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Ryu HS, Kim HJ, Ji WB, Kim BC, Kim JH, Moon SK, Kang SI, Kwak HD, Kim ES, Kim CH, Kim TH, Noh GT, Park BS, Park HM, Bae JM, Bae JH, Seo NE, Song CH, Ahn MS, Eo JS, Yoon YC, Yoon JK, Lee KH, Lee KH, Lee KY, Lee MS, Lee SH, Lee JM, Lee JE, Lee HH, Ihn MH, Jang JH, Jeon SK, Chae KJ, Choi JH, Pyo DH, Ha GW, Han KS, Hong YK, Hong CW, Kwak JM. Colon cancer: the 2023 Korean clinical practice guidelines for diagnosis and treatment. Ann Coloproctol 2024; 40:89-113. [PMID: 38712437 PMCID: PMC11082542 DOI: 10.3393/ac.2024.00059.0008] [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] [Received: 01/20/2024] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 05/08/2024] Open
Abstract
Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients' values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.
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Affiliation(s)
- Hyo Seon Ryu
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Institute for Evidence-based Medicine, Cochrane Collaboration, Seoul, Korea
| | - Woong Bae Ji
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Ji Hun Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Kyung Moon
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Sung Il Kang
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Tae Hyung Kim
- Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Gyoung Tae Noh
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Byung-Soo Park
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyeung-Min Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jeong Mo Bae
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Jung Hoon Bae
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ni Eun Seo
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Hoon Song
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi Sun Ahn
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Seon Eo
- Department of Nuclear Medicine and Molecular Imaging, Korea University College of Medicine, Seoul, Korea
| | - Young Chul Yoon
- Department of General Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Kee Yoon
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Korea
| | - Kyung Ha Lee
- Department of Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kil-Yong Lee
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Myung Su Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Min Lee
- Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Ji Eun Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Han Hee Lee
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myong Hoon Ihn
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Je-Ho Jang
- Department of Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Kum Ju Chae
- Department of Radiology, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jin-Ho Choi
- Center for Lung Cancer, Department of Thoracic Surgery, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dae Hee Pyo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gi Won Ha
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Kyung Su Han
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Young Ki Hong
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Chang Won Hong
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Jung-Myun Kwak
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Korean Colon Cancer Multidisciplinary Committee
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Institute for Evidence-based Medicine, Cochrane Collaboration, Seoul, Korea
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Ansan Hospital, Ansan, Korea
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
- Department of Nuclear Medicine and Molecular Imaging, Korea University College of Medicine, Seoul, Korea
- Department of General Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Korea
- Department of Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
- Department of Radiology, Jeonbuk National University Medical School, Jeonju, Korea
- Center for Lung Cancer, Department of Thoracic Surgery, Research Institute and Hospital, National Cancer Center, Goyang, Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Vogel J, Sekler J, Gückel B, Pfannenberg C, Nikolaou K, La Fougère C, Dittmann H, Reinert CP. How [ 18F]FDG-PET/CT Affects the Management of Patients with Differentiated Thyroid Carcinoma in Clinical Routines. Cancers (Basel) 2024; 16:588. [PMID: 38339339 PMCID: PMC10854596 DOI: 10.3390/cancers16030588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE To investigate the impact of [18F]FDG-PET/CT on the management of differentiated thyroid carcinoma (DTC) in routine clinical settings. MATERIAL AND METHODS In total, 98 patients (55 females, age 56 ± 18 years) with histologically confirmed thyroid cancer, including all types of DTC and poorly differentiated thyroid cancer (PDTC, n = 7), underwent [18F]FDG-PET/CT for staging or recurrence diagnostics performed using a state-of-the art clinical scanner (Biograph mCT, Siemens Healthineers) with a standardized examination protocol. The impact of PET/CT on clinical decision making was prospectively evaluated using standardized questionnaires completed by the referring physicians before and after PET/CT. Patient outcome was analyzed for OS drawn from patient records. RESULTS Referring physicians were unable to establish a treatment plan for 81% of patients with thyroid cancer in the absence of PET/CT. The use of PET/CT had a notable influence on patient management, leading to the development of a well-defined treatment plan for 92% of patients. Moreover, after PET/CT a change in pre-PET/CT-intended treatments occurred in 32% of cases, and further invasive diagnostic could be waived in 7% of cases. [18F]FDG-PET/CT revealed a tumor detection rate of 68% (local tumor: 19%, lymph node metastases: 40%, distant metastases: 42%). HTg levels, when stimulated via TSH, were considerably higher in patients with metastases detected on PET/CT, compared to those without metastatic findings (p = 0.02). OS was significantly worse in patients with PDTC (p = 0.002) compared to follicular thyroid cancer (FTC) and PTC or even in patients with distant metastases at first diagnosis (p = 0.03). CONCLUSIONS This prospective registry study confirms that [18F]FDG-PET/CT used in a routine clinical setting has a very important impact on the management of patients with thyroid cancer by initiating treatments and reducing the uses of additional imaging and invasive tests.
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Affiliation(s)
- Jonas Vogel
- Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University Hospital of Tuebingen, Otfried-Mueller-Strasse 14, 72076 Tuebingen, Germany
- Diagnostic and Interventional Radiology, Department of Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (C.P.R.)
| | - Julia Sekler
- Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University Hospital of Tuebingen, Otfried-Mueller-Strasse 14, 72076 Tuebingen, Germany
- Diagnostic and Interventional Radiology, Department of Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (C.P.R.)
| | - Brigitte Gückel
- Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University Hospital of Tuebingen, Otfried-Mueller-Strasse 14, 72076 Tuebingen, Germany
- Diagnostic and Interventional Radiology, Department of Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (C.P.R.)
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”, University of Tuebingen, 72076 Tuebingen, Germany
| | - Christina Pfannenberg
- Diagnostic and Interventional Radiology, Department of Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (C.P.R.)
| | - Konstantin Nikolaou
- Diagnostic and Interventional Radiology, Department of Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (C.P.R.)
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”, University of Tuebingen, 72076 Tuebingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tuebingen, 72074 Tuebingen, Germany
| | - Christian La Fougère
- Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University Hospital of Tuebingen, Otfried-Mueller-Strasse 14, 72076 Tuebingen, Germany
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”, University of Tuebingen, 72076 Tuebingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tuebingen, 72074 Tuebingen, Germany
| | - Helmut Dittmann
- Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University Hospital of Tuebingen, Otfried-Mueller-Strasse 14, 72076 Tuebingen, Germany
| | - Christian Philipp Reinert
- Diagnostic and Interventional Radiology, Department of Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (C.P.R.)
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Sotirchos VS, Petre EN, Sofocleous CT. Percutaneous image-guided ablation for hepatic metastases. J Med Imaging Radiat Oncol 2023; 67:832-841. [PMID: 37944085 DOI: 10.1111/1754-9485.13594] [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: 06/22/2023] [Accepted: 09/21/2023] [Indexed: 11/12/2023]
Abstract
The presence of hepatic metastases indicates advanced disease and is associated with significant morbidity and mortality, especially when the hepatic disease is not amenable to locoregional treatments. The primary tumour of origin, the distribution and extent of metastatic disease, the underlying liver reserve, the patient performance status and the presence of comorbidities are factors that determine whether a patient will benefit from hepatectomy or local curative-intent treatments. For patients with metastatic colorectal cancer, the most common primary cancer that spreads to the liver, several studies have demonstrated a survival benefit for patients who can be treated with hepatectomy and/or percutaneous ablation, compared to those treated with chemotherapy alone. Despite advances in surgical techniques increasing the percentage of patients eligible for surgery, most patients have unresectable disease or are poor surgical candidates. Percutaneous ablation can be used to provide local disease control and prolong survival for both surgical and non-surgical candidates. This is typically offered to patients with small hepatic metastases that can be ablated with optimal (≥10 mm) or at least adequate minimum ablation margins (≥5 mm), as high local tumour control rates can be achieved for these patients which are comparable to surgical resection. This review summarizes available evidence and outcomes following percutaneous ablation of the most frequently encountered types of hepatic metastases in the clinical practice of interventional oncology. Patient selection, technical considerations, follow-up protocols and oncologic outcomes are presented and discussed.
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Affiliation(s)
- Vlasios S Sotirchos
- Interventional Oncology/Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elena N Petre
- Interventional Oncology/Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Constantinos T Sofocleous
- Interventional Oncology/Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Soyluoglu S, Ozdemir Gunay B. Contribution of Metabolic Parameters and Pericolic Fat Stranding on Preoperative 18F-FDG PET/CT in Predicting Post-operative Histopathology and Outcome in Colorectal Cancer. Nucl Med Mol Imaging 2023; 57:223-234. [PMID: 37720878 PMCID: PMC10504194 DOI: 10.1007/s13139-023-00808-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 09/19/2023] Open
Abstract
Purpose We aimed to investigate the additional value of preoperative PET/CT and reveal relationships between metabolic parameters, pericolic fat stranding finding, postoperative histopathology, and overall survival in colorectal cancer (CRC). Methods CRC patients who underwent preoperative PET/CT between January 2017-December 2021 were analyzed. Lymph nodes, organ metastases, and metabolic parameters were evaluated from PET/CT. The pericolic fat stranding was evaluated from CT component. Relationships between these factors and postoperative histopathological findings were statistically analyzed. Survival analyses were performed. Results Ninety-one patients (59 males, 32 females) were included in the study. All tumors showed high FDG uptake (mean SUVmax 19.5 ± 9.9). SUVmax of the tumor differed significantly at T3 and T4 stages (p = 0.041). A significant correlation was found between MTV, TLG values and the differentiation degree (p = 0.005, 0.003, respectively). PET/CT predicted the N stage with a high accuracy rate (80%). PET/CT found additional metastases that changed treatment decisions in one-third of patients. A relationship was found between tumor length, surgical margin, lymphovascular invasion and pericolic fat stranding. In multivariate analysis, differentiation degree (HR = 26.1, 95%CI 1.672-408.467), MTV (HR = 0.3, 95%CI 0.071-0.841), TLG (HR = 3.5, 95%CI 1.065-11.193), and lymphovascular invasion (HR = 0.2, 95%CI 0.026-0.853, p = 0.033) were independent factors affecting overall survival. Conclusion Preoperative PET/CT contributes to CRC management by detecting additional metastases as well as predicting prognosis and postoperative findings such as T stage, N stage and tumor differentiation. The SUVmax may differentiate between T3 and T4 tumor. Reporting of pericolic fat stranding may contribute to the estimation of lymphatic invasion and positive surgical margin.
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Affiliation(s)
- Selin Soyluoglu
- Faculty of Medicine, Department of Nuclear Medicine, Trakya University, Balkan Yerleskesi Trakya Üniversitesi Tıp Fakultesi Nukleer Tıp AD, Edirne, 22030 Turkey
| | - Busra Ozdemir Gunay
- Faculty of Medicine, Department of Nuclear Medicine, Trakya University, Balkan Yerleskesi Trakya Üniversitesi Tıp Fakultesi Nukleer Tıp AD, Edirne, 22030 Turkey
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Li H, Gu GL, Li SY, Yan Y, Hu SD, Fu Z, Du XH. Multidisciplinary discussion and management of synchronous colorectal liver metastases: A single center study in China. World J Gastrointest Oncol 2023; 15:1616-1625. [PMID: 37746642 PMCID: PMC10514728 DOI: 10.4251/wjgo.v15.i9.1616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/24/2023] [Accepted: 08/04/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The multidisciplinary team (MDT) has been carried out in many large hospitals now. However, given the costs of time and money and with little strong evidence of MDT effectiveness being reported, critiques of MDTs persist. AIM To evaluate the effects of MDTs on patients with synchronous colorectal liver metastases and share our opinion on management of synchronous colorectal liver metastases. METHODS In this study we collected clinical data of patients with synchronous colorectal liver metastases from February 2014 to February 2017 in the Chinese People's Liberation Army General Hospital and subsequently divided them into an MDT+ group and an MDT- group. In total, 93 patients in MDT+ group and 169 patients in MDT- group were included totally. RESULTS Statistical increases in the rate of chest computed tomography examination (P = 0.001), abdomen magnetic resonance imaging examination (P = 0.000), and preoperative image staging (P = 0.0000) were observed in patients in MDT+ group. Additionally, the proportion of patients receiving chemotherapy (P = 0.019) and curative resection (P = 0.042) was also higher in MDT+ group. Multivariable analysis showed that the population of patients assessed by MDT meetings had higher 1-year [hazard ratio (HR) = 0.608, 95% confidence interval (CI): 0.398-0.931, P = 0.022] and 5-year (HR = 0.694, 95%CI: 0.515-0.937, P = 0.017) overall survival. CONCLUSION These results proved that MDT management did bring patients with synchronous colorectal liver metastases more opportunities for comprehensive examination and treatment, resulting in better outcomes.
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Affiliation(s)
- Hao Li
- Graduate School, Medical School of Chinese People’s Liberation Army, Beijing 100039, China
- Department of General Surgery, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
| | - Guo-Li Gu
- Department of General Surgery, Air Force Medical Center, Air Force Medical University, Beijing 100142, China
| | - Song-Yan Li
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100039, China
| | - Yang Yan
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100039, China
| | - Shi-Dong Hu
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100039, China
| | - Ze Fu
- Graduate School, Medical School of Chinese People’s Liberation Army, Beijing 100039, China
| | - Xiao-Hui Du
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100039, China
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Siriwardena AK, Serrablo A, Fretland ÅA, Wigmore SJ, Ramia-Angel JM, Malik HZ, Stättner S, Søreide K, Zmora O, Meijerink M, Kartalis N, Lesurtel M, Verhoef C, Balakrishnan A, Gruenberger T, Jonas E, Devar J, Jamdar S, Jones R, Hilal MA, Andersson B, Boudjema K, Mullamitha S, Stassen L, Dasari BVM, Frampton AE, Aldrighetti L, Pellino G, Buchwald P, Gürses B, Wasserberg N, Gruenberger B, Spiers HVM, Jarnagin W, Vauthey JN, Kokudo N, Tejpar S, Valdivieso A, Adam R. The multi-societal European consensus on the terminology, diagnosis and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE. HPB (Oxford) 2023; 25:985-999. [PMID: 37471055 DOI: 10.1016/j.hpb.2023.05.360] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases with a focus on terminology, diagnosis and management. METHODS This project was a multi-organisational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis and management. Statements were refined during an online Delphi process and those with 70% agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising twelve key statements. RESULTS Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term "early metachronous metastases" applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour with "late metachronous metastases" applied to those detected after 12 months. Disappearing metastases applies to lesions which are no longer detectable on MR scan after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways including systemic chemotherapy, synchronous surgery and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed. CONCLUSIONS The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.
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Affiliation(s)
| | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Stephen J Wigmore
- Hepatobiliary and Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jose M Ramia-Angel
- Department of Surgery, University Hospital of Guadalajara, Guadalajara, Spain
| | - Hassan Z Malik
- Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergutklinikum, Vöcklabruck, Austria
| | - Kjetil Søreide
- Department of Surgery, Bergen University Hospital, Bergen, Norway
| | - Oded Zmora
- Department of Colorectal Surgery, Shamir Medical Center, Tel Aviv, Israel
| | - Martijn Meijerink
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | | | | | - Cornelis Verhoef
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Anita Balakrishnan
- Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Thomas Gruenberger
- Department of Surgery, HPB Center, Health Network Vienna, Clinic Favoriten and Sigmund Freud University, Vienna, Austria
| | - Eduard Jonas
- Department of Surgery, Groote Schuur Hospital, Cape Town
| | - John Devar
- Department of Surgery, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Saurabh Jamdar
- Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Robert Jones
- Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Bodil Andersson
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Karim Boudjema
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, Hôpital Pontchaillou, Rennes, France
| | | | - Laurents Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bobby V M Dasari
- Hepatobiliary and Liver Transplant Unit, Queen Elizabeth University Hospital, Birmingham, UK
| | - Adam E Frampton
- Hepato-Pancreato-Biliary Unit, Royal Surrey County Hospital, Guildford, UK
| | - Luca Aldrighetti
- Department of Surgery, Vita Salute San Raffaele University & IRCCS San Raffaele Hospital, Milan, Italy
| | - Gianluca Pellino
- Department of Colorectal Surgery, Vall D'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Pamela Buchwald
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Bengi Gürses
- Department of Radiology, Koc University Medical Faculty, Istanbul, Turkey
| | - Nir Wasserberg
- Department of Surgery, Beilinson Hospital, Rabin Medical Center, Tel Aviv University, Israel
| | - Birgit Gruenberger
- Department of Medical Oncology and Haematology, Landesklinikum Wiener Neustadt, Lower Austria, Austria
| | - Harry V M Spiers
- Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke's Hospital, Cambridge, UK
| | - William Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Norihiro Kokudo
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | - René Adam
- Hepatobiliary and Transplant Unit, Hôpital Paul Brousse, Paris, France
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Dayes IS, Metser U, Hodgson N, Parpia S, Eisen AF, George R, Blanchette P, Cil TD, Arnaout A, Chan A, Levine MN. Impact of 18F-Labeled Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Versus Conventional Staging in Patients With Locally Advanced Breast Cancer. J Clin Oncol 2023; 41:3909-3916. [PMID: 37235845 DOI: 10.1200/jco.23.00249] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/08/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE Patients with locally advanced breast cancer (LABC) typically undergo staging tests at presentation. If staging does not detect metastases, treatment consists of curative intent combined modality therapy (neoadjuvant chemotherapy, surgery, and regional radiation). Positron emission tomography-computed tomography (PET-CT) may detect more asymptomatic distant metastases, but the evidence is based on uncontrolled studies. METHODS For inclusion, patients had histological evidence of invasive ductal carcinoma of the breast and TNM stage III or IIb (T3N0, but not T2N1). Consenting patients from six regional cancer centers in Ontario were randomly assigned to 18F-labeled fluorodeoxyglucose PET-CT or conventional staging (bone scan, CT of the chest/abdomen and pelvis). The primary end point was upstaging to stage IV. A key secondary outcome was receiving curative intent combined modality therapy (ClinicalTrials.gov identifier: NCT02751710). RESULTS Between December 2016 and April 2022, 184 patients were randomly assigned to whole-body PET-CT and 185 patients to conventional staging. Forty-three (23%) PET-CT patients were upstaged to stage IV compared with 21 (11%) conventional staged patients (absolute difference, 12.3% [95% CI, 3.9 to 19.9]; P = .002). Consequently, treatment was changed in 35 (81.3%) of 43 upstaged PET-CT patients and 20 (95.2%) of the 21 upstaged conventional patients. Subsequently, 149 (81%) patients in the PET-CT group received combined modality treatment versus 165 (89.2%) patients in the conventional staging group (absolute difference, 8.2% [95% CI, 0.1 to 15.4]; P = .03). CONCLUSION In patients with LABC, PET-CT detected more distant metastases than conventional staging, and fewer PET-CT patients received combined modality therapy. Our randomized trial demonstrates the utility of the PET-CT staging strategy.
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Affiliation(s)
- Ian S Dayes
- Department of Oncology, McMaster University, Hamilton, ON, Canada
- Juravinski Cancer Centre-Hamilton Health Sciences, Hamilton, ON, Canada
- Ontario Clinical Oncology Group, Hamilton, ON, Canada
- Escarpment Cancer Research Institute, Hamilton, ON, Canada
| | - Ur Metser
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- University Health Network Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Nicole Hodgson
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Sameer Parpia
- Department of Oncology, McMaster University, Hamilton, ON, Canada
- Ontario Clinical Oncology Group, Hamilton, ON, Canada
- Escarpment Cancer Research Institute, Hamilton, ON, Canada
| | - Andrea F Eisen
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre-Odette Cancer Centre, Toronto, ON, Canada
- Ontario Health, Toronto, ON, Canada
| | - Ralph George
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- St Michael's Hospital, Toronto, ON, Canada
| | - Phillip Blanchette
- Department of Oncology, Western University, London, ON, Canada
- London Health Sciences Regional Cancer Program, London, ON, Canada
| | - Tulin D Cil
- University Health Network Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Angel Arnaout
- Department of Surgery, Ottawa University, Ottawa, ON, Canada
- Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Adrien Chan
- Northern Ontario School of Medicine, Thunder Bay ON, Canada
- Thunder Bay Regional Health Sciences Cancer Centre, Thunder Bay, ON, Canada
| | - Mark N Levine
- Department of Oncology, McMaster University, Hamilton, ON, Canada
- Juravinski Cancer Centre-Hamilton Health Sciences, Hamilton, ON, Canada
- Ontario Clinical Oncology Group, Hamilton, ON, Canada
- Escarpment Cancer Research Institute, Hamilton, ON, Canada
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8
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Spiliopoulos S, Moschovaki-Zeiger O, Sethi A, Festas G, Reppas L, Filippiadis D, Kelekis N. An update on locoregional percutaneous treatment technologies in colorectal cancer liver metastatic disease. Expert Rev Med Devices 2023; 20:293-302. [PMID: 36825337 DOI: 10.1080/17434440.2023.2185137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Liver-dominant metastatic colorectal cancer is noted in approximately 20%-35% of the patients. Systemic chemotherapy remains the first-line treatment for mCRC, but the prognosis is poor due to liver failure. Novel minimally invasive technologies have enabled the optimization of locoregional treatment options. AREAS COVERED This is a comprehensive review of novel locoregional treatment technologies, both percutaneous ablation and transcatheter arterial treatments, which can be used to decrease hepatic disease progression in patients with mCRC. Trans-arterial radioembolization is the most recently developed locoregional treatment for metastatic liver disease, and robust evidence has been accumulated over the past years. EXPERT OPINION Image-guided techniques, endovascular and ablative, have gained wide acceptance for the treatment of liver malignancies, in selected patients with non-resectable disease. The optimization of dosimetry and microsphere technological advancement will certainly upgrade the role of liver radioembolization segmentectomy or lobectomy in the upcoming years, due to its curative intent. Also, ablative interventions provide local curative intent, offering significant and sustained local tumor control. Standardization protocols in terms of predictability and reliability using immediate treatment assessment and ablation zone software could further ameliorate clinical outcomes.
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Affiliation(s)
- Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Akshay Sethi
- Department of Interventional Radiology, Aberdeen Royal Infirmary Hospital, NHS Grampian, Aberdeen, UK
| | - George Festas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Dimitris Filippiadis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
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9
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Zhu HB, Xu D, Sun XF, Li XT, Zhang XY, Wang K, Xing BC, Sun YS. Prediction of hepatic lymph node metastases based on magnetic resonance imaging before and after preoperative chemotherapy in patients with colorectal liver metastases underwent surgical resection. Cancer Imaging 2023; 23:18. [PMID: 36810192 PMCID: PMC9942330 DOI: 10.1186/s40644-023-00529-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Patients with colorectal liver metastases (CRLM) combined with hepatic lymph node (HLN) metastases have a poor prognosis. In this study, we developed and validated a model using clinical and magnetic resonance imaging (MRI) parameters to predict HLN status before surgery. METHODS A total of 104 CRLM patients undergoing hepatic lymphonodectomy with pathologically confirmed HLN status after preoperative chemotherapy were enrolled in this study. The patients were further divided into a training group (n = 52) and a validation group (n = 52). The apparent diffusion coefficient (ADC) values, including ADCmean and ADCmin of the largest HLN before and after treatment, were measured. rADC was calculated referring to the target liver metastases, spleen, and psoas major muscle (rADC-LM, rADC-SP, rADC-m). In addition, ADC change rate (Δ% ADC) was quantitatively calculated. A multivariate logistic regression model for predicting HLN status in CRLM patients was constructed using the training group and further tested in the validation group. RESULTS In the training cohort, post-ADCmean (P = 0.018) and the short diameter of the largest lymph node after treatment (P = 0.001) were independent predictors for metastatic HLN in CRLM patients. The model's AUC was 0.859 (95% CI, 0.757-0.961) and 0.767 (95% CI 0.634-0.900) in the training and validation cohorts, respectively. Patients with metastatic HLN showed significantly worse overall survival (p = 0.035) and recurrence-free survival (p = 0.015) than patients with negative HLN. CONCLUSIONS The developed model using MRI parameters could accurately predict HLN metastases in CRLM patients and could be used to preoperatively assess the HLN status and facilitate surgical treatment decisions in patients with CRLM.
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Affiliation(s)
- Hai-bin Zhu
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
| | - Da Xu
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
| | - Xue-Feng Sun
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
| | - Xiao-Ting Li
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
| | - Xiao-Yan Zhang
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
| | - Kun Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 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, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
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10
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Sharma A, Ravindra SG, Singh TP, Kumar R. Role of Positron Emission Tomography/Computed Tomography in Gastrointestinal Malignancies: A Brief Review and Pictorial Essay. Indian J Nucl Med 2022; 37:249-258. [PMID: 36686294 PMCID: PMC9855232 DOI: 10.4103/ijnm.ijnm_208_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/02/2022] [Accepted: 03/16/2022] [Indexed: 11/07/2022] Open
Abstract
Positron emission tomography/computed tomography (PET/CT) is increasingly becoming a mainstay in diagnosis and management of many malignant disorders. However, its role in the assessment of gastro-intestinal lesions is still evolving. The aim of this review was to demonstrate the areas, where PET/CT is impactful and where it has limitations. This will allow for us to reduce unnecessary investigations and develop methods to overcome the limitations.
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Affiliation(s)
- Anshul Sharma
- Department of Nuclear Medicine, HBCH and RC (TMC), Mullanpur, Punjab, India
| | - Shubha G Ravindra
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tejesh Pratap Singh
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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11
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Tonini V, Vigutto G, Donati R. Liver surgery for colorectal metastasis: New paths and new goals with the help of artificial intelligence. Artif Intell Gastroenterol 2022; 3:28-35. [DOI: 10.35712/aig.v3.i2.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/28/2022] [Accepted: 04/19/2022] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is one of the most common neoplasia with an high risk to metastatic spread. Improving medical and surgical treatment is moving along with improving the precision of diagnosis and patient's assessment, the latter two aided more and more with the use of artificial intelligence (AI). The management of colorectal liver metastasis is multidisciplinary, and surgery is the main option. After the diagnosis, a surgical assessment of the patient is fundamental. Reaching a R0 resection with a proper remnant liver volume can be done using new techniques involving also artificial intelligence. Considering the recent application of artificial intelligence as a valid substitute for liver biopsy in chronic liver diseases, several authors tried to apply similar techniques to pre-operative imaging of liver metastasis. Radiomics showed good results in identifying structural changes in a unhealthy liver and in evaluating the prognosis after a liver resection. Recently deep learning has been successfully applied in estimating the remnant liver volume before surgery. Moreover AI techniques can help surgeons to perform an early diagnosis of neoplastic relapse or a better differentiation between a colorectal metastasis and a benign lesion. AI could be applied also in the histopathological diagnostic tool. Although AI implementation is still partially automatized, it appears faster and more precise than the usual diagnostic tools and, in the short future, could become the new gold standard in liver surgery.
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Affiliation(s)
- Valeria Tonini
- Department of Medical and Surgical Sciences, Sant' Orsola Hospital University of Bologna, Bologna 40138, Italy
| | - Gabriele Vigutto
- Department of Medical and Surgical Sciences, St Orsola Hospital, University of Bologna, Bologna 40138, Italy
| | - Riccardo Donati
- Department of Electrical, Electronic and Information Engineering ”Guglielmo Marconi” (DEI), University of Bologna, Bologna 40138, Italy
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12
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Lin YM, Bale R, Brock KK, Odisio BC. Contemporary evidence on colorectal liver metastases ablation: toward a paradigm shift in locoregional treatment. Int J Hyperthermia 2022; 39:649-663. [DOI: 10.1080/02656736.2021.1970245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Yuan-Mao Lin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Kristy K. Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruno C. Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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13
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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: 21] [Impact Index Per Article: 10.5] [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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14
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Jonsson J, Hemmingsson O, Strengbom R, Axelsson J, Riklund K, Nyström H. Does 18F-FDG PET/CT change the surgical management of potentially resectable colorectal liver metastases? Scand J Surg 2022; 111:14574969221083144. [PMID: 35348393 DOI: 10.1177/14574969221083144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Resectability assessment of patients with colorectal liver metastases is based on computed tomography and liver magnetic resonance imaging. Addition of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography has been recommended, but the impact of the added information remains unclear. The primary aim of this study was to determine how preoperative positron emission tomography/computed tomography changed management in patients with potentially resectable colorectal liver metastases. The secondary aim was to investigate whether findings on positron emission tomography/computed tomography correlated to metastatic disease in cases with extended surgery and influenced oncological outcomes. METHODS A retrospective observational study of the impact of adding positron emission tomography/computed tomography to conventional imaging in the surgical decision-making of colorectal liver metastases. All patients with colorectal liver metastases diagnosed by conventional imaging were included and assessed by a multidisciplinary team conference at Umeå University Hospital between June 2013 and December 2017. Eligibility criteria were all patients with potentially resectable colorectal liver metastases. Patients who underwent preoperative positron emission tomography/computed tomography in addition to conventional radiology were compared with those who underwent conventional imaging only. RESULTS 151/220 patients underwent preoperative positron emission tomography/computed tomography. Findings on positron emission tomography/computed tomography changed the management in 10.6% of the patients. Eight patients were excluded from surgery after detection by positron emission tomography/computed tomography of extrahepatic disease. Eight patients underwent more extended surgery than initially planned due to positron emission tomography/computed tomography. Five of these positron emission tomography-positive resected sites were verified by pathology as metastatic disease. No difference in overall survival was seen following surgical resection in patients with and without a preoperative positron emission tomography/computed tomography. CONCLUSIONS Preoperative positron emission tomography/computed tomography resulted in a changed surgical management in 10.6% of cases in a selected cohort.
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Affiliation(s)
- Josefin Jonsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Oskar Hemmingsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Rebecca Strengbom
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Jan Axelsson
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Hanna Nyström
- Umeå University Hospital Kirurgcentrum By 10A SE-901 85 Umeå Sweden.,Department of Surgical and Perioperative Sciences, Surgery Umeå University Umeå Sweden.,Wallenberg Centre for Molecular Medicine Umeå University Umeå Sweden
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15
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Bonney GK, Chew CA, Lodge P, Hubbard J, Halazun KJ, Trunecka P, Muiesan P, Mirza DF, Isaac J, Laing RW, Iyer SG, Chee CE, Yong WP, Muthiah MD, Panaro F, Sanabria J, Grothey A, Moodley K, Chau I, Chan ACY, Wang CC, Menon K, Sapisochin G, Hagness M, Dueland S, Line PD, Adam R. Liver transplantation for non-resectable colorectal liver metastases: the International Hepato-Pancreato-Biliary Association consensus guidelines. Lancet Gastroenterol Hepatol 2021; 6:933-946. [PMID: 34506756 DOI: 10.1016/s2468-1253(21)00219-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022]
Abstract
Colorectal cancer is a prevalent disease worldwide, with more than 50% of patients developing metastases to the liver. Despite advances in improving resectability, most patients present with non-resectable colorectal liver metastases requiring palliative systemic therapy and locoregional disease control strategies. There is a growing interest in the use of liver transplantation to treat non-resectable colorectal liver metastases in well selected patients, leading to a surge in the number of studies and prospective trials worldwide, thereby fuelling the emerging field of transplant oncology. The interdisciplinary nature of this field requires domain-specific evidence and expertise to be drawn from multiple clinical specialities and the basic sciences. Importantly, the wider societal implication of liver transplantation for non-resectable colorectal liver metastases, such as the effect on the allocation of resources and national transplant waitlists, should be considered. To address the urgent need for a consensus approach, the International Hepato-Pancreato-Biliary Association commissioned the Liver Transplantation for Colorectal liver Metastases 2021 working group, consisting of international leaders in the areas of hepatobiliary surgery, colorectal oncology, liver transplantation, hepatology, and bioethics. The aim of this study was to standardise nomenclature and define management principles in five key domains: patient selection, evaluation of biological behaviour, graft selection, recipient considerations, and outcomes. An extensive literature review was done within the five domains identified. Between November, 2020, and January, 2021, a three-step modified Delphi consensus process was undertaken by the workgroup, who were further subgrouped into the Scientific Committee, Expert Panel, and Transplant Centre Representatives. A final consensus of 44 statements, standardised nomenclature, and a practical management algorithm is presented. Specific criteria for clinico-patho-radiological assessments with molecular profiling is crucial in this setting. After this, the careful evaluation of biological behaviour with bridging therapy to transplantation with an appropriate assessment of the response is required. The sequencing of treatment in synchronous metastatic disease requires special consideration and is highlighted here. Some ethical dilemmas within organ allocation for malignant indications are discussed and the role for extended criteria grafts, living donor transplantation, and machine perfusion technologies for non-resectable colorectal liver metastases are reviewed. Appropriate immunosuppressive regimens and strategies for the follow-up and treatment of recurrent disease are proposed. This consensus guideline provides a framework by which liver transplantation for non-resectable colorectal liver metastases might be safely instituted and is a meaningful step towards future evidenced-based practice for better patient selection and organ allocation to improve the survival for patients with this disease.
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Affiliation(s)
- Glenn K Bonney
- Division of Hepatobiliary and Pancreatic Surgery, National University Hospital, Singapore.
| | - Claire Alexandra Chew
- Division of Hepatobiliary and Pancreatic Surgery, National University Hospital, Singapore
| | - Peter Lodge
- Department of Transplantation and Hepatobiliary Surgery, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Joleen Hubbard
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Karim J Halazun
- Division of Liver Transplantation and Hepato-Pancreato-Biliary Surgery, Department of Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Pavel Trunecka
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Paolo Muiesan
- Department of Hepatobiliary Surgery, Careggi University Hospital, Florence, Italy
| | - Darius F Mirza
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - John Isaac
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard W Laing
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Shridhar Ganpathi Iyer
- Division of Hepatobiliary and Pancreatic Surgery, National University Hospital, Singapore
| | - Cheng Ean Chee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Wei Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Mark Dhinesh Muthiah
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Fabrizio Panaro
- Division of Hepato-Pancreato-Biliary Surgery and Transplantation, Department of Surgery, Saint Eloi Hospital, Montpellier University Hospital-School of Medicine, Montpellier, France
| | - Juan Sanabria
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Axel Grothey
- Department of Medical Oncology, West Cancer Center and Research Institute, Germantown, TN, USA
| | - Keymanthri Moodley
- The Centre of Medical Ethics and Law, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Ian Chau
- Department of Medicine, Royal Marsden Hospital, London, UK
| | - Albert C Y Chan
- Division of Liver Transplantation, Hepatobiliary & Pancreatic Surgery, Queen Mary Hospital, Hong Kong
| | - Chih Chi Wang
- Department of Surgery, Liver Transplantation Centre, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Krishna Menon
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Gonzalo Sapisochin
- Abdominal Transplant and Hepato-Pancreato-Biliary Surgical Oncology, Multi-Organ Transplant Program, Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Morten Hagness
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Svein Dueland
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - René Adam
- Hepato Biliary Surgery, Cancer and Transplantation Unit, AP-HP Paul Brousse Hospital, University Paris-Saclay, Villejuif, France
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16
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Görgec B, Hansen I, Kemmerich G, Syversveen T, Abu Hilal M, Belt EJT, Bisschops RHC, Bollen TL, Bosscha K, Burgmans MC, Cappendijk V, De Boer MT, D'Hondt M, Edwin B, Gielkens H, Grünhagen DJ, Gillardin P, Gobardhan PD, Hartgrink HH, Horsthuis K, Kok NFM, Kint PAM, Kruimer JWH, Leclercq WKG, Lips DJ, Lutin B, Maas M, Marsman HA, Morone M, Pennings JP, Peringa J, Te Riele WW, Vermaas M, Wicherts D, Willemssen FEJA, Zonderhuis BM, Bossuyt PMM, Swijnenburg RJ, Fretland ÅA, Verhoef C, Besselink MG, Stoker J. Clinical added value of MRI to CT in patients scheduled for local therapy of colorectal liver metastases (CAMINO): study protocol for an international multicentre prospective diagnostic accuracy study. BMC Cancer 2021; 21:1116. [PMID: 34663243 PMCID: PMC8524830 DOI: 10.1186/s12885-021-08833-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/04/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Abdominal computed tomography (CT) is the standard imaging method for patients with suspected colorectal liver metastases (CRLM) in the diagnostic workup for surgery or thermal ablation. Diffusion-weighted and gadoxetic-acid-enhanced magnetic resonance imaging (MRI) of the liver is increasingly used to improve the detection rate and characterization of liver lesions. MRI is superior in detection and characterization of CRLM as compared to CT. However, it is unknown how MRI actually impacts patient management. The primary aim of the CAMINO study is to evaluate whether MRI has sufficient clinical added value to be routinely added to CT in the staging of CRLM. The secondary objective is to identify subgroups who benefit the most from additional MRI. METHODS In this international multicentre prospective incremental diagnostic accuracy study, 298 patients with primary or recurrent CRLM scheduled for curative liver resection or thermal ablation based on CT staging will be enrolled from 17 centres across the Netherlands, Belgium, Norway, and Italy. All study participants will undergo CT and diffusion-weighted and gadoxetic-acid enhanced MRI prior to local therapy. The local multidisciplinary team will provide two local therapy plans: first, based on CT-staging and second, based on both CT and MRI. The primary outcome measure is the proportion of clinically significant CRLM (CS-CRLM) detected by MRI not visible on CT. CS-CRLM are defined as liver lesions leading to a change in local therapeutical management. If MRI detects new CRLM in segments which would have been resected in the original operative plan, these are not considered CS-CRLM. It is hypothesized that MRI will lead to the detection of CS-CRLM in ≥10% of patients which is considered the minimal clinically important difference. Furthermore, a prediction model will be developed using multivariable logistic regression modelling to evaluate the predictive value of patient, tumor and procedural variables on finding CS-CRLM on MRI. DISCUSSION The CAMINO study will clarify the clinical added value of MRI to CT in patients with CRLM scheduled for local therapy. This study will provide the evidence required for the implementation of additional MRI in the routine work-up of patients with primary and recurrent CRLM for local therapy. TRIAL REGISTRATION The CAMINO study was registered in the Netherlands National Trial Register under number NL8039 on September 20th 2019.
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Affiliation(s)
- B Görgec
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - I Hansen
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.,The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - G Kemmerich
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - T Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - M Abu Hilal
- Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - E J T Belt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - R H C Bisschops
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - T L Bollen
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - M C Burgmans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - V Cappendijk
- Department of Radiology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - M T De Boer
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - M D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - B Edwin
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.,The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - H Gielkens
- Department of Radiology, Medical Spectrum Twente, Enschede, The Netherlands
| | - D J Grünhagen
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands.,Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - P Gillardin
- Department of Radiology, Hospital Oost-Limburg, Genk, Belgium
| | - P D Gobardhan
- Department of Surgery, Amphia Hospital, Breda, The Netherlands
| | - H H Hartgrink
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - K Horsthuis
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - N F M Kok
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P A M Kint
- Department of Radiology, Amphia Hospital, Breda, The Netherlands
| | - J W H Kruimer
- Department of Radiology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - W K G Leclercq
- Department of Surgery, Máxima Medical Centre, Veldhoven, The Netherlands
| | - D J Lips
- Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - B Lutin
- Department of Radiology, Groeninge Hospital, Kortrijk, Belgium
| | - M Maas
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H A Marsman
- Department of Surgery, OLVG, Amsterdam, The Netherlands
| | - M Morone
- Department of Radiology, Poliambulanza Foundation Hospital, Brescia, Italy
| | - J P Pennings
- Department of Radiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - J Peringa
- Department of Radiology, OLVG, Amsterdam, The Netherlands
| | - W W Te Riele
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M Vermaas
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - D Wicherts
- Department of Surgery, Hospital Oost-Limburg, Genk, Belgium
| | - F E J A Willemssen
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B M Zonderhuis
- Department of Surgery, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - P M M Bossuyt
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R J Swijnenburg
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Å A Fretland
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway.,The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - C Verhoef
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands.,Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - J Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
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17
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Sassi I, Ghalleb M, Chemlali M, Mbarek M, Charfi L, Chargui R, Rahal K. Uterine cervix metastasis from primary colon adenocarcinoma: a case report and review of the literature. J Med Case Rep 2021; 15:486. [PMID: 34598716 PMCID: PMC8487153 DOI: 10.1186/s13256-021-03055-2] [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: 02/04/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Metastases to the female genital tract from extragenital primary tumors are unusual. We report a rare case of uterine cervix metastasis from colon adenocarcinoma and discuss diagnostic and therapeutic issues. Case report We report a case of a 38-year-old North African Caucasian woman treated for a non-metastatic colon adenocarcinoma. She had a sigmoidectomy and incomplete adjuvant chemotherapy. Six months later, she consulted with vaginal bleeding caused by a cervical tumor, which was confirmed to be metastatic disease, and the patient underwent decompressive and hemostatic radiotherapy. Conclusion Uterine cervix metastasis from primary colon adenocarcinoma is rare. The resection remains the standard protocol for the local treatment of resectable metastatic disease. Otherwise, systemic therapy is the preferable option.
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Affiliation(s)
- I Sassi
- Surgical Oncology Department, Institute Salah Azaiez de Cancer, Tunis, Tunisia.,Faculté de Medicine Tunis El Manar, Tunis, Tunisia
| | - M Ghalleb
- Surgical Oncology Department, Institute Salah Azaiez de Cancer, Tunis, Tunisia. .,Faculté de Medicine Tunis El Manar, Tunis, Tunisia.
| | - M Chemlali
- Surgical Oncology Department, Institute Salah Azaiez de Cancer, Tunis, Tunisia.,Faculté de Medicine Tunis El Manar, Tunis, Tunisia
| | - M Mbarek
- Surgical Oncology Department, Institute Salah Azaiez de Cancer, Tunis, Tunisia.,Faculté de Medicine Tunis El Manar, Tunis, Tunisia
| | - L Charfi
- Pathology Department, Institute Salah Azaiez de Cancer, Tunis, Tunisia.,Faculté de Medicine Tunis El Manar, Tunis, Tunisia
| | - R Chargui
- Surgical Oncology Department, Institute Salah Azaiez de Cancer, Tunis, Tunisia.,Faculté de Medicine Tunis El Manar, Tunis, Tunisia
| | - K Rahal
- Surgical Oncology Department, Institute Salah Azaiez de Cancer, Tunis, Tunisia.,Faculté de Medicine Tunis El Manar, Tunis, Tunisia
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18
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Lin YM, Paolucci I, Brock KK, Odisio BC. Image-Guided Ablation for Colorectal Liver Metastasis: Principles, Current Evidence, and the Path Forward. Cancers (Basel) 2021; 13:cancers13163926. [PMID: 34439081 PMCID: PMC8394430 DOI: 10.3390/cancers13163926] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Colorectal cancer is the fourth most common type of cancer globally. Approximately 20% of patients with colorectal cancer present with synchronous liver metastases, and up to 60% will develop metachronous metastases during the course of the disease. Although liver resection is currently considered the local treatment of choice for colorectal liver metastasis (CLM), less than one-third of patients are eligible for surgery at the time of diagnosis of CLM. Ablation is a well-established, less invasive, locoregional therapy for patients with small CLMs, which has shown favorable oncological outcomes in patients with unresectable CLMs, comparable to those in patients eligible for surgery. The increasing knowledge of factors affecting oncological outcomes has allowed selected patients with resectable small volume CLMs to be treated with thermal ablation with curative intent. The continuous technological evolutions in imaging and image guidance have contributed to this paradigm shift in CLM treatment. The importance of patient selection, patient factors, tumor factors, ablation techniques, and clinical applications is discussed in this article. Abstract Image-guided ablation can provide effective local tumor control in selected patients with CLM. A randomized controlled trial suggested that radiofrequency ablation combined with systemic chemotherapy resulted in a survival benefit for patients with unresectable CLM, compared to systemic chemotherapy alone. For small tumors, ablation with adequate margins can be considered as an alternative to resection. The improvement of ablation technologies can allow the treatment of tumors close to major vascular structures or bile ducts, on which the applicability of thermal ablation modalities is challenging. Several factors affect the outcomes of ablation, including but not limited to tumor size, number, location, minimal ablation margin, RAS mutation status, prior hepatectomy, and extrahepatic disease. Further understanding of the impact of tumor biology and advanced imaging guidance on overall patient outcomes might help to tailor its application, and improve outcomes of image-guided ablation.
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Affiliation(s)
- Yuan-Mao Lin
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
| | - Iwan Paolucci
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
| | - Kristy K. Brock
- Department of Imaging Physics, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Bruno C. Odisio
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.-M.L.); (I.P.)
- Correspondence: ; Tel.: +1-713-563-7066
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19
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Evaluation and Management of Colorectal Cancer Hepatic Metastases. Dis Colon Rectum 2021; 64:777-780. [PMID: 33872286 DOI: 10.1097/dcr.0000000000002103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A 65-year-old man presents with new liver lesions on surveillance imaging 2 years after a right hemicolectomy for cecal adenocarcinoma. The primary tumor was pT3N1, microsatellite stable, and KRAS wild type. He completed adjuvant FOLFOX. His CEA level is 22 ng/mL. There are two 1.5-cm lesions in the right lobe near the dome of the liver and a 4-cm lesion in segment II. No luminal recurrence is detected endoscopically, and there is no evidence of peritoneal or pulmonary disease.
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20
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Imaging and Image-Guided Thermal Ablation for Oligometastatic Colorectal Cancer Liver Disease. ACTA ACUST UNITED AC 2021; 26:124-128. [PMID: 32205536 DOI: 10.1097/ppo.0000000000000440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Colorectal cancer affects more than 1 million people worldwide, and half of this population develops liver metastases. Image-guided thermal ablation is an acceptable local therapy for the management of oligometastatic colorectal cancer liver disease, in patients who are noneligible for surgery, or present with recurrence after hepatectomy. Continuous technological evolutions, understanding of tumor variability through disease biology and genetics, and optimization of ablation parameters with ablation margin assessment have allowed patients with resectable small-volume disease to be treated by thermal ablation with curative intent. The growing role of imaging and image guidance in thermal ablation for patient selection, procedure planning, tumor targeting, and assessment of technical success is discussed in this article.
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21
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Majlesara A, Ghamarnejad O, Khajeh E, Golriz M, Gharabaghi N, Hoffmann K, Chang DH, Büchler MW, Mehrabi A. Portal vein arterialization as a salvage procedure in hepatopancreatobiliary surgery: a systematic review. Can J Surg 2021; 64:E173-E182. [PMID: 33739801 PMCID: PMC8064267 DOI: 10.1503/cjs.012419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Portal vein arterialization (PVA) is a possible option when hepatic artery reconstruction is impossible during liver resection. The aim of this study was to review the literature on the clinical application of PVA in hepatopancreatobiliary (HPB) surgery. Methods We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched the PubMed, Embase and Web of Science databases until December 2019. Experimental (animal) studies, review articles and letters were excluded. Results Twenty studies involving 57 patients were included. Cholangiocarcinoma was the most common indication for surgery (40 patients [74%]). An end-to-side anastomosis between a celiac trunk branch and the portal vein was the main PVA technique (35 patients [59%]). Portal hypertension was the most common long-term complication (12 patients [21%] after a mean of 4.1 mo). The median follow-up period was 12 (range 1–87) months. The 1-, 3- and 5-year survival rates were 64%, 27% and 20%, respectively. Conclusion Portal vein arterialization can be considered as a rescue option to improve the outcome in patients with acute liver de-arterialization when arterial reconstruction is not possible. To prevent portal hypertension and liver injuries due to thrombosis or overarterialization, vessel calibre adjustment and timely closure of the anastomosis should be considered. Further prospective experimental and clinical studies are needed to investigate the potential of this procedure in patients whose liver is suddenly de-arterialized during HPB procedures.
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Affiliation(s)
- Ali Majlesara
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - Omid Ghamarnejad
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - Elias Khajeh
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - Mohammad Golriz
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - Negin Gharabaghi
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - Katrin Hoffmann
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - De-Hua Chang
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - Markus W Büchler
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
| | - Arianeb Mehrabi
- From the Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (Majlesara, Ghamarnejad, Khajeh, Golriz, Gharabaghi, Hoffman, Büchler, Mehrabi); and the Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (Chang)
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22
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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: 2] [Impact Index Per Article: 0.7] [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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23
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Padmanabhan C, Nussbaum DP, D'Angelica M. Surgical Management of Colorectal Cancer Liver Metastases. Surg Oncol Clin N Am 2021; 30:1-25. [PMID: 33220799 DOI: 10.1016/j.soc.2020.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Approximately 50% of colorectal cancer patients develop liver metastases. Hepatic metastases represent the most common cause of colorectal cancer-related mortality. Metastasectomy, if possible, represents the most effective treatment strategy; 20% of patients will be cured and more than 50% survive at least 5 years. Nuances to treatment planning hinge on whether patients present with resectable disease upfront, whether the future liver remnant is adequate, and whether the primary tumor, if present, is colon versus rectal in origin. This article discusses considerations impacting our approach to patients with colorectal liver metastases and the role for various multimodal treatment options.
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Affiliation(s)
- Chandrasekhar Padmanabhan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-1272, New York, NY 10065, USA
| | - Daniel P Nussbaum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-1272, New York, NY 10065, USA
| | - Michael D'Angelica
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, C-898, New York, NY 10065, USA.
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24
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Serrano PE, Gu CS, Moulton CA, Gallinger S. Positron Emission Tomography Combined With Computed Tomography vs. No Positron Emission Tomography Combined With Computed Tomography for the Management of Patients With Resectable Colorectal Cancer Liver Metastases and Synchronous Extrahepatic Disease. Am Surg 2020; 87:1431-1437. [PMID: 33345573 DOI: 10.1177/0003134820954834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Selected patients with colorectal cancer liver metastases (CRLM) and synchronous extrahepatic disease (EHD) are considered for surgery. OBJECTIVES To evaluate the change in surgical management and long-term survival (disease-free survival [DFS] and overall survival [OS]) for patients with CRLM and EHD who undergo positron emission tomography combined with computed tomography (PET-CT) vs no PET-CT. METHODS Patients with CRLM were enrolled in a trial evaluating the effect of PET-CT (vs no PET-CT) on surgical management, DFS, and OS. This is a sub-study of the trial, including only patients with synchronous EHD. Cox proportional hazard models were used to calculate risks for recurrence and death. Survival were described by Kaplan-Meier method and compared with log-rank test. RESULTS Of 25 patients with EHD (PET-CT arm: 14/270 (5%) and no PET-CT arm: 11/134 (8%)), PET-CT changed surgical management in 14%, all of which avoided liver resection due to more extensive disease. Complete metastasectomy was achieved in 36% (5/14) and 72% (8/11), respectively. Respectively, PET-CT vs no PET-CT had statistically similar median DFS, 5.6 months (95% confidence interval (CI) 3.6-18) vs 7.6 months (95% CI 2.9-15) and median OS, 42 months (95% CI 25-48) vs 29 months (95% CI 17-41). EHD was associated with worse DFS (hazard ratio HR = 1.89, 95% CI 1.41-2.52) and OS (HR = 2.47, 95% CI 1.6-3.83). CONCLUSIONS Preoperative PET-CT for the management of resectable CRLM did not improve long-term outcomes among patients who had synchronous EHD; however, it changed surgical management in a relatively significant proportion of patients.
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Affiliation(s)
- Pablo E Serrano
- Department of Surgery, 153004McMaster University, Canada.,Ontario Clinical Oncology Group, McMaster University, Canada
| | - Chu-Shu Gu
- Ontario Clinical Oncology Group, McMaster University, Canada.,Department of Oncology, 152999McMaster University, Canada
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25
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Nam SY, Ahn SJ, Jang YR, Chun YS, Park HK, Choi SJ, Choi HY, Kim JH. Diagnostic accuracy of non-contrast abdominopelvic computed tomography scans in follow-up of breast cancer patients. Br J Radiol 2020; 94:20201087. [PMID: 33306919 DOI: 10.1259/bjr.20201087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of follow-up with non-enhanced CT (NECT) in patients with breast cancer. METHODS The present retrospective study included 1396 patients with breast cancer. Group A included patients with no metastasis to evaluate the diagnostic performance of NECT in detecting newly developed metastasis. Group B included patients with known hepatic metastasis to evaluate the accuracy of NECT for the assessment of hepatic metastasis. RESULTS Group A included 895 patients (mean age 52.8 years). Among them, 145 patients had 160 metastases. The per-patient sensitivities for diagnosing newly developed metastasis were 68.3 and 53.8% according to the two reviewers, while the per-lesion sensitivities were 89.4 and 85.0%. Sensitivities for bone metastasis were 98.9 and 95.9%, while sensitivities for hepatic metastasis were 73.7 and 68.4%. In group B, the accuracy of hepatic metastasis response evaluation according to the RECIST criteria was 70.8% for reviewer 1 and 63.8% for reviewer 2. CONCLUSIONS NECT showed inadequate diagnostic performance in detecting newly developed metastasis and in evaluating the response of hepatic metastasis. However, NECT can be utilized as a follow-up modality in patients with decreased renal function or hypersensitivity to iodinated contrast media. ADVANCES IN KNOWLEDGE The risk of side effects of contrast media should be considered as important when NECT can be utilized as a follow-up modality in decreased renal function patients.
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Affiliation(s)
- Sang Yu Nam
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Su Joa Ahn
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Young Rock Jang
- Department of Internal Medicine, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Yong Soon Chun
- Department of Surgery Breast Cancer Center, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Heung Kyu Park
- Department of Surgery Breast Cancer Center, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Seung Joon Choi
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Hye Young Choi
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Jeong Ho Kim
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
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26
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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: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [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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Abstract
At the moment, international guidelines for rectal cancer suggest to consider F-FDG PET/CT scan in a few conditions: (1) at disease presentation in case of suspected or proven metastatic synchronous adenocarcinoma with potentially curable M1 disease; (2) in the recurrence workup for serial carcinoembryonic antigen level elevation; (3) in the recurrence workup with metachronous metastases documented by CT, MRI, or biopsy; (4) in case of strong contraindication to IV contrast agent administration; and (5) to evaluate an equivocal finding on a contrast-enhanced CT or MRI. PET/CT is not indicated in the follow-up or surveillance of rectal cancer. On the other hand, an attentive evaluation of the literature shows that PET/CT may also be used in some circumstances with significant levels of diagnostic accuracy. This review article aims to emphasize differences between current international guidelines and scientific literature in the role of PET/CT in rectal cancer.
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28
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Abstract
International colon cancer guidelines suggest F-FDG PET/CT in a few circumstances: (1) at disease presentation in case of suspected or proven metastatic synchronous adenocarcinoma; (2) in the workup of recurrent colon cancer with metachronous metastases documented by CT, MRI, or biopsy and in case of serial CEA elevation with negative colonoscopy and negative CT; and (3) in case of contraindication to iodine- and gadolinium-based contrast agents. However, review of the literature has shown that PET/CT can also be used in other scenarios with significant levels of diagnostic advantage. This review aims to emphasize differences between guidelines and scientific literature for the use of PET/CT in colon cancer.
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29
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Sandach P, Kasper-Virchow S, Rischpler C, Herrmann K. Molecular Imaging and Therapy of Colorectal and Anal Cancer. Semin Nucl Med 2020; 50:465-470. [PMID: 32768009 DOI: 10.1053/j.semnuclmed.2020.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Colorectal cancer is the cancer with the third highest incidence both in males and females in the USA and is also frequently occurring in other industrialized nations. Anal cancer on the other hand is much rarer, but has a rising incidence, especially in high income nations and with a connection to HIV infections, homosexual men and a younger age of the first sexual encounter. Both have high mortality rates in common and are complex to handle in terms of prevention, staging, treatment and diagnostic of recurrence. This article aims to give an overview about the established diagnostic methods of nuclear medicine, especially sole PET and (contrast enhanced) hybrid imaging with 18F-FDG as tracer for primary staging, restaging, therapy monitoring and radiotherapy planning in current guidelines, with a special focus on the American guidelines of the National Comprehensive Cancer Network for colorectal and anal cancer. There will also be an outlook on potential future adjustments in those leading to a more significant representation of nuclear medicine by giving a synopsis of the available studies and data published in international medical press. New tracers that are still in research stage, progress in the imaging techniques, for example a further establishment of PET/MR hybrid imaging, the use of artificial intelligence and parametric imaging, as well as possible future theranostic applications like c-MET binding peptides will also be shortly discussed.
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Affiliation(s)
- Patrick Sandach
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Germany.
| | - Stefan Kasper-Virchow
- Westdeutsches Magen-und Darmzentrum Essen, Universitätsklinikum Essen, Essen, Germany.
| | | | - Ken Herrmann
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Essen, Germany.
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30
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Lei S, Ge Y, Tian S, Cai B, Gao X, Wang N, Wang G, Wang L, Wang Z. Colorectal Cancer Metastases to Brain or Bone and the Relationship to Primary Tumor Location: a Population-Based Study. J Gastrointest Surg 2020; 24:1833-1842. [PMID: 31313144 DOI: 10.1007/s11605-019-04308-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/12/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The association of primary tumor location with incidence and prognosis of brain or bone metastasis in metastatic colorectal cancer (mCRC) patients remains unclear. We dissect this association across a large population. METHODS A total of 202,401 CRC patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015 were included. For brain metastasis, 9478 cases without brain metastasis information were excluded, leaving 192,923 CRC for incidence analysis and multivariable logistic/Cox regression analyses. Similarly, 193,013 CRC were eligible for bone metastasis analyses. RESULTS The incidence of brain or bone metastasis at initial diagnosis was 1.38% and 6.12% in mCRC cohort, respectively. Median survival of CRC patients with brain or bone metastasis was 4 and 5 months, respectively. Primary tumor location is not associated with the incidence of brain metastasis but with bone metastasis. For bone metastasis, right-sided colon cancer (RCC) patients exhibited the lowest incidence, whereas rectal cancer (RC) patients had the highest. For both brain and bone metastases, RCC patients always had the shortest median survival, whereas RC patients had the longest. The common risk factors for brain or bone metastasis were grade III and multi-extracerebral or ectosteal metastases. The favorable prognostic factors for brain or bone metastasis were being female, married, insured, and RC. RCC is an unfavorable prognostic factor. CONCLUSIONS Primary tumor location impacts incidence proportions of bone metastasis and survival of both brain and bone mCRC patients. Primary tumor location should be taken into consideration in clinical practice and prognostic assessment.
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Affiliation(s)
- Shijun Lei
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yizhi Ge
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shaobo Tian
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bo Cai
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiang Gao
- Jame J. Peters VA Medical Center, Bronx, NY, 10468, USA
| | - Ning Wang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Guobin Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Lin Wang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Zheng Wang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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31
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Abstract
There have been significant developments in the management of advanced and recurrent colorectal cancer in recent decades. 70% of primary colorectal tumours arise in the colon and for patients with stage I-III disease, the standard of care is surgical resection followed by adjuvant therapy where appropriate. Locoregional recurrence (LR) occurs in 4-11.5% of patients following treatment of primary colon cancer with curative intent, and can be categorised as peri-anastomotic, mesenteric/paracolic (nodal), retroperitoneal and peritoneal. Of these, peritoneal recurrence is usually recognised as the most challenging type of recurrence to manage. Patients with isolated peri-anastomotic or limited nodal recurrence in the mesentery or retroperitoneum may be curable by radical salvage surgery, which often requires en bloc multi-visceral resection, while patients with low volume peritoneal metastases may be candidates for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ensuring complete resection along embryonic mesocolic planes or en bloc resection of contiguously involved structures are best strategies to reduce the likelihood of local recurrence through a R1 resection margin. The role of complete mesocolic excision (CME) with high vascular ligation has been demonstrated to increase nodal yield and improve overall survival although this is more contentious. In patients with T4a disease and serosal surface involvement, peritoneal recurrence represents the greatest threat. Efforts for early diagnosis of peritoneal recurrence in these patients or prophylactic treatment, while intuitive have not demonstrated the survival benefit that would be expected. Other than locoregional recurrence (LR), systemic recurrence may occur in up to 50% of patients who have undergone curative resection for colorectal cancer. In keeping with portal venous outflow, the most common site of systemic recurrence is the liver. Although previously thought to be a fatal condition, liver resection is now the standard of care where liver metastases can be completely resected with clear margins plus leaving an adequate liver remnant with intact vascular inflow, outflow and biliary drainage. This can usually be achieved in 26-45% of patients presenting with liver metastases. Liver surgeons at the forefront of liver resection have also developed techniques to induce liver hypertrophy so as to improve likelihood of resectability. Even where patients have non-resectable disease, ablative techniques have become increasingly common. Naturally, none of these would be possible without the advent of improved chemotherapeutic and biological options in the field of medical oncology. Pulmonary metastasectomy with curative intent may be possible in a small number (10%) of patients with lung metastases, which is associated with an overall survival of up to 40%. Unlike liver metastases, proportionally less patients with pulmonary metastases will be resectable. For these patients, several ablative options are available. For all patients with recurrent colon cancer, patient selection for radical salvage surgery and decisions surrounding treatment strategy (including use of systemic therapy or ablative procedures) should take place in a multidisciplinary team setting.
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Affiliation(s)
- Kilian G M Brown
- SOuRCe (Surgical Outcomes Research Centre), Royal Prince Alfred Hospital, Sydney, Australia.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Cherry E Koh
- SOuRCe (Surgical Outcomes Research Centre), Royal Prince Alfred Hospital, Sydney, Australia.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, Discipline of Surgery, University of Sydney, Australia
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32
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Abstract
Image-guided percutaneous thermal ablation is a widely acceptable local therapy for patients with colorectal liver metastases who are noneligible for surgery or present with recurrence after hepatectomy. The increasing knowledge of factors that affect oncologic outcomes has allowed selected patients with resectable small volume colorectal liver metastases to be treated by thermal ablation with curative intent. The continuous technological evolutions in imaging and image-guidance and the wide implementation of microwave ablation that overcomes most of the limitations of radiofrequency ablation have contributed to this paradigm shift. The importance of patient selection, ablation margin evaluation, and confirmation of complete tumor ablation (A0) are discussed in this article.
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33
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Elfrink AKE, Pool M, van der Werf LR, Marra E, Burgmans MC, Meijerink MR, den Dulk M, van den Boezem PB, Te Riele WW, Patijn GA, Wouters MWJM, Leclercq WKG, Liem MSL, Gobardhan PD, Buis CI, Kuhlmann KFD, Verhoef C, Besselink MG, Grünhagen DJ, Klaase JM, Kok NFM. Preoperative imaging for colorectal liver metastases: a nationwide population-based study. BJS Open 2020; 4:605-621. [PMID: 32374497 PMCID: PMC7397351 DOI: 10.1002/bjs5.50291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
Background In patients with colorectal liver metastases (CRLM) preoperative imaging may include contrast‐enhanced (ce) MRI and [18F]fluorodeoxyglucose (18F‐FDG) PET–CT. This study assessed trends and variation between hospitals and oncological networks in the use of preoperative imaging in the Netherlands. Methods Data for all patients who underwent liver resection for CRLM in the Netherlands between 2014 and 2018 were retrieved from a nationwide auditing database. Multivariable logistic regression analysis was used to assess use of ceMRI, 18F‐FDG PET–CT and combined ceMRI and 18F‐FDG PET–CT, and trends in preoperative imaging and hospital and oncological network variation. Results A total of 4510 patients were included, of whom 1562 had ceMRI, 872 had 18F‐FDG PET–CT, and 1293 had combined ceMRI and 18F‐FDG PET–CT. Use of ceMRI increased over time (from 9·6 to 26·2 per cent; P < 0·001), use of 18F‐FDG PET–CT decreased (from 28·6 to 6·0 per cent; P < 0·001), and use of both ceMRI and 18F‐FDG PET–CT 16·9 per cent) remained stable. Unadjusted variation in the use of ceMRI, 18F‐FDG PET–CT, and combined ceMRI and 18F‐FDG PET–CT ranged from 5·6 to 100 per cent between hospitals. After case‐mix correction, hospital and oncological network variation was found for all imaging modalities. Discussion Significant variation exists concerning the use of preoperative imaging for CRLM between hospitals and oncological networks in the Netherlands. The use of MRI is increasing, whereas that of 18F‐FDG PET–CT is decreasing.
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Affiliation(s)
- A K E Elfrink
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands.,Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - M Pool
- Department of Surgery, Amsterdam University Medical Centre, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands.,Department of Radiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - L R van der Werf
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands.,Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - E Marra
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | - M C Burgmans
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - M R Meijerink
- Department of Interventional Radiology, Amsterdam University Medical Centre, Cancer Centre Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
| | - M den Dulk
- Departments of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - W W Te Riele
- University Medical Centre Utrecht, Utrecht, the Netherlands.,St Antonius Hospital, Nieuwegein, the Netherlands
| | | | - M W J M Wouters
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands
| | | | - M S L Liem
- Medisch Spectrum Twente, Enschede, the Netherlands
| | | | - C I Buis
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - K F D Kuhlmann
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - C Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M G Besselink
- Department of Surgery, Amsterdam University Medical Centre, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - D J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J M Klaase
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - N F M Kok
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Hazhirkarzar B, Khoshpouri P, Shaghaghi M, Ghasabeh MA, Pawlik TM, Kamel IR. Current state of the art imaging approaches for colorectal liver metastasis. Hepatobiliary Surg Nutr 2020; 9:35-48. [PMID: 32140477 DOI: 10.21037/hbsn.2019.05.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
One of the most common cancers worldwide, colorectal cancer (CRC) has been associated with significant morbidity and mortality and therefore represents an enormous burden to the health care system. Recent advances in CRC treatments have provided patients with primary and metastatic CRC a better long-term prognosis. The presence of synchronous or metachronous metastasis has been associated, however, with worse survival. The most common site of metastatic disease is the liver. A variety of treatment modalities aimed at targeting colorectal liver metastases (CRLM) has been demonstrated to improve the prognosis of these patients. Loco-regional approaches such as surgical resection and tumor ablation (operative and percutaneous) can provide patients with a chance at long-term disease control and even cure in select populations. Patient selection is important in defining the most suitable treatment option for CRLM in order to provide the best possible survival benefit while avoiding unnecessary interventions and adverse events. Medical imaging plays a crucial role in evaluating the characteristics of CRLMs and disease resectability. Size of tumors, proximity to adjacent anatomical structures, and volume of the unaffected liver are among the most important imaging parameters to determine the suitability of patients for surgical management or other appropriate treatment approaches. We herein provide a comprehensive overview of current-state-of-the-art imaging in the management of CRLM, including staging, treatment planning, response and survival assessment, and post-treatment surveillance. Computed tomography (CT) scan and magnetic resonance imaging (MRI) are two most commonly used techniques, which can be used solely or in combination with functional imaging modalities such as positron emission tomography (PET) and diffusion weighted imaging (DWI). Providing up-to-date evidence on advantages and disadvantages of imaging modalities and tumor assessment criteria, the current review offers a practice guide to assist providers in choosing the most suitable imaging approach for patients with CRLM.
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Affiliation(s)
- Bita Hazhirkarzar
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pegah Khoshpouri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohammadreza Shaghaghi
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mounes Aliyari Ghasabeh
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Ihab R Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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35
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Serrano PE, Gu CS, Moulton CA, Husien M, Jalink D, Martel G, Tsang ME, Hallet J, McAlister V, Gallinger S, Levine M. Effect of PET-CT on disease recurrence and management in patients with potentially resectable colorectal cancer liver metastases. Long-term results of a randomized controlled trial. J Surg Oncol 2020; 121:1001-1006. [PMID: 32034769 DOI: 10.1002/jso.25864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/27/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Preoperative evaluation of resectable colorectal cancer liver metastases with positron emission tomography (PET) combined with computed tomography (PET-CT) is used extensively. The PETCAM trial evaluated the effect of PET-CT (intervention) vs no PET-CT (control) on surgical management. PET-CT resulted in 8% change in surgical management, therefore, we aimed to compare long-term outcomes (disease-free [DFS], overall survival [OS]). METHODS Trial recruitment (2005-2010) had prospective follow-up until 2013. Events from 2013 to 2017 were collected retrospectively. Survival was described by the Kaplan-Meier method and compared with log-rank test. Oncologic risk factors were calculated using Cox proportional hazard models. RESULTS Among 404 patients randomized, there were no differences in DFS (hazard ratio [HR] = 1.13; 95% confidence interval [CI], 0.89 to 1.43) or OS (HR, 1.02; 95% CI, 0.78-1.32) between groups. For all patients randomized, median DFS (PET-CT vs no PET-CT) was 16 months (95% CI, 13-18) and 15 months (95% CI, 11-22), P = .33. For patients who underwent liver resection (n = 368), DFS (17 vs 16 months, P = .51) and OS (58 months vs 52 months, P = .90) were similar between groups, respectively. Risk factors for DFS and OS were age, tumor size, node-positive disease, extrahepatic metastases and disease-free duration. CONCLUSION Preoperative PET-CT changes surgical management in a small percentage of cases, without effect on recurrence rates or long-term survival.
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Affiliation(s)
- Pablo E Serrano
- Department of Surgery, McMaster University, Hamilton, Ontario.,Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario
| | - Chu-Shu Gu
- Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario.,Department of Oncology, McMaster University, Hamilton, Ontario
| | | | | | - Diederick Jalink
- Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario
| | | | | | - Julie Hallet
- Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario
| | | | | | - Mark Levine
- Ontario Clinical Oncology Group, McMaster University, Hamilton, Ontario.,Department of Oncology, McMaster University, Hamilton, Ontario
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Sivesgaard K, Larsen LP, Sørensen M, Kramer S, Schlander S, Amanavicius N, Mortensen FV, Pedersen EM. Whole-body MRI added to gadoxetic acid-enhanced liver MRI for detection of extrahepatic disease in patients considered eligible for hepatic resection and/or local ablation of colorectal cancer liver metastases. Acta Radiol 2020; 61:156-167. [PMID: 31189329 DOI: 10.1177/0284185119855184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) can detect extrahepatic disease before local treatment of colorectal liver metastases. Purpose To investigate if whole-body magnetic resonance imaging (MRI) added to gadoxetic acid liver MRI could replace FDG-PET/CT for detection of extrahepatic disease in patients with colorectal liver metastases eligible for hepatic local treatment. Material and Methods This health-research-ethics-committee-approved prospective consecutive diagnostic accuracy study with written informed consent analyzed 79 cases included between 29 June 2015 and 7 February 2017. Whole-body MRI covering the thorax, abdomen, and pelvis and FDG-PET/CT including contrast-enhanced CT was performed 0–3 days before local treatment of liver metastases. Whole-body MR images were read independently by two readers. FDG-PET/CT images were read independently by two pairs of readers. Histopathology and follow-up imaging were used as reference standard. Sensitivities and specificities were calculated and compared including noninferiority analysis. Results Seventy-five malignant lesions and 419 benign lesions were confirmed. Sensitivities of both PET/CT reader pairs 1 and 2 (56.7 and 67.9%) and MRI reader 2 (63.0%) were significantly higher than that of MRI reader 1 (42.7) (P<0.04). Specificities of both PET/CT reader pairs 1 and 2 (92.5 and 92.4%) and MRI reader 1 (91.1%) were significantly higher than that of MRI reader 2 (86.3%) ( P < 0.02). Sensitivity of MRI reader 2 was non-inferior compared to PET/CT reader pair 1. Specificities of both MRI readers were non-inferior to both PET/CT reader pairs. Conclusion For detection of extrahepatic disease in patients with colorectal liver metastases, whole-body MRI was non-inferior to FDG-PET/CT for some reader combinations. However, reader-independent non-inferiority could not be demonstrated.
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Affiliation(s)
- Kim Sivesgaard
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars P Larsen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Sørensen
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Stine Kramer
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus, Denmark
| | - Sven Schlander
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Frank V Mortensen
- Department of Surgery, Section for Upper Gastrointestinal and Hepato-pancreato-biliary Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Erik M Pedersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
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Watanabe A, Harimoto N, Yokobori T, Araki K, Kubo N, Igarashi T, Tsukagoshi M, Ishii N, Yamanaka T, Handa T, Oyama T, Higuchi T, Shirabe K. FDG-PET reflects tumor viability on SUV in colorectal cancer liver metastasis. Int J Clin Oncol 2020; 25:322-329. [PMID: 31612350 DOI: 10.1007/s10147-019-01557-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/28/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Liver resection is the most effective procedure for colorectal cancer liver metastasis (CRLM); however, early recurrence is an important problem that affects the postoperative prognoses of patients with CRLM. We previously suggested a therapeutic algorithm for CRLM using fluorodeoxyglucose-positron emission tomography (FDG-PET) and revealed the applicability of FDG-PET in predicting the prognosis after liver resection of CRLM. In this study, we assessed the correlation between FDG-PET and biological viability such as proliferation or metabolic activity. METHODS We retrospectively evaluated 61 patients who underwent hepatectomy for CRLM. We assessed hypoxia inducible factor-1α (HIF-1α), pyruvate kinase isozyme M2 (PKM2), glucose transporter 1 (GLUT1), and Ki-67 expression via immunohistochemistry and evaluated the correlation between standardized uptake value (SUV) and these factors. RESULTS High HIF-1α, PKM2, and GLUT1 expression were positively correlated with high SUV expression (P = 0.0444, 0.0296, and 0.0245, respectively). Ki-67 and SUV were also positively correlated (P = 0.00164). HIF-1α expression and PKM2 expression were significantly correlated (P = 0.0430), and PKM2 expression and GLUT1 expression were extremely significantly correlated (P < 0.0001). CONCLUSION SUV reflected tumor proliferation or metabolic factors in CRLM. FDG-PET could be a useful modality for assessing tumor viability and may provide useful information regarding the appropriate treatment strategy for CRLM.
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Affiliation(s)
- Akira Watanabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norifumi Harimoto
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Takehiko Yokobori
- Research Program for Omics-Based Medical Science, Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kenichiro Araki
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norio Kubo
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takamichi Igarashi
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Mariko Tsukagoshi
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norihiro Ishii
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takahiro Yamanaka
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tadashi Handa
- Department of Diagnostic Pathology, Gunma University, Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tetsunari Oyama
- Department of Diagnostic Pathology, Gunma University, Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Zamboni G, Mazzaro A, Mansueto G. How to Best Image Colorectal Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2020. [DOI: 10.1007/s11888-019-00447-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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PET in Gastrointestinal, Pancreatic, and Liver Cancers. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, Hasegawa K, Hotta K, Ishida H, Ishiguro M, Ishihara S, Kanemitsu Y, Kinugasa Y, Murofushi K, Nakajima TE, Oka S, Tanaka T, Taniguchi H, Tsuji A, Uehara K, Ueno H, Yamanaka T, Yamazaki K, Yoshida M, Yoshino T, Itabashi M, Sakamaki K, Sano K, Shimada Y, Tanaka S, Uetake H, Yamaguchi S, Yamaguchi N, Kobayashi H, Matsuda K, Kotake K, Sugihara K. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 2020; 25:1-42. [PMID: 31203527 PMCID: PMC6946738 DOI: 10.1007/s10147-019-01485-z] [Citation(s) in RCA: 1000] [Impact Index Per Article: 250.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 02/06/2023]
Abstract
The number of deaths from colorectal cancer in Japan continues to increase. Colorectal cancer deaths exceeded 50,000 in 2016. In the 2019 edition, revision of all aspects of treatments was performed, with corrections and additions made based on knowledge acquired since the 2016 version (drug therapy) and the 2014 version (other treatments). The Japanese Society for Cancer of the Colon and Rectum guidelines 2019 for the treatment of colorectal cancer (JSCCR guidelines 2019) have been prepared to show standard treatment strategies for colorectal cancer, to eliminate disparities among institutions in terms of treatment, to eliminate unnecessary treatment and insufficient treatment and to deepen mutual understanding between healthcare professionals and patients by making these guidelines available to the general public. These guidelines have been prepared by consensuses reached by the JSCCR Guideline Committee, based on a careful review of the evidence retrieved by literature searches and in view of the medical health insurance system and actual clinical practice settings in Japan. Therefore, these guidelines can be used as a tool for treating colorectal cancer in actual clinical practice settings. More specifically, they can be used as a guide to obtaining informed consent from patients and choosing the method of treatment for each patient. Controversial issues were selected as clinical questions, and recommendations were made. Each recommendation is accompanied by a classification of the evidence and a classification of recommendation categories based on the consensus reached by the Guideline Committee members. Here, we present the English version of the JSCCR guidelines 2019.
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Affiliation(s)
- Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan.
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Tetsuya Hamaguchi
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Megumi Ishiguro
- Department of Chemotherapy and Oncosurgery, Tokyo Medical and Dental University Medical Hospital, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiko Murofushi
- Department of Radiation Oncology, faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Takako Eguchi Nakajima
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroya Taniguchi
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Akihito Tsuji
- Department of Clinical Oncology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Keisuke Uehara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kentaro Yamazaki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Takayuki Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Michio Itabashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Yasuhiro Shimada
- Division of Clinical Oncology, Kochi Health Sciences Center, Kochi, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroyuki Uetake
- Department of Specialized Surgeries, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | | | - Hirotoshi Kobayashi
- Department of Surgery, Mizonokuchi Hospital, Teikyo University School of Medicine, Kanagawa, Japan
| | - Keiji Matsuda
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Kenjiro Kotake
- Department of Surgery, Sano City Hospital, Tochigi, Japan
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Sobhani I, Itti E, Luciani A, Baumgaertner I, Layese R, André T, Ducreux M, Gornet JM, Goujon G, Aparicio T, Taieb J, Bachet JB, Hemery F, Retbi A, Mons M, Flicoteaux R, Rhein B, Baron S, Cherrak I, Rufat P, Le Corvoisier P, de'Angelis N, Natella PA, Maoulida H, Tournigand C, Durand Zaleski I, Bastuji-Garin S. Colorectal cancer (CRC) monitoring by 6-monthly 18FDG-PET/CT: an open-label multicentre randomised trial. Ann Oncol 2019; 29:931-937. [PMID: 29365058 PMCID: PMC5913635 DOI: 10.1093/annonc/mdy031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background [18F]2-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (18FDG-PET/CT) has high sensitivity for detecting recurrences of colorectal cancer (CRC). Our objective was to determine whether adding routine 6-monthly 18FDG-PET/CT to our usual monitoring strategy improved patient outcomes and to assess the effect on costs. Patients and methods In this open-label multicentre trial, patients in remission of CRC (stage II perforated, stage III, or stage IV) after curative surgery were randomly assigned (1 : 1) to usual monitoring alone (3-monthly physical and tumour marker assays, 6-monthly liver ultrasound and chest radiograph, and 6-monthly whole-body computed tomography) or with 6-monthly 18FDG-PET/CT, for 3 years. A multidisciplinary committee reviewed each patient’s data every 3 months and classified the recurrence status as yes/no/doubtful. Recurrences were treated with curative surgery alone if feasible and with chemotherapy otherwise. The primary end point was treatment failure defined as unresectable recurrence or death. Relative risks were estimated, and survival was analysed using the Kaplan–Meier method, log-rank test, and Cox models. Direct costs were compared. Results Of the 239 enrolled patients, 120 were in the intervention arm and 119 in the control arm. The failure rate was 29.2% (31 unresectable recurrences and 4 deaths) in the intervention group and 23.7% (27 unresectable recurrences and 1 death) in the control group (relative risk = 1.23; 95% confidence interval, 0.80–1.88; P = 0.34). The multivariate analysis also showed no significant difference (hazards ratio, 1.33; 95% confidence interval, 0.8–2.19; P = 0.27). Median time to diagnosis of unresectable recurrence (months) was significantly shorter in the intervention group [7 (3–20) versus 14.3 (7.3–27), P = 0.016]. Mean cost/patient was higher in the intervention group (18 192 ± 27 679 € versus 11 131 ± 13 €, P < 0.033). Conclusion 18FDG-PET/CT, when added every 6 months, increased costs without decreasing treatment failure rates in patients in remission of CRC. The control group had very close follow-up, and any additional improvement (if present) would be small and hard to detect. ClinicalTrials.gov identifier NCT00624260
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Affiliation(s)
- I Sobhani
- EA7375 (EC2M3 Research Team), Université Paris-Est Créteil (UPEC)-Val de Marne, Créteil, France; Department of Gastroenterology, APHP-Hôpital Henri Mondor, Créteil, France.
| | - E Itti
- Department of Nuclear Medicine, APHP-Hôpital Henri Mondor, Créteil, France
| | - A Luciani
- Department of Medical Imaging, APHP-Hôpital Henri Mondor, Créteil, France
| | - I Baumgaertner
- EA7375 (EC2M3 Research Team), Université Paris-Est Créteil (UPEC)-Val de Marne, Créteil, France
| | - R Layese
- Public Health, Unité de Recherche Clinique (URC Mondor), APHP-Hôpital Henri Mondor, Créteil, France; CEpiA Clinical Epidemiology and Ageing Un, EA7376, Université Paris-Est (UPEC), A-TVB DHU, IMRB, Créteil, France
| | - T André
- Sorbonnes University and Department of Medical Oncology, APHP-Hôpital St Antoine, Paris, France
| | - M Ducreux
- Department of Gastrointestinal Oncology, Institut Gustave Roussy, Villejuif, France
| | - J-M Gornet
- Department of Gastroenterology, APHP-Hôpital St Louis, Paris, France
| | - G Goujon
- Department of Gastroenterology, APHP-Hôpital Bichat, Paris, France
| | - T Aparicio
- Department of Gastroenterology, APHP-Hôpital Avicenne, Paris, France
| | - J Taieb
- Department of Gastrointestinal Oncology, APHP-Hôpital Européen Georges Pompidou, Paris, France
| | - J-B Bachet
- Department of Gastroenterology and Medical Informatics, APHP-Hôpital Pitié-Salpêtrière, Paris, France
| | - F Hemery
- Department of Medical Informatics, APHP-Hôpital Henri Mondor, Créteil, France
| | - A Retbi
- Sorbonnes University and Department of Medical Oncology, APHP-Hôpital St Antoine, Paris, France
| | - M Mons
- Department of Gastrointestinal Oncology, Institut Gustave Roussy, Villejuif, France
| | - R Flicoteaux
- Department of Gastroenterology, APHP-Hôpital St Louis, Paris, France
| | - B Rhein
- Department of Medical Informatics, Centre Hospitalier d'Intercommunal de Créteil, Créteil, France
| | - S Baron
- Department of Gastroenterology, APHP-Hôpital Avicenne, Paris, France
| | - I Cherrak
- Department of Gastrointestinal Oncology, APHP-Hôpital Européen Georges Pompidou, Paris, France
| | - P Rufat
- Department of Gastroenterology and Medical Informatics, APHP-Hôpital Pitié-Salpêtrière, Paris, France
| | - P Le Corvoisier
- Clinical Investigations Centre, APHP-Hôpital Henri Mondor, Créteil, France
| | - N de'Angelis
- EA7375 (EC2M3 Research Team), Université Paris-Est Créteil (UPEC)-Val de Marne, Créteil, France
| | - P-A Natella
- Public Health, Unité de Recherche Clinique (URC Mondor), APHP-Hôpital Henri Mondor, Créteil, France
| | - H Maoulida
- Healthcare Economics Research Unit, APHP, Paris, France, France
| | - C Tournigand
- EA7375 (EC2M3 Research Team), Université Paris-Est Créteil (UPEC)-Val de Marne, Créteil, France
| | | | - S Bastuji-Garin
- Public Health, Unité de Recherche Clinique (URC Mondor), APHP-Hôpital Henri Mondor, Créteil, France; CEpiA Clinical Epidemiology and Ageing Un, EA7376, Université Paris-Est (UPEC), A-TVB DHU, IMRB, Créteil, France
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The Utility of PET/Computed Tomography for Radiation Oncology Planning, Surveillance, and Prognosis Prediction of Gastrointestinal Tumors. PET Clin 2019; 15:77-87. [PMID: 31735304 DOI: 10.1016/j.cpet.2019.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
At present, the strongest evidence for the use of PET/computed tomography (CT) in gastrointestinal (GI) malignancies is to rule out distant metastatic disease at diagnosis, radiation treatment planning for anal malignancies, and disease recurrence monitoring in colorectal and anal malignancies. Use of PET/CT for GI malignancies continues to evolve over time, with new studies evaluating prognostic abilities of PET/CT and with increasing sensitivity and spatial resolution of more modern PET/CT scanners. The authors encourage future applications and prospective evaluation of the use of PET/CT in the staging, prognostication, and recurrence prediction for GI malignancies.
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Aspirin suppresses chemoresistance and enhances antitumor activity of 5-Fu in 5-Fu-resistant colorectal cancer by abolishing 5-Fu-induced NF-κB activation. Sci Rep 2019; 9:16937. [PMID: 31729451 PMCID: PMC6858464 DOI: 10.1038/s41598-019-53276-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 10/30/2019] [Indexed: 12/21/2022] Open
Abstract
Chemoresistance to 5-fluorouracil (5-Fu)-based chemotherapy is a leading obstacle in achieving effective treatment for colorectal cancer (CRC). Typically, NF-κB activation induced by the chemotherapeutics themselves is an important cause resulting in chemoresistance. Specifically, NF-κB activation can inhibit tumor cell apoptosis and induce chemoresistance. Drugs that can prevent NF-κB activation induced by chemotherapeutics are urgently needed to overcome chemoresistance. Obviously, aspirin is one of these agents, which has been demonstrated to possess antitumor activities and as an inhibitor of NF-κB. The current study aimed to investigate whether aspirin was able to overcome the chemoresistance to 5-Fu in CRC, together with the potential synergistic mechanisms. Our results suggested that aspirin remarkably potentiated the inhibitory effect of 5-Fu on the growth and invasion of resistant cells in vitro. In vivo, aspirin markedly enhanced the antitumor activity of 5-Fu in suppressing tumor growth and metastasis, and down-regulating the expression of NF-κB-regulated genes in the 5-Fu-resistant cells. Obviously, aspirin completely eradicated the 5-Fu-induced NF-κB activation, without inducing pronounced adverse effects. Taken together, findings in this study suggest that aspirin can reverse chemoresistance and potentiate the antitumor effect of 5-Fu, which is achieved through abolishing the 5-Fu-induced NF-κB activation, suggesting that aspirin may be a promising adjuvant therapeutic agent for CRC.
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Serrano PE, Gu C, Husien M, Jalink D, Ritter A, Martel G, Tsang ME, Law CH, Hallet J, McAlister V, Sela N, Solomon H, Moulton C, Gallinger S, Levine M. Risk factors for survival following recurrence after first liver resection for colorectal cancer liver metastases. J Surg Oncol 2019; 120:1420-1426. [DOI: 10.1002/jso.25735] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/05/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Pablo E. Serrano
- Department of SurgeryMcMaster University Hamilton Ontario Canada
- Ontario Clinical Oncology GroupMcMaster University Hamilton Ontario Canada
| | - Chu‐Shu Gu
- Ontario Clinical Oncology GroupMcMaster University Hamilton Ontario Canada
- Department of OncologyMcMaster University Hamilton Ontario Canada
| | - Mohamed Husien
- Grand River Regional Cancer Centre Kitchener Ontario Canada
| | - Diederick Jalink
- Cancer Centre of Southeastern Ontario at Kingston General Hospital Kingston Ontario Canada
| | - Anne Ritter
- Cancer Centre of Southeastern Ontario at Kingston General Hospital Kingston Ontario Canada
| | | | | | - Calvin H. Law
- Odette Cancer CentreSunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Julie Hallet
- Odette Cancer CentreSunnybrook Health Sciences Centre Toronto Ontario Canada
| | | | | | | | | | | | - Mark Levine
- Ontario Clinical Oncology GroupMcMaster University Hamilton Ontario Canada
- Department of OncologyMcMaster University Hamilton Ontario Canada
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Derlin T, Grünwald V, Steinbach J, Wester HJ, Ross TL. Molecular Imaging in Oncology Using Positron Emission Tomography. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:175-181. [PMID: 29607803 DOI: 10.3238/arztebl.2018.0175] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/04/2017] [Accepted: 11/22/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Anatomical and molecular data can be acquired simultaneously through the use of positron emission tomography (PET) in combination with computed tomography (CT) or magnetic resonance imaging (MRI) as a hybrid technique. A variety of radiopharmaceuticals can be used to characterize various metabolic processes or to visualize the expression of receptors, enzymes, and other molecular target structures. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed, as well as on guidelines from Germany and abroad and on systematic reviews and meta-analyses. RESULTS Established radiopharmaceuticals for PET, such as 2-[18F]fluoro-2- deoxyglucose ([18F]FDG), enable the visualization of physiological processes on the molecular level and can provide vital information for clinical decision-making. For example, PET can be used to evaluate pulmonary nodules for malignancy with 95% sensitivity and 82% specificity. It can be used both for initial staging and for the guidance of further treatment. Alongside the PET radiopharmaceuticals that have already been well studied and evaluated, newer ones are increasingly becoming available for the noninvasive phenotyping of tumor diseases, e.g., for analyzing the expression of prostate-specific membrane antigen (PSMA), of somatostatin receptors, or of chemokine receptors on tumor cells. CONCLUSION PET is an important component of diagnostic algorithms in oncology. It can help make diagnosis more precise and treatment more individualized. An increasing number of PET radiopharmaceuticals are now expanding the available options for imaging. Many radiopharmaceuticals can be used not only for noninvasive analysis of the expression of therapeutically relevant target structures, but also for the ensuing, target-directed treatment with radionuclides.
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Affiliation(s)
- Thorsten Derlin
- Department of Nuclear Medicine, Hannover Medical School; Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School; Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden; Department of Pharmaceutical Radiochemistry, Technical University of Munich, Garching
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Abstract
BACKGROUND Hybrid imaging FDG PET/CT (18F‑fluordeoxyglucose positron emission tomography/computed tomography) has gained increasing importance in oncology in recent years. DIAGNOSIS A focal increase in FDG uptake in the gastrointestinal tract may be due to colorectal carcinoma. Such a finding requires further clarification. PRIMARY STAGING Staging of the primary and locoregional lymph nodes remains a domain of established imaging modalities as FDG PET/CT does not provide a clear additional benefit. Liver metastases can be detected with high sensitivity by FDG PET/CT, but MRI is superior in small lesions. RADIATION THERAPY PLANNING So far FDG PET/CT plays a subordinate role in the radiation therapy planning of rectal cancer. However, it can potentially contribute to the optimization of planning target volumes. THERAPY MONITORING FDG PET/CT is suitable for monitoring therapy because morphological and metabolic changes of the tumor can be detected in early stages. This enables early detection of nonresponders after beginning neoadjuvant chemoradiation therapy of rectal cancer. FDG PET/CT can also be used for therapy control of liver metastases, especially after local therapeutic procedures. DETECTION OF RECURRENCE With clinical suspicion of local recurrence and increased tumor markers, FDG PET/CT is a valuable tool as tumor recurrence can be detected with high sensitivity and specificity.
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Daza JF, Solis NM, Parpia S, Gallinger S, Moulton CA, Belley-Cote EP, Levine MN, Serrano PE. A meta-analysis exploring the role of PET and PET-CT in the management of potentially resectable colorectal cancer liver metastases. Eur J Surg Oncol 2019; 45:1341-1348. [DOI: 10.1016/j.ejso.2019.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/01/2019] [Accepted: 03/18/2019] [Indexed: 02/03/2023] Open
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Vera R, González-Flores E, Rubio C, Urbano J, Valero Camps M, Ciampi-Dopazo JJ, Orcajo Rincón J, Morillo Macías V, Gomez Braco MA, Suarez-Artacho G. Multidisciplinary management of liver metastases in patients with colorectal cancer: a consensus of SEOM, AEC, SEOR, SERVEI, and SEMNIM. Clin Transl Oncol 2019; 22:647-662. [PMID: 31359336 DOI: 10.1007/s12094-019-02182-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/08/2019] [Indexed: 12/12/2022]
Abstract
Colorectal cancer (CRC) has the second-highest tumor incidence and is a leading cause of death by cancer. Nearly 20% of patients with CRC will have metastases at the time of diagnosis, and more than 50% of patients with CRC develop metastatic disease during the course of their disease. A group of experts from the Spanish Society of Medical Oncology, the Spanish Association of Surgeons, the Spanish Society of Radiation Oncology, the Spanish Society of Vascular and Interventional Radiology, and the Spanish Society of Nuclear Medicine and Molecular Imaging met to discuss and provide a multidisciplinary consensus on the management of liver metastases in patients with CRC. The group defined the different scenarios in which the disease can present: fit or unfit patients with resectable liver metastases, patients with potential resectable liver metastases, and patients with unresectable liver metastases. Within each scenario, the different strategies and therapeutic approaches are discussed.
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Affiliation(s)
- R Vera
- Medical Oncology, Complejo Hospitalario de Navarra, Calle Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
| | | | - C Rubio
- Radiation Oncology Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - J Urbano
- Vascular and Interventional Radiology, Vithas Hospitals Group, Madrid, Spain
| | - M Valero Camps
- Nuclear Medicine, Clínica Rotger (Quiron Salud), Palma de Mallorca, Spain
| | - J J Ciampi-Dopazo
- Interventional Radiology Unit, Complejo Hospitalario de Toledo, Toledo, Spain
| | - J Orcajo Rincón
- Nuclear Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - V Morillo Macías
- Radiation Oncology, Hospital Provincial de Castellón, Castellón, Spain
| | - M A Gomez Braco
- Hepatobiliary and Liver Transplantation Unit, University Hospital Virgen del Rocío, Sevilla, Spain
| | - G Suarez-Artacho
- Hepatobiliary and Liver Transplantation Unit, University Hospital Virgen del Rocío, Sevilla, Spain
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Fonouni H, Khajeh E, Ghamarnejad O, Kashfi A, Aydogdu E, Majlesara A, Mohammadi S, Gharabaghi N, Konstantinidis L, Longerich T, Mehrabi A, Kulu Y. Histopathological effects of modern topical sealants on the liver surface after hepatectomy: an experimental swine study. Sci Rep 2019; 9:7088. [PMID: 31068637 PMCID: PMC6506469 DOI: 10.1038/s41598-019-43694-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 04/27/2019] [Indexed: 12/11/2022] Open
Abstract
The present study aimed to determine the impact of different sealant materials on histopathological changes to the liver surface after liver resection. Thirty-six landrace pigs underwent left anatomical hemihepatectomy and were assigned to a histopathological control group (HPC, n = 9) with no bleeding control, a clinically simulated control group (CSC, n = 9) with no sealant but bipolar cauterization and oversewing of the liver surface, and two treatment groups (n = 9 each) with a collagen-based sealant (CBS) or a fibrinogen-based sealant (FBS) on resection surface. After postoperative day 6, tissue samples were histologically examined. There were no significant differences in preoperative parameters between the groups. Fibrin production was higher in sealant groups compared with the HPC and CSC groups (both p < 0.001). Hepatocellular regeneration in sealant groups was higher than in both control groups. A significantly higher regeneration was seen in the FBS group. Use of sealants increased the degree of fibrin exudation at the resection plane. Increased hepatocellular necrosis was seen in the CBS group compared with the FBS group. The posthepatectomy hepatocellular regeneration rate was higher in the FBS group compared with the CBS group. Randomized studies are needed to assess the impact of sealants on posthepatectomy liver regeneration in the clinical setting.
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Affiliation(s)
- Hamidreza Fonouni
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Omid Ghamarnejad
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arash Kashfi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Emre Aydogdu
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ali Majlesara
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sara Mohammadi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Negin Gharabaghi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lukas Konstantinidis
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas Longerich
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Yakup Kulu
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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Chow FCL, Chok KSH. Colorectal liver metastases: An update on multidisciplinary approach. World J Hepatol 2019; 11:150-172. [PMID: 30820266 PMCID: PMC6393711 DOI: 10.4254/wjh.v11.i2.150] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/24/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023] Open
Abstract
Liver metastasis is the commonest form of distant metastasis in colorectal cancer. Selection criteria for surgery and liver-directed therapies have recently been extended. However, resectability remains poorly defined. Tumour biology is increasingly recognized as an important prognostic factor; hence molecular profiling has a growing role in risk stratification and management planning. Surgical resection is the only treatment modality for curative intent. The most appropriate surgical approach is yet to be established. The primary cancer and the hepatic metastasis can be removed simultaneously or in a two-step approach; these two strategies have comparable long-term outcomes. For patients with a limited future liver remnant, portal vein embolization, combined ablation and resection, and associating liver partition and portal vein ligation for staged hepatectomy have been advocated, and each has their pros and cons. The role of neoadjuvant and adjuvant chemotherapy is still debated. Targeted biological agents and loco-regional therapies (thermal ablation, intra-arterial chemo- or radio-embolization, and stereotactic radiotherapy) further improve the already favourable results. The recent debate about offering liver transplantation to highly selected patients needs validation from large clinical trials. Evidence-based protocols are missing, and therefore optimal management of hepatic metastasis should be personalized and determined by a multi-disciplinary team.
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Affiliation(s)
| | - Kenneth Siu-Ho Chok
- Department of Surgery and State Key Laboratory for Liver Research, the University of Hong Kong, Hong Kong, China
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