the introduction of targeted biologics and immunotherapeutic agents. The increasing efficacy of contemporary systemic therapies has led to an expansion in the proportion of patients eligible for curative-intent surgery. Consequently, the use of neoadjuvant strategies is becoming progressively more established. For patients with CRLM, the primary advantage of neoadjuvant chemotherapy (NCT) is the potential to down-stage metastatic disease in order to facilitate hepatic resection. On the other hand, the routine use of NCT for patients with resectable metastases remains controversial, especially given the potential risk of inducing chemotherapy-associated liver injury prior to hepatectomy. Current guidelines recommend upfront surgery in patients with initially resectable disease and low operative risk, reserving NCT for patients with borderline resectable or unresectable disease and high operative risk. Patients undergoing NCT require close monitoring for tumor response and conversion of CRLM to resectability. In light of the growing number of treatment options available to patients with metastatic CRC, it is generally agreed that these patients are best served at tertiary centers with an expert multidisciplinary team.
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Affiliation(s)
- Marissa Guo
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH 43210, United States
| | - Ning Jin
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, United States
| | - Timothy Pawlik
- Department of Surgery, The Ohio State University, Columbus, OH 43210, United States
| | - Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Medical Center, Columbus, OH 43210, United States
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Osei-Bordom DC, Kamarajah S, Christou N. Colorectal Cancer, Liver Metastases and Biotherapies. Biomedicines 2021; 9:894. [PMID: 34440099 PMCID: PMC8389538 DOI: 10.3390/biomedicines9080894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022] Open
Abstract
(1) Background: colorectal cancer (CRC) is one of the deadliest causes of death by cancer worldwide. Its first main metastatic diffusion spreads to the liver. Different mechanisms such as the epithelial-mesenchymal transition and angiogenesis are the characteristics of this invasion. At this stage, different options are possible and still in debate, especially regarding the use of targeted therapeutics and biotherapies. (2) Methods: A review of the literature has been done focusing on the clinical management of liver metastasis of colorectal cancer and the contribution of biotherapies in this field. (3) Results: In a clinical setting, surgeons and oncologists consider liver metastasis in CRC into two groups to launch adapted therapeutics: resectable and non-resectable. Around these two entities, the combination of targeted therapies and biotherapies are of high interest and are currently tested to know in which molecular and clinical conditions they have to be applied to impact positively both on survival and quality of life of patients.
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Affiliation(s)
- Daniel-Clement Osei-Bordom
- Department of General Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham B15 2TH, UK; (D.-C.O.-B.); (S.K.)
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
- NIHR Birmingham Biomedical Research Centre, Centre for Liver and Gastroenterology Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Sivesh Kamarajah
- Department of General Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham B15 2TH, UK; (D.-C.O.-B.); (S.K.)
| | - Niki Christou
- Department of General Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham B15 2TH, UK; (D.-C.O.-B.); (S.K.)
- Department of General Surgery, University Hospital of Limoges, 87000 Limoges, France
- EA3842 CAPTuR Laboratory “Cell Activation Control, Tumor Progression and Therapeutic Resistance”, Faculty of Medicine, 2 Rue du Docteur Marcland, 87025 Limoges, France
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Melstrom LG, Warner SG, Wong P, Sun V, Raoof M, Singh G, Chavin KD, Fong Y, Adam R, Hugh TJ. Management of disappearing colorectal liver metastases: an international survey. HPB (Oxford) 2021; 23:506-511. [PMID: 33144051 DOI: 10.1016/j.hpb.2020.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/13/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Improved chemotherapy response rates have lead to "disappearing" colorectal liver metastases (dCRLM). We aim to assess management patterns of dCRLM from an international body of hepatobiliary surgeons. METHODS A survey was designed, tested for item relevance, readability and content validity, and distributed to the AHPBA, IHPBA and ANZHPBA. RESULTS The majority of 226 respondents were <15 years from training (69%), practiced in academia (82%) and devoted >50% of their practice to hepatobiliary (75%). Surgeons utilize CT(45%) or MRI(47%) for preoperative planning with a preferred imaging interval of <6 weeks. Nearly all have experienced dCRLM (99%) and 63% of surgeons have waited a few months to assess for durability of response prior to definitive surgical/ablative therapy. Only 24% place fiducial markers for lesions <1-cm prior to neoadjuvant chemotherapy. Intra-operatively, 97% of surgeons perform ultrasound, and 71% ablation. When a tumor has "disappeared," 49% elect for observation and 31% resect if the dCRLM is superficial. Of those electing observation, 87% believe there is effective treatment with progression on surveillance imaging. CONCLUSIONS Nearly all surgeons have experienced dCRLM with half choosing observation over intervention due to the belief that these lesions may be re-addressed in the future.
