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Dupré A, Rivoire M, Metzger S, Cropet C, Vincenot J, Peyrat P, Chen Y, Pérol D, Melodelima D. Intra-operative High-Intensity Focused Ultrasound in Patients With Colorectal Liver Metastases: A Prospective Ablate-and-Resect Study. Ultrasound Med Biol 2023; 49:1845-1851. [PMID: 37268553 DOI: 10.1016/j.ultrasmedbio.2023.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/07/2023] [Accepted: 04/21/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE High-intensity focused ultrasound (HIFU) is a recent, non-ionizing and non-invasive technology of focal destruction. Independence from the heat-sink effect of blood flow makes HIFU an interesting technique for focal ablation of liver tumors. Current available technology is based on extracorporeal treatment that limits use of HIFU for the treatment of liver tumors, as elementary ablations are small and must be juxtaposed to treat tumors, resulting in long-duration treatment. We developed an HIFU probe with toroidal technology, which increases the volume of ablation, for intra-operative use, and we assessed the feasibility and efficacy of this device in patients with colorectal liver metastasis (CLM) measuring less than 30 mm. METHODS This study was an ablate-and-resect, prospective, single-center, phase II study. All ablations were performed in the area of liver scheduled for liver resection to avoid loss of chance of recovery. The primary objective was to ablate CLM with safety margins (>5 mm). RESULTS Between May 2014 and July 2020, 15 patients were enrolled and 24 CLM were targeted. The HIFU ablation time was 370 s. In total, 23 of 24 CLM were successfully treated (95.8%). No damage occurred to extrahepatic tissues. HIFU ablations were oblate shaped with an average long axis of 44.3 ± 6.1 mm and an average shortest axis of 35.9 ± 6.7 mm. On pathological examination, the average diameter of the treated metastasis was 12.2 ± 4.8 mm. CONCLUSION Intra-operative HIFU can safely and accurately produce large ablations in 6 min with real-time guidance (ClinicalTrials.gov identifier: NCT01489787).
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Affiliation(s)
- Aurélien Dupré
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; LabTAU, INSERM, Université Lyon 1, Centre Léon Bérard, Lyon, France.
| | - Michel Rivoire
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France; LabTAU, INSERM, Université Lyon 1, Centre Léon Bérard, Lyon, France
| | | | - Claire Cropet
- DRCI, Biostatistics Unit, Centre Léon Bérard, Lyon, France
| | - Jérémy Vincenot
- LabTAU, INSERM, Université Lyon 1, Centre Léon Bérard, Lyon, France
| | - Patrice Peyrat
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Yao Chen
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - David Pérol
- DRCI, Biostatistics Unit, Centre Léon Bérard, Lyon, France
| | - David Melodelima
- LabTAU, INSERM, Université Lyon 1, Centre Léon Bérard, Lyon, France
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Abstract
The liver is a common site for metastatic spread for various primary tumor histologies. Stereotactic body radiation therapy (SBRT) is a non-invasive treatment technique with broad patient candidacy for the ablation of tumors in the liver and other organs. SBRT involves focused, high-dose radiation therapy delivered in one to several treatments, resulting in high rates of local control. Use of SBRT for ablation of oligometastatic disease has increased in recent years and emerging prospective data have demonstrated improvements in progression free and overall survival in some settings. When delivering SBRT to liver metastases, clinicians must balance the priorities of delivering ablative tumor dosing while respecting dose constraints to surrounding organs at risk (OARs). Motion management techniques are crucial for meeting dose constraints, ensuring low rates of toxicity, maintaining quality of life, and can allow for dose escalation. Advanced radiotherapy delivery approaches including proton therapy, robotic radiotherapy, and real-time MR-guided radiotherapy may further improve the accuracy of liver SBRT. In this article, we review the rationale for oligometastases ablation, the clinical outcomes with liver SBRT, tumor dose and OAR considerations, and evolving strategies to improve liver SBRT delivery.
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Affiliation(s)
- Sangjune Laurence Lee
- Division of Radiation Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada.
| | - Michael F Bassetti
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
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Chiu AM, Savoor R, Gordon AC, Riaz A, Sato KT, Hohlastos E, Salem R, Lewandowski RJ. Yttrium-90 Radiation Segmentectomy in Oligometastatic Secondary Hepatic Malignancies. J Vasc Interv Radiol 2023; 34:362-368. [PMID: 36526074 DOI: 10.1016/j.jvir.2022.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 10/23/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of yttrium-90 (90Y) radiation segmentectomy (RS) in the treatment of oligometastatic secondary hepatic malignancies. MATERIALS AND METHODS This institutional review board-approved retrospective study evaluated 16 patients with oligometastatic secondary hepatic malignancies who were treated with RS. The median patient age was 61.9 years (range, 38.6-85.7 years). Of the 16 patients, 11 (68.8%) presented with solitary lesions. The median index tumor size was 3.1 cm (95% CI, 2.3-3.9). Primary outcomes were evaluation of clinical and biochemical toxicities using National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0, and imaging response using Response Evaluation Criteria in Solid Tumors, version 1.1. Secondary outcomes were time to progression (TTP) and overall survival (OS) as estimated by the Kaplan-Meier method. RESULTS Clinical Grade 3 toxicities were limited to 1 (6.7%) patient who experienced fatigue, abdominal pain, nausea, and vomiting. Biochemical Grade 3 toxicities occurred in 1 (6.7%) patient who experienced lymphopenia. No Grade 4 clinical or biochemical toxicities were identified. Disease control was achieved in 14 (93.3%) of 15 patients. The median TTP of the treated tumor was 72.9 months (95% CI, 11.2 to no estimate). The median OS was 60.9 months (95% CI, 24.7 to no estimate). CONCLUSIONS 90Y RS displayed an excellent safety profile and was effective in achieving a high disease control rate in the treatment of oligometastatic secondary hepatic malignancies.
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Affiliation(s)
- Andrew M Chiu
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rohan Savoor
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew C Gordon
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ahsun Riaz
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kent T Sato
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elias Hohlastos
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Riad Salem
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert J Lewandowski
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Acciuffi S, Meyer F, Bauschke A, Croner R, Settmacher U, Altendorf-Hofmann A. Solitary colorectal liver metastasis: overview of treatment strategies and role of prognostic factors. J Cancer Res Clin Oncol 2021; 148:657-665. [PMID: 34914005 PMCID: PMC8881245 DOI: 10.1007/s00432-021-03880-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/07/2021] [Indexed: 12/09/2022]
Abstract
The following is an overview of the treatment strategies and the prognostic factors to consider in the therapeutic choice of patients characterized by solitary colorectal liver metastasis. Liver resection is the only potential curative option; nevertheless, only 25% of the patients are considered to be eligible for surgery. To expand the potentially resectable pool of patients, surgeons developed multidisciplinary techniques like portal vein embolization, two-stage hepatectomy or associating liver partition and portal vein ligation for staged hepatectomy. Moreover, mini-invasive surgery is gaining support, since it offers lower post-operative complication rates and shorter hospital stay with no differences in long-term outcomes. In case of unresectable disease, various techniques of local ablation have been developed. Radiofrequency ablation is the most commonly used form of thermal ablation: it is widely used for unresectable patients and is trying to find its role in patients with small resectable metastasis. The identification of prognostic factors is crucial in the choice of the treatment strategy. Previous works that focused on patients with solitary colorectal liver metastasis obtained trustable negative predictive factors such as presence of lymph-node metastasis in the primary tumour, synchronous metastasis, R status, right-sided primary colon tumor, and additional presence of extrahepatic tumour lesion. Even the time factor could turn into a predictor of tumour biology as well as further clinical course, and could be helpful to discern patients with worse prognosis.
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Affiliation(s)
- S Acciuffi
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - F Meyer
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - A Bauschke
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - R Croner
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - U Settmacher
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - A Altendorf-Hofmann
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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Thai Doan K, Nguyễn Việt L, Nguyen Tien T, Nguyen Canh B, Ngo Thi H, Nguyen Thanh N, Bui Quang B, Le Van Q, Woong Lee H, Mai Hong B. Prognostic Factors of Radiofrequency Ablation plus Systemic Chemotherapy for Unresectable Colorectal Cancer with Liver Metastasis. Int J Hepatol 2020; 2020:8836922. [PMID: 33381321 DOI: 10.1155/2020/8836922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/22/2020] [Accepted: 11/26/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Survival outcomes in patients with unresectable colorectal cancer (CRC) liver metastasis treated by radiofrequency ablation (RFA) combined with systemic chemotherapy and correlation with potential prognostic factors were investigated. Material and Methods. A retrospective cohort study was conducted on 61 CRC patients with unresectable liver metastasis who underwent liver tumor-directed percutaneous RFA combined with conventional systemic chemotherapy between October 2013 and September 2018. Survival analyses were conducted using the Kaplan-Meier method, and the log-rank test was used to characterize differences in the median survival time and the 1-year, 3-year, and 5-year overall survival rates of subgroups to identify prognostic factors. RESULTS Median overall survival and progression-free survival of all patients were 32 and 14 months, respectively. The cumulative survival rates at 1-, 3-, and 5-years were 93.2%; 44.5%, and 38.2%, respectively. Univariate analysis revealed that pre-RFA serum CEA levels, Eastern Cooperative Oncology Group (ECOG) status, number of liver lesions, the size of the largest lesion, and the total lesion size were prognostic factors. However, multivariate analysis demonstrated that only the number of liver lesions and the size of the largest lesion were independent prognostic factors for survival. CONCLUSION RFA plus systemic chemotherapy provides an encouraging survival outcome for patients with unresectable CRC liver metastasis. Multivariate analysis demonstrated that the number and size of liver metastatic lesions are independent prognostic factors for survival.
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Joharatnam-Hogan N, Wilson W, Shiu KK, Fusai GK, Davidson B, Hochhauser D, Bridgewater J, Khan K. Multimodal Treatment in Metastatic Colorectal Cancer (mCRC) Improves Outcomes-The University College London Hospital (UCLH) Experience. Cancers (Basel) 2020; 12:cancers12123545. [PMID: 33261002 PMCID: PMC7760146 DOI: 10.3390/cancers12123545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Despite notable advances in the management of metastatic colorectal cancer (mCRC) over the last two decades, treatment intent in the vast majority of patients remains palliative due to technically unresectable disease, extensive disease, or co-morbidities precluding major surgery. Up to 30% of individuals with mCRC are considered potentially suitable for primary or metastasis-directed multimodal therapy, including surgical resection, ablative techniques, or stereotactic radiotherapy (RT), with the aim of improving survival outcomes. We reviewed the potential benefits of multimodal therapy on the survival of patients with mCRC treated at the UCLH. METHODS Clinical data on baseline characteristics, multimodal treatments, and survival outcomes were retrospectively collected from all patients with mCRC receiving systemic chemotherapy between January 2013 and April 2017. Primary outcome was the impact of multimodal therapy on overall survival, compared to systemic therapy alone, and the effect of different types of multimodal therapy on survival outcome, and was assessed using the Kaplan-Meier approach. All analyses were adjusted for age, gender, and side of primary tumour. RESULTS One-hundred and twenty-five patients with mCRC were treated during the study period (median age: 62 years (range 19-89). The liver was the most frequent metastatic site (78%; 97/125). A total of 52% (65/125) had ≥2 lines of systemic chemotherapy. Of the 125 patients having systemic chemotherapy, 74 (59%) underwent multimodal treatment to the primary tumour or metastasis. Median overall survival (OS) was 25.7 months [95% Confidence Interval (CI) 21.5-29.0], and 3-year survival, 26%. Univariate analysis demonstrated that patients who had additional procedures (surgery/ablation/RT) were significantly less likely to die (Hazard Ratio (HR) 0.18, 95% CI 0.12-0.29, p < 0.0001) compared to those receiving systemic chemotherapy alone. Increasing number of multimodal procedures was associated with an incremental increase in survival-with median OS 28.4 m, 35.7 m, and 64.8 m, respectively, for 1, 2, or ≥3 procedures (log-rank p < 0.0001). After exclusion of those who received systemic chemotherapy only (n = 51), metastatic resections were associated with improved survival (adjusted HR 0.36, 95% CI 0.20-0.63, p < 0.0001), confirmed in multivariate analysis. Multiple single-organ procedures did not improve survival. CONCLUSION Multimodal therapy for metastatic bowel cancer is associated with significant survival benefit. Resection/radical RT of the primary and resection of metastatic disease should be considered to improve survival outcomes following multidisciplinary team (MDT) discussion and individual assessment of fitness.
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Affiliation(s)
- Nalinie Joharatnam-Hogan
- Department of Gastrointestinal Oncology, University College London Hospital NHS Foundation Trust, London NW1 2PG, UK; (N.J.-H.); (K.K.S.); (D.H.); (J.B.)
| | - William Wilson
- Department of Statistics, Cancer Research UK and UCL Cancer Trials Centre, London W1T 4TJ, UK;
| | - Kai Keen Shiu
- Department of Gastrointestinal Oncology, University College London Hospital NHS Foundation Trust, London NW1 2PG, UK; (N.J.-H.); (K.K.S.); (D.H.); (J.B.)
| | - Giuseppe Kito Fusai
- HPB and Liver Transplant Unit, Royal Free London NHS Foundation Trust, London NW13 1QG, UK; (G.K.F.); (B.D.)
| | - Brian Davidson
- HPB and Liver Transplant Unit, Royal Free London NHS Foundation Trust, London NW13 1QG, UK; (G.K.F.); (B.D.)
| | - Daniel Hochhauser
- Department of Gastrointestinal Oncology, University College London Hospital NHS Foundation Trust, London NW1 2PG, UK; (N.J.-H.); (K.K.S.); (D.H.); (J.B.)
| | - John Bridgewater
- Department of Gastrointestinal Oncology, University College London Hospital NHS Foundation Trust, London NW1 2PG, UK; (N.J.-H.); (K.K.S.); (D.H.); (J.B.)
| | - Khurum Khan
- Department of Gastrointestinal Oncology, University College London Hospital NHS Foundation Trust, London NW1 2PG, UK; (N.J.-H.); (K.K.S.); (D.H.); (J.B.)
- Research Department of Oncology, UCL Cancer Institute, London WC1E 6BT, UK
- Department of Medical Oncology, North Middlesex University Hospital, London N18 1QX, UK
- Department of Oncology, GI Cancer Lead North London & Oncology Research Lead North Middlesex University Hospital, London N18 1QX, UK
- Correspondence: or
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Lau DK, Burge M, Roy A, Chau I, Haller DG, Shapiro JD, Peeters M, Pavlakis N, Karapetis CS, Tebbutt NC, Segelov E, Price TJ. Update on optimal treatment for metastatic colorectal cancer from the AGITG expert meeting: ESMO congress 2019. Expert Rev Anticancer Ther 2020; 20:251-270. [PMID: 32186929 DOI: 10.1080/14737140.2020.1744439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Outcomes in metastatic colorectal cancer are improving, due to the tailoring of therapy enabled by better understanding of clinical behavior according to molecular subtype.Areas covered: A review of the literature and recent conference presentations was undertaken on the topic of systemic treatment of metastatic colorectal cancer. This review summarizes expert discussion of the current evidence for therapies in metastatic colorectal cancer (mCRC) based on molecular subgrouping.Expert opinion: EGFR-targeted and VEGF-targeted antibodies are now routinely incorporated into treatment strategies for mCRC. EGFR-targeted antibodies are restricted to patients with extended RAS wild-type profiles, with evidence that they should be further restricted to patients with left-sided tumors. Clinically distinct treatment pathways based on tumor RAS, BRAF, HER2 and MMR status, are now clinically applicable. Evidence suggests therapy for additional subgroups will soon be defined; the most advanced being for patients with KRAS G12 C mutation and gene TRK fusion defects.
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Affiliation(s)
- David K Lau
- GI and Lymphoma Unit, Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Matthew Burge
- Medical Oncology, Royal Brisbane Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Amitesh Roy
- Medical Oncology, Flinders Centre for Innovation in Cancer, Bedford Park, Australia
| | - Ian Chau
- GI and Lymphoma Unit, Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - Daniel G Haller
- Abramson Cancer Center at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeremy D Shapiro
- Monash University, Melbourne, Australia.,Medical Oncology, Cabrini Medical Centre, Melbourne, Australia
| | - Marc Peeters
- Medical Oncology, University Hospital Antwerp, Edegem, Belgium
| | - Nick Pavlakis
- Medical Oncology, Royal North Shore Hospital, St Leonards, Australia.,Sydney University, Camperdown, Sydney, Australia
| | | | - Niall C Tebbutt
- Medical Oncology, Austin Health, Heidelberg, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Eva Segelov
- Monash University, Melbourne, Australia.,Medical Oncology, Monash Medical Centre, Clayton, Australia
| | - Timothy J Price
- Medical Oncology, The Queen Elizabeth Hospital, Woodville, Australia
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Imai K, Adam R, Baba H. How to increase the resectability of initially unresectable colorectal liver metastases: A surgical perspective. Ann Gastroenterol Surg 2019; 3:476-486. [PMID: 31549007 PMCID: PMC6749948 DOI: 10.1002/ags3.12276] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/29/2019] [Accepted: 06/20/2019] [Indexed: 12/15/2022] Open
Abstract
Although surgical resection is the only treatment of choice that can offer prolonged survival and a chance of cure in patients with colorectal liver metastases (CRLM), nearly 80% of patients are deemed to be unresectable at the time of diagnosis. Considerable efforts have been made to overcome this initial unresectability, including expanding the indication of surgery, the advent of conversion chemotherapy, and development and modification of specific surgical techniques, regulated under multidisciplinary approaches. In terms of specific surgical techniques, portal vein ligation/embolization can increase the volume of future liver remnant and thereby reduce the risk of hepatic insufficiency and death after major hepatectomy. For multiple bilobar CRLM that were traditionally considered unresectable even with preoperative chemotherapy and portal vein embolization, two-stage hepatectomy was introduced and has been adopted worldwide with acceptable short- and long-term outcomes. Recently, ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) was reported as a novel variant of two-stage hepatectomy. Although issues regarding safety remain unresolved, rapid future liver remnant hypertrophy and subsequent shorter intervals between the two stages lead to a higher feasibility rate, reaching 98%. In addition, adding radiofrequency ablation and vascular resection and reconstruction techniques can allow expansion of the pool of patients with CRLM who are candidates for liver resection and thus a cure. In this review, we discuss specific techniques that may expand the criteria for resectability in patients with initially unresectable CRLM.
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Affiliation(s)
- Katsunori Imai
- Department of Gastroenterological SurgeryGraduate School of Life SciencesKumamoto UniversityKumamotoJapan
| | - René Adam
- Centre Hépato‐BiliaireAP‐HPHôpital Universitaire Paul BrousseVillejuifFrance
| | - Hideo Baba
- Department of Gastroenterological SurgeryGraduate School of Life SciencesKumamoto UniversityKumamotoJapan
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Rice SL, Bale R, Breen DJ, de Baere T, Denys A, Guiu B, Goldberg N, Kim E, Lewandowski RJ, Helmberger T, Mejerjink M, Pereira PL, Solbiati L, Solomon SB, Sofocleous CT. The Management of Colorectal Cancer Liver Metastases: The Interventional Radiology Viewpoint. Int J Radiat Oncol Biol Phys 2019; 103:537-539. [PMID: 30722965 DOI: 10.1016/j.ijrobp.2018.08.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 02/07/2023]
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Pellerin O, Pereira H, Moussa N, Del Giudice C, Pernot S, Dean C, Chatellier G, Sapoval M. Can cone-beam CT tumor blood volume predicts the response to chemoembolization of colorectal liver metastases? Results of an observational study. Eur Radiol 2019; 29:5022-31. [PMID: 30788587 DOI: 10.1007/s00330-019-6007-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/13/2018] [Accepted: 01/15/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE To determine whether intraprocedural C-arm cone-beam CT (CBCT) parenchymal blood volume (PBV) can predict the response of colorectal cancer liver metastases (CRCLM) 2 months after irinotecan drug-eluting bead (DEBIRI) chemoembolization. MATERIALS AND METHODS This single-center observational study was compliant with the Helsinki Declaration and approved by our institutional review board. Thirty-four consecutive CRCLM patients referred for DEBIRI chemoembolization were enrolled between March 2015 and December 2016. Tumor size was assessed at baseline and 2 months after DEBIRI chemoembolization by multidetector CT (Response Evaluation Criteria in Solid Tumors RECIST 1.0), and PBV was measured before and after DEBIRI chemoembolization. Two independent readers reviewed all data. We determined the potential correlation (Spearman's rank correlation) between intraprocedural PBV values and tumor response at 2 months. The relationship between tumor response and PBV was studied using a mixed model. A logistic regression model was applied to study the relationship between patient "Responder/Non-responder" and PBV. RESULTS There was a strong correlation between baseline PBV or the percent change of PBV and the 2-month tumor response (rho = - 0.8587 (p = 0.00001) and rho = 0.8027 (p = 0.00001), respectively). The mixed model showed that an increase of 1 ml/1000 ml in PBV of a tumor before DEBIRI chemoembolization led to a 0.54 mm decrease in diameter (p < 0.005). A 1% decrease in PBV after DEBIRI chemoembolization resulted in tumor shrinkage of 0.75 mm (p < 0.005). The logistic regression model showed that patients with a 1% smaller mean decrease of PBV after DEBIRI chemoembolization had a 10% lower likelihood of achieving disease control (OR = 0.9, 95% confidence interval (CI) = 0.81-1; p = 0.0493). CONCLUSION Intraprocedural PBV may predict tumor response to DEBIRI chemoembolization. KEY POINTS • There is a strong relationship between the parenchymal blood volume (PBV) of colorectal liver metastases before DEBIRI chemoembolization and tumor response at 2 months. • Higher PBV values before DEBIRI chemoembolization correlate with greater tumor shrinkage, but only if the PBV decreases by more than 70% after DEBIRI chemoembolization. • Each increase of 1% in the mean decrease of PBV after DEBIRI chemoembolization resulted in a 10% lower likelihood of achieving disease control (OR = 0.9, 95% confidence interval (CI) = 0.81-1; p = 0.0493).
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Sharma A, Duijm M, Oomen-de Hoop E, Aerts JG, Verhoef C, Hoogeman M, Nuyttens JJ. Survival and prognostic factors of pulmonary oligometastases treated with stereotactic body radiotherapy. Acta Oncol 2019; 58:74-80. [PMID: 30280633 DOI: 10.1080/0284186x.2018.1521986] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) for pulmonary oligometastatic disease achieves excellent treatment outcomes in terms of local control and toxicity. Patients treated with SBRT are often elderly and have multiple co-morbidities. This subset of patients may experience different survival as compared to young and fit patients subjected to radical metastasectomies. The purpose of this retrospective study was to evaluate OS and identify factors associated with OS for inoperable pulmonary oligometastases treated with SBRT. MATERIAL AND METHODS Criteria used for selection of patients with oligometastases included: metastases limited to ≤2 organs and in total ≤5 metastases at the time of treatment. Peripheral tumors were treated with 51 Gy to 60 Gy in three fractions or a single fraction of 30 Gy. Central tumors received a dose of 45-60 Gy in 5-8 fractions. Survival probabilities were estimated by means of Kaplan-Meier method and the relation between potential prognostic factors and OS was studied by means of Cox regression analyses. RESULTS In this study, 327 inoperable pulmonary oligometastases in 206 patients were treated with SBRT from the year 2005 to 2015. Primary sites of pulmonary oligometastases included colorectal carcinoma (n = 118), lung carcinoma (n = 36), melanoma (n = 11), sarcoma (n = 10), breast carcinoma (n = 7), and other tumors sites (n = 24). Median follow-up was 26 months. Median survival was 33 months. The 2-year and 5-year OS rates were 63% and 30%, respectively. On univariate analysis synchronous oligometastases (HR 0.59) and colorectal primary (HR 0.64) were associated with improved OS. On multivariable analysis synchronous oligometastases (HR 0.56), colorectal primary (HR 0.62) and tumor size <3 cm (HR 0.68) were independently associated with OS. CONCLUSIONS SBRT to pulmonary oligometastases was associated with a 2-year OS of 63%. Tumor size <3 cm and colorectal primary tumors experienced improved OS compared to tumors >3 cm and non-colorectal primary tumors.
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Affiliation(s)
- Aman Sharma
- Department of Radiation and Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands
| | - Marloes Duijm
- Department of Radiation and Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands
| | - Esther Oomen-de Hoop
- Department of Radiation and Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands
| | - Joachim G. Aerts
- Department of Pulmonology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands
| | - Mischa Hoogeman
- Department of Radiation and Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands
| | - Joost Jan Nuyttens
- Department of Radiation and Oncology, Erasmus MC-Cancer Institute, Rotterdam, The Netherlands
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Stewart CL, Warner S, Ito K, Raoof M, Wu GX, Kessler J, Kim JY, Fong Y. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure? Curr Probl Surg 2018; 55:330-379. [PMID: 30526930 DOI: 10.1067/j.cpsurg.2018.08.004] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Camille L Stewart
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Susanne Warner
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Kaori Ito
- Department of Surgery, Michigan State University, Lansing, MI
| | - Mustafa Raoof
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Geena X Wu
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Jonathan Kessler
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - Jae Y Kim
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Yuman Fong
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA.
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13
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Hong JC, Ayala-Peacock DN, Lee J, Blackstock AW, Okunieff P, Sung MW, Weichselbaum RR, Kao J, Urbanic JJ, Milano MT, Chmura SJ, Salama JK. Classification for long-term survival in oligometastatic patients treated with ablative radiotherapy: A multi-institutional pooled analysis. PLoS One 2018; 13:e0195149. [PMID: 29649281 DOI: 10.1371/journal.pone.0195149] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 03/06/2018] [Indexed: 12/12/2022] Open
Abstract
Background Radiotherapy is increasingly used to treat oligometastatic patients. We sought to identify prognostic criteria in oligometastatic patients undergoing definitive hypofractionated image-guided radiotherapy (HIGRT). Methods Exclusively extracranial oligometastatic patients treated with HIGRT were pooled. Characteristics including age, sex, primary tumor type, interval to metastatic diagnosis, number of treated metastases and organs, metastatic site, prior systemic therapy for primary tumor treatment, prior definitive metastasis-directed therapy, and systemic therapy for metastasis associated with overall survival (OS), progression-free survival (PFS), and treated metastasis control (TMC) were assessed by the Cox proportional hazards method. Recursive partitioning analysis (RPA) identified prognostic risk strata for OS and PFS based on pretreatment factors. Results 361 patients were included. Primary tumors included non-small cell lung (17%), colorectal (19%), and breast cancer (16%). Three-year OS was 56%, PFS was 24%, and TMC was 72%. On multivariate analysis, primary tumor, interval to metastases, treated metastases number, and mediastinal/hilar lymph node, liver, or adrenal metastases were associated with OS. Primary tumor site, involved organ number, liver metastasis, and prior primary disease chemotherapy were associated with PFS. OS RPA identified five classes: class 1: all breast, kidney, or prostate cancer patients (BKP) (3-year OS 75%, 95% CI 66–85%); class 2: patients without BKP with disease-free interval of 75+ months (3-year OS 85%, 95% CI 67–100%); class 3: patients without BKP, shorter disease-free interval, ≤ two metastases, and age < 62 (3-year OS 55%, 95% CI 48–64%); class 4: patients without BKP, shorter disