Tan XR, Li J, Chen HW, Luo W, Jiang N, Wang ZB, Wang S. Successful multidisciplinary therapy for a patient with liver metastasis from ascending colon adenocarcinoma: A case report and review of literature. World J Clin Cases 2023; 11(7): 1498-1505 [PMID: 36926405 DOI: 10.12998/wjcc.v11.i7.1498]
Corresponding Author of This Article
Shuai Wang, MS, Associate Chief Physician, Department of Oncology, Daping Hospital, Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing 400042, China. sharondenise_mine@163.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 6, 2023; 11(7): 1498-1505 Published online Mar 6, 2023. doi: 10.12998/wjcc.v11.i7.1498
Successful multidisciplinary therapy for a patient with liver metastasis from ascending colon adenocarcinoma: A case report and review of literature
Xiao-Rong Tan, Juan Li, Hua-Wei Chen, Wei Luo, Nan Jiang, Zheng-Bo Wang, Shuai Wang
Xiao-Rong Tan, Oncological Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
Juan Li, Hua-Wei Chen, Wei Luo, Nan Jiang, Zheng-Bo Wang, Shuai Wang, Department of Oncology, Daping Hospital, Army Medical University, Chongqing 400042, China
Author contributions: Tan XR and Wang S were the patient's oncologists, reviewed the literature, and contributed to drafting the manuscript; Li J and Wang S were responsible for revising the manuscript for important intellectual content; Chen HW and Jiang N reviewed the literature and contributed to drafting the manuscript; Wang ZB and Luo W analyzed and interpreted the imaging findings; all authors issued final approval for the version to be submitted.
Informed consent statement: A written informed consent was obtained from the patient for publication of this case report.
Conflict-of-interest statement: All the authors have nothing to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shuai Wang, MS, Associate Chief Physician, Department of Oncology, Daping Hospital, Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing 400042, China. sharondenise_mine@163.com
Received: September 20, 2022 Peer-review started: September 20, 2022 First decision: December 26, 2022 Revised: January 7, 2023 Accepted: February 10, 2023 Article in press: February 10, 2023 Published online: March 6, 2023 Processing time: 162 Days and 21.8 Hours
Abstract
BACKGROUND
Liver metastasis is the most common form of distant metastasis in colorectal cancer, and the only possible curative treatment for patients with colorectal liver metastases (CRLM) is hepatectomy. However, approximately 25% of patients with CRLM have indications for liver resection at the initial diagnosis. Strategies aimed at downstaging large or multifocal tumors to enable curative resection are appealing.
CASE SUMMARY
A 42-year-old man was diagnosed with ascending colon cancer and liver metastases. Due to the huge lesion size and compression of the right portal vein, the liver metastases were initially diagnosed as unresectable lesions. The patient was treated with preoperative transcatheter arterial chemoembolization (TACE) consisting of 5-fluorouracil/Leucovorin/oxaliplatin/Endostar®. After four courses, radical right-sided colectomy and ileum transverse colon anastomosis were performed. Postoperatively, the pathological analysis revealed moderately differentiated adenocarcinoma with necrosis and negative margins. Thereafter, S7/S8 partial hepatectomy was performed after two courses of neoadjuvant chemotherapy. Pathological examination of the resected specimen revealed a pathologically complete response (pCR). Intrahepatic recurrence was detected more than two months after the operation, and the patient was then treated with TACE consisting of irinotecan/Leucovorin/fluorouracil therapy plus Endostar®. Subsequently, the patient was treated with a γ-knife to enhance local control. Notably, a pCR was reached, and the patient's overall survival time was > 9 years.
CONCLUSION
Multidisciplinary treatment can promote the conversion of initially unresectable colorectal liver metastasis and facilitate complete pathological remission of liver lesions.
Core Tip: We report a multidisciplinary strategy, including 5-fluorouracil/Leucovorin/oxaliplatin/Endostar® (mFOLFOX6 plus Endostar®) and transcatheter arterial chemoembolization, that may help improve resectability of initially unresectable colorectal liver metastasis (CRLM) and achieve pathologically complete response (pCR). After the recurrence of liver metastasis, the patient received TACE comprising irinotecan/Leucovorin/fluorouracil therapy plus Endostar® and was treated with γ-knife. The patient's overall survival time exceeded 9 years. To date, this is the first case that mFOLFOX6 combined with Endostar® in conversion therapy of initially unresectable CRLM and liver metastases that achieved pCR. Our study implies that Endostar® has a potential value in conversion therapy and combination therapy of initially unresectable CRLM.