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Affiliation(s)
- Laleh G Melstrom
- City of Hope Comprehensive Cancer Center Department of Surgery, USA.
| | - Susanne G Warner
- City of Hope Comprehensive Cancer Center Department of Surgery, USA
| | - Paul Wong
- City of Hope Comprehensive Cancer Center Department of Surgery, USA
| | - Virginia Sun
- City of Hope Comprehensive Cancer Center Department of Population Sciences, USA
| | - Mustafa Raoof
- City of Hope Comprehensive Cancer Center Department of Surgery, USA
| | - Gagandeep Singh
- City of Hope Comprehensive Cancer Center Department of Surgery, USA
| | | | - Yuman Fong
- City of Hope Comprehensive Cancer Center Department of Surgery, USA
| | - Rene Adam
- Paul-Brousse Hospital, Assistance Publique Hopitaux de Paris Department of Surgery, France
| | - Thomas J Hugh
- University of Sydney, Department of Surgery, Australia
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Muaddi H, Silva S, Choi WJ, Coburn N, Hallet J, Law C, Cheung H, Karanicolas PJ. When is a Ghost Really Gone? A Systematic Review and Meta-analysis of the Accuracy of Imaging Modalities to Predict Complete Pathological Response of Colorectal Cancer Liver Metastases After Chemotherapy. Ann Surg Oncol 2021; 28:6805-6813. [PMID: 33772391 DOI: 10.1245/s10434-021-09824-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Administration of chemotherapy to patients with colorectal liver metastases may result in disappearing liver metastases (DLM). This poses a therapeutic dilemma due to the uncertainty of true complete (pathological) response. OBJECTIVE We aimed to examine the diagnostic performance of imaging modalities in detecting true complete response in patients with DLM after chemotherapy. METHODS We performed a systematic search for articles assessing the diagnostic performance of imaging modalities in evaluating DLM following chemotherapy. True complete response was defined as 1-year recurrence-free survival in non-resected patients or complete pathological response on histologic examination in resected patients. We calculated the negative predictive value (NPV) for detecting true complete response of each imaging modality using a random effects model. RESULTS Thirteen studies comprising 332 patients with at least one DLM were included. The number of DLMs after chemotherapy was 955 with computed tomography (CT), 104 with positron emission tomography (PET), 50 with intraoperative ultrasound (IOUS), 585 with magnetic resonance imaging (MRI), and 175 with contrast-enhanced IOUS (CEIOUS). Substantial variation in study design, patient characteristics, and imaging features was observed. Pooled NPV was 0.79 (95% confidence interval [CI] 0.53-0.96), 0.73 (95% CI 0.58-0.85), 0.54 (95% CI 0.37-0.7), 0.47 (95% CI 0.34-0.61), and 0.22 (95% CI 0.11-0.39) for CEIOUS, MRI, IOUS, CT, and PET, respectively. CONCLUSION After chemotherapy, MRI or CEIOUS are the most accurate imaging modalities for assessment of DLM and should be used routinely in this context. Given the high NPV of these two modalities, surgical resection of visible CRLM is warranted if technically possible, even if DLM remain.
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Affiliation(s)
- Hala Muaddi
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Stephanie Silva
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Woo Jin Choi
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Natalie Coburn
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Julie Hallet
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Calvin Law
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada.,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Helen Cheung
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Paul J Karanicolas
- Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada. .,Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Wu XA, Shi Y, Du SD. Surgical treatment of colorectal liver metastasis. Shijie Huaren Xiaohua Zazhi 2021; 29:110-115. [DOI: 10.11569/wcjd.v29.i3.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Liver metastasis is the most common form of distant metastasis in colorectal cancer and is a key factor for prognosis in patients with colorectal cancer. Surgery may be the only way to cure colorectal liver metastases. This paper mainly summarizes the latest progress in surgical treatment of colorectal liver metastases, including how to increase resection rate of liver metastases with neoadjuvant therapy or staged hepatectomy, the effect of surgical margin on the prognosis of patients, the timing of surgery in patients with synchronous colorectal liver metastasis, the impact of laparoscopic hepatectomy of liver metastases, the application of liver transplantation in patients with colorectal liver metastases, etc, with an aim to help develop an optimal treatment for patients with colorectal liver metastases through combination of surgical innovations with individualized treatment, thereby improving patients' disease-free survival and overall survival.
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Affiliation(s)
- Xiang-An Wu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Dongcheng District, Beijing 100730, China
| | - Yue Shi
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Dongcheng District, Beijing 100730, China
| | - Shun-Da Du
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Dongcheng District, Beijing 100730, China
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Koh DM, Ba-Ssalamah A, Brancatelli G, Fananapazir G, Fiel MI, Goshima S, Ju SH, Kartalis N, Kudo M, Lee JM, Murakami T, Seidensticker M, Sirlin CB, Tan CH, Wang J, Yoon JH, Zeng M, Zhou J, Taouli B. Consensus report from the 9 th International Forum for Liver Magnetic Resonance Imaging: applications of gadoxetic acid-enhanced imaging. Eur Radiol 2021; 31:5615-5628. [PMID: 33523304 PMCID: PMC8270799 DOI: 10.1007/s00330-020-07637-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/17/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
Objectives The 9th International Forum for Liver Magnetic Resonance Imaging (MRI) was held in Singapore in September 2019, bringing together radiologists and allied specialists to discuss the latest developments in and formulate consensus statements for liver MRI, including the applications of gadoxetic acid–enhanced imaging. Methods As at previous Liver Forums, the meeting was held over 2 days. Presentations by the faculty on days 1 and 2 and breakout group discussions on day 1 were followed by delegate voting on consensus statements presented on day 2. Presentations and discussions centered on two main meeting themes relating to the use of gadoxetic acid–enhanced MRI in primary liver cancer and metastatic liver disease. Results and conclusions Gadoxetic acid–enhanced MRI offers the ability to monitor response to systemic therapy and to assist in pre-surgical/pre-interventional planning in liver metastases. In hepatocellular carcinoma, gadoxetic acid–enhanced MRI provides precise staging information for accurate treatment decision-making and follow-up post therapy. Gadoxetic acid–enhanced MRI also has potential, currently investigational, indications for the functional assessment of the liver and the biliary system. Additional voting sessions at the Liver Forum debated the role of multidisciplinary care in the management of patients with liver disease, evidence to support the use of abbreviated imaging protocols, and the importance of standardizing nomenclature in international guidelines in order to increase the sharing of scientific data and improve the communication between centers. Key Points • Gadoxetic acid–enhanced MRI is the preferred imaging method for pre-surgical or pre-interventional planning for liver metastases after systemic therapy. • Gadoxetic acid–enhanced MRI provides accurate staging of HCC before and after treatment with locoregional/biologic therapies. • Abbreviated protocols for gadoxetic acid–enhanced MRI offer potential time and cost savings, but more evidence is necessary. The use of gadoxetic acid–enhanced MRI for the assessment of liver and biliary function is under active investigation. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-020-07637-4.
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Affiliation(s)
- Dow-Mu Koh
- Department of Diagnostic Radiology, Royal Marsden Hospital, Sutton, UK.
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Brancatelli
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica avanzata (BiND), University of Palermo, Palermo, Italy
| | | | - M Isabel Fiel
- Department of Pathology, Molecular and Cell Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Satoshi Goshima
- Department of Diagnostic Radiology & Nuclear Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Sheng-Hong Ju
- Department of Radiology, Zhongda Hospital, Southeast University, Nanjing, People's Republic of China
| | - Nikolaos Kartalis
- Department of Radiology Huddinge, Karolinska University Hospital, Stockholm, Sweden.,Division of Radiology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Masatoshi Kudo
- Department of Hepatology and Gastroenterology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Jeong Min Lee
- Department of Radiology, College of Medicine, Seoul National University, Seoul, South Korea
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Max Seidensticker
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Claude B Sirlin
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Lee Kong Chian School of Medicine, Singapore, Singapore
| | - Jin Wang
- Department of Radiology, Third Affiliated Hospital of Sun Yat Sen University, Guangzhou, People's Republic of China
| | - Jeong Hee Yoon
- Department of Radiology, College of Medicine, Seoul National University, Seoul, South Korea
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jian Zhou
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Bachir Taouli
- Department of Diagnostic, Molecular, and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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41
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Behrenbruch C, Prabhakaran S, Udayasiri D D, Michael M, Hollande F, Hayes I, Heriot AG, Knowles B, Thomson BN. Association between imaging response and survival following neoadjuvant chemotherapy in patients with resectable colorectal liver metastases: A cohort study. J Surg Oncol 2021; 123:1263-1273. [PMID: 33524184 DOI: 10.1002/jso.26400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/12/2020] [Accepted: 01/18/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND The association between the imaging response (structural or metabolic) to neoadjuvant chemotherapy (neoCT) before colorectal liver metastasis (CRLM) and survival is unclear. METHOD A total of 201 patients underwent their first CRLM resection. A total of 94 (47%) patients were treated with neoCT. A multivariable, Cox proportional hazard regression analysis was performed to compare overall survival (OS) and progression-free survival (PFS) between response groups. RESULTS Multivariable regression analysis of the CT/MRI (n = 94) group showed no difference in survival (OS and PFS) in patients who had stable disease/partial response (SD/PR) or complete response (CR) versus patients who had progressive disease (PD) (OS: HR, 0.36 (95% CI: 0.11-1.19) p = .094, HR, 0.78 (95% CI: 0.13-4.50) p = .780, respectively), (PFS: HR, 0.70 (95% CI: 0.36-1.35) p = .284, HR, 0.51 (0.18-1.45) p = .203, respectively). In the FDG-PET group (n = 60) there was no difference in the hazard of death for patients with SD/PR or CR versus patients with PD for OS or PFS except for the PFS in the small CR subgroup (OS: HR, 0.75 (95% CI: 0.11-4.88) p = .759, HR, 1.21 (95% CI: 0.15-9.43) p = .857), (PFS: HR, 0.34% (95% CI: 0.09-1.22), p = .097, HR, 0.17 (95% CI: 0.04-0.62) p = .008, respectively). CONCLUSION There was no convincing evidence of association between imaging response to neoCT and survival following CRLM resection.
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Affiliation(s)
- C Behrenbruch
- Sir Peter MacCallum Department of Oncology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia.,Department of Clinical Pathology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - S Prabhakaran
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia
| | - D Udayasiri D
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia.,Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.,Colorectal Surgery Unit, The Royal Melbourne Hospital, Parkville, Australia
| | - M Michael
- Sir Peter MacCallum Department of Oncology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia.,Department of Medical Oncology, Victorian Comprehensive Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - F Hollande
- Department of Clinical Pathology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia.,Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, Australia
| | - I Hayes
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia.,Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.,Colorectal Surgery Unit, The Royal Melbourne Hospital, Parkville, Australia
| | - A G Heriot
- Sir Peter MacCallum Department of Oncology, Victorian Comprehensive Cancer Centre, The University of Melbourne, Melbourne, Australia.,Department of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,Department of Surgery, St Vincent's Hospital, The University of Melbourne, Fitzroy, Australia
| | - B Knowles
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia
| | - B N Thomson
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Australia.,Department of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.,Department of Surgery, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
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42
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Chan G, Chee CE. Perioperative Chemotherapy for Liver Metastasis of Colorectal Cancer. Cancers (Basel) 2020; 12:E3535. [PMID: 33256170 PMCID: PMC7760826 DOI: 10.3390/cancers12123535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 02/07/2023] Open
Abstract
The liver is the dominant site of metastasis for patients with colorectal cancer. For those with isolated liver metastases, surgical resection with systemic therapy has led to long-term remission in as high as 80% of patients in well-selected cohorts. This review will focus on how systemic therapy should be integrated with resection of liver metastases; in particular, the use of clinical risk scores based on clinicopathological features that help with patient selection, various approaches to the treatment of micro-metastatic disease (peri-operative versus post-operative chemotherapy), as well as conversion chemotherapy for those with initially upfront unresectable disease will be discussed.
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Affiliation(s)
| | - Cheng E. Chee
- Department of Haematology-Oncology, National University Hospital Singapore, National University Cancer Institute, Singapore 119228, Singapore;
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43
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Martin J, Petrillo A, Smyth EC, Shaida N, Khwaja S, Cheow HK, Duckworth A, Heister P, Praseedom R, Jah A, Balakrishnan A, Harper S, Liau S, Kosmoliaptsis V, Huguet E. Colorectal liver metastases: Current management and future perspectives. World J Clin Oncol 2020; 11:761-808. [PMID: 33200074 PMCID: PMC7643190 DOI: 10.5306/wjco.v11.i10.761] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/14/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
The liver is the commonest site of metastatic disease for patients with colorectal cancer, with at least 25% developing colorectal liver metastases (CRLM) during the course of their illness. The management of CRLM has evolved into a complex field requiring input from experienced members of a multi-disciplinary team involving radiology (cross sectional, nuclear medicine and interventional), Oncology, Liver surgery, Colorectal surgery, and Histopathology. Patient management is based on assessment of sophisticated clinical, radiological and biomarker information. Despite incomplete evidence in this very heterogeneous patient group, maximising resection of CRLM using all available techniques remains a key objective and provides the best chance of long-term survival and cure. To this end, liver resection is maximised by the use of downsizing chemotherapy, optimisation of liver remnant by portal vein embolization, associating liver partition and portal vein ligation for staged hepatectomy, and combining resection with ablation, in the context of improvements in the functional assessment of the future remnant liver. Liver resection may safely be carried out laparoscopically or open, and synchronously with, or before, colorectal surgery in selected patients. For unresectable patients, treatment options including systemic chemotherapy, targeted biological agents, intra-arterial infusion or bead delivered chemotherapy, tumour ablation, stereotactic radiotherapy, and selective internal radiotherapy contribute to improve survival and may convert initially unresectable patients to operability. Currently evolving areas include biomarker characterisation of tumours, the development of novel systemic agents targeting specific oncogenic pathways, and the potential re-emergence of radical surgical options such as liver transplantation.
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Affiliation(s)
- Jack Martin
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Angelica Petrillo
- Department of Precision Medicine, Division of Medical Oncology, University of Campania "L. Vanvitelli", Napoli 80131, Italy, & Medical Oncology Unit, Ospedale del Mare, 80147 Napoli Italy
| | - Elizabeth C Smyth
- Department of Oncology, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Nadeem Shaida
- Department of Radiology, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB22 0QQ, United Kingdom
| | - Samir Khwaja
- Department of Radiology, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB22 0QQ, United Kingdom
| | - HK Cheow
- Department of Nuclear Medicine, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Adam Duckworth
- Department of Pathology, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Paula Heister
- Department of Pathology, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Raaj Praseedom
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Asif Jah
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Anita Balakrishnan
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Simon Harper
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Siong Liau
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Emmanuel Huguet
- Department of Surgery, Addenbrookes Hospital, NIHR Comprehensive Biomedical Research and Academic Health Sciences Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
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Xu D, Yan XL, Liu JM, Li J, Xing BC. The characteristics and long-term survival of patients with colorectal liver metastases with pathological complete response after chemotherapy. J Cancer 2020; 11:6256-6263. [PMID: 33033509 PMCID: PMC7532511 DOI: 10.7150/jca.47911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/13/2020] [Indexed: 01/05/2023] Open
Abstract
Purpose: Preoperative chemotherapy is widely used for colorectal liver metastasis (CRLM). Pathological complete response (PCR) after chemotherapy indicates complete tumor regression and an extremely favorable prognosis. This study aimed to explore the characteristics and long-term survival of CRLM patients with pCR, who underwent surgery after preoperative chemotherapy. Methods: We retrospectively analyzed the clinical data of 494 CRLM patients who underwent hepatectomy after preoperative chemotherapy between January 2006 and January 2019. pCR was defined as the absence of any cancer cells on pathological examination. Results: Thirty (6.07%) patients achieved pCR after preoperative chemotherapy; 70% patients who achieved pCR did not experience recurrence and were cured after hepatectomy. The long-term prognosis of patients with pCR was extremely favorable, with 10-year overall and disease-free survivals of 85.2% and 73.7%, respectively; these were significantly better than those of patients without pCR (31.3% and 15.2%, respectively). Liver metastases <3 cm, preoperative carcinoembryonic antigen level ≤20 ng/mL, primary T stage 1-2, and right-sided primary tumors were independent predictors for pCR. Conclusion: pCR occurred in 6% of patients with CRLM after preoperative chemotherapy. Patients with a smaller tumor burden are more likely to benefit from chemotherapy and achieve pCR.
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Affiliation(s)
- Da Xu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiao-Luan Yan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jia-Ming Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Juan Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Bao-Cai Xing
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, Beijing 100142, China
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45
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Barimani D, Kauppila JH, Sturesson C, Sparrelid E. Imaging in disappearing colorectal liver metastases and their accuracy: a systematic review. World J Surg Oncol 2020; 18:264. [PMID: 33032620 PMCID: PMC7545848 DOI: 10.1186/s12957-020-02037-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/25/2020] [Indexed: 12/14/2022] Open
Abstract
Background Approximately 30% of patients with colorectal cancer develop colorectal liver metastases (CRLM). CRLM that become undetectable by imaging after chemotherapy are called disappearing liver metastases (DLM). But a DLM is not necessarily equal to cure. An increasing incidence of patients with DLM provides surgeons with a difficult dilemma: to resect or to not resect the original sites of DLM? The aim of this review was to investigate to what extent a DLM equates a complete response (CR) and to compare outcomes. Methods This review was conducted in accordance with the PRISMA guidelines and registered in Prospero (registration number CRD42017070441). Literature search was made in the PubMed and Embase databases. During the process of writing, PubMed was repeatedly searched and reference lists of included studies were screened for additional studies of interest for this review. Results were independently screened by two authors with the Covidence platform. Studies eligible for inclusion were those reporting outcomes of DLM in adult patients undergoing surgery following chemotherapy. Results Fifteen studies were included with a total of 2955 patients with CRLM. They had 4742 CRLM altogether. Post-chemotherapy, patients presented with 1561 DLM. Patients with one or more DLM ranged from 7 to 48% (median 19%). Median DLM per patient was 3.4 (range 0.4–5.6). Patients were predominantly evaluated by contrast-enhanced computed tomography (CE-CT) before and after chemotherapy, with some exceptions and with addition of magnetic resonance imaging (MRI) in some studies. Intraoperative ultrasound (IOUS) was universally performed in all but two studies. If a DLM remained undetectable by IOUS, this DLM represented a CR in 24–96% (median 77.5%). Further, if a DLM on preoperative CE-CT remained undetectable by additional workup with MRI and CE-IOUS, this DLM was equal to a CR in 75–94% (median 89%). Patients with resected DLM had a longer disease-free survival compared to patients with DLM left in situ but statistically significant differences in overall survival could not be found. Conclusion Combination of CE-CT, MRI, and IOUS showed promising results in accurately identifying DLM with CR. This suggests that leaving DLM in situ could be an alternative to surgical resection when a DLM remains undetectable by MRI and IOUS.
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Affiliation(s)
- Darius Barimani
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
| | - Joonas H Kauppila
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.,Surgery Research Unit, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention, and Technology (CLINTEC), Center for Digestive Diseases, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
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46
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Ricke J, Westphalen CB, Seidensticker M. Therapeutic Concepts for Oligometastatic Gastrointestinal Tumours. Visc Med 2020; 36:359-363. [PMID: 33178732 DOI: 10.1159/000509897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 12/25/2022] Open
Abstract
Background Clinical trials have proven a survival benefit from applying local therapies for oligometastatic cancers of various origin. Summary Today, the definition of oligometa-static disease is based on limited lesion numbers and organ systems involved. Treatment guidelines by the European Organisation for Research and Treatment of Cancer (EORTC), European Society for Medical Oncology (ESMO) and several other groups suggest a threshold of up to 5 tumours. Established biological markers indicating the aggressiveness of a given tumour (and therefore suggesting local treatment only or the addition of or complete switch to systemic therapies) are missing, except for disease-free survival, the only recommended parameter for patient selection beyond lesion count. Key Message The following article discusses clinical implications as well as local techniques established for the treatment of oligometastatic disease.
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Affiliation(s)
- Jens Ricke
- Klinik und Poliklinik für Radiologie, LMU Klinikum, Munich, Germany
| | - Christoph Benedikt Westphalen
- Medizinische Klinik und Poliklinik III und CCC München, Klinikum der Universität München, LMU München, Munich, Germany
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47
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Pérez-Santiago L, Dorcaratto D, Garcés-Albir M, Muñoz-Forner E, Huerta Álvaro M, Roselló Keranën S, Sabater L. The actual management of colorectal liver metastases. MINERVA CHIR 2020; 75:328-344. [PMID: 32773753 DOI: 10.23736/s0026-4733.20.08436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Colorectal cancer is one of the most frequent cancers in the world and between 50% and 60% of patients will develop colorectal liver metastases (CRLM) during the disease. There have been great improvements in the management of CRLM during the last decades. The combination of modern chemotherapeutic and biological systemic treatments with aggressive surgical resection strategies is currently the base for the treatment of patients considered unresectable until few years ago. Furthermore, several new treatments for the local control of CRLM have been developed and are now part of the arsenal of multidisciplinary teams for the treatment of these complex patients. The aim of this review was to summarize and update the management of CRLM, its controversies and relevant evidence.
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Affiliation(s)
- Leticia Pérez-Santiago
- Unit of Liver, Biliary and Pancreatic Surgery, Department of Surgery, Clinic Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Dimitri Dorcaratto
- Unit of Liver, Biliary and Pancreatic Surgery, Department of Surgery, Clinic Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain -
| | - Marina Garcés-Albir
- Unit of Liver, Biliary and Pancreatic Surgery, Department of Surgery, Clinic Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Elena Muñoz-Forner
- Unit of Liver, Biliary and Pancreatic Surgery, Department of Surgery, Clinic Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Marisol Huerta Álvaro
- Department of Medical Oncology, Clinic Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Susana Roselló Keranën
- Department of Medical Oncology, Clinic Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Luis Sabater
- Unit of Liver, Biliary and Pancreatic Surgery, Department of Surgery, Clinic Hospital, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
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48
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Ihemelandu C, Levine EA, Aklilu M, Yacoub G, Howerton R, Bolemon B, Graham M, Russell G, Shen P. Optimal Timing of Systemic Therapy in Resectable Colorectal Liver Metastases. Am Surg 2020. [DOI: 10.1177/000313481307900432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Perioperative chemotherapy has been shown to improve disease-free survival compared with surgery alone for resectable colorectal liver metastases (CLM). We examined our experience with systemic chemotherapy in this clinical setting. A prospectively collected liver surgery database identified 210 patients treated for resectable CLM from 1996 to 2010. Results were correlated to four treatment groups: posthepatectomy adjuvant only, prehepatectomy preoperative only, peri-operative (preoperative and adjuvant), and surgery only. Seventy-nine (37.6%) patients received posthepatectomy adjuvant only treatment, 33 (15.7%) received prehepatectomy preoperative only treatment, 46 (21.9%) received perioperative (preoperative and adjuvant) treatment, whereas 52 (24.8%) received surgery alone. Preoperative and adjuvant systemic chemotherapy regimens were as follows: 23 (29.1%) and 18 (14.4%) received a 5-fluorouracil monotherapy regimen, 19 (24.1%) and 31 (24.8%) received an irinotecan-based regimen, and 28 (35.4%) and 37 (29.6%) received an oxaliplatin-based regimen. Nine (11.4%) and 12 (9.6%) received some other unknown combination. Treatment groups showed no difference in gender, mean tumor size, number of tumors, margin status, or postoperative complications with the only difference being a higher incidence of metachronous tumors in the preoperative only and perioperative groups (P = 0.01). Median follow-up and overall survival were 25 and 41 months, respectively. The adjuvant, preoperative, perioperative, and surgery only groups had a median survival time of 48, 35, 39, and 29 months, respectively (log-rank P = 0.04). Independent predictors of overall survival on multivariate analysis included treatment algorithm used and postoperative complication status. Adjuvant only systemic therapy was associated with an improved survival in resectable CLM. Prospective randomized trials are needed to confirm these findings.
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Affiliation(s)
- Chukwuemeka Ihemelandu
- Department of General Surgery, Surgical Oncology Section, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Edward A. Levine
- Department of General Surgery, Surgical Oncology Section, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mebea Aklilu
- Department of Internal Medicine, Hematology and Oncology Section, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - George Yacoub
- Department of Internal Medicine, Hematology and Oncology Section, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Russell Howerton
- Department of General Surgery, Surgical Oncology Section, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Britt Bolemon
- Department of Internal Medicine, Hematology and Oncology Section, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Matthew Graham
- Department of Internal Medicine, Hematology and Oncology Section, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Greg Russell
- Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Perry Shen
- Department of General Surgery, Surgical Oncology Section, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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49
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Pugh SA, Bridgewater JA, Primrose JN. Hepatic metastases resection after cetuximab: are we missing something? - Authors' reply. Lancet Oncol 2020; 21:e229. [PMID: 32359494 DOI: 10.1016/s1470-2045(20)30239-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - John N Primrose
- Department of Surgery, University of Southampton, Southampton SO16 6YD, UK.
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50
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Dueland S, Line PD. Response to the Comment on"Survival Following Liver Transplantation for Patients With Non-resectable Liver Only Colorectal Metastases": What if those Lesions Are Gone? Ann Surg 2020; 271:e124. [PMID: 32301798 DOI: 10.1097/sla.0000000000003604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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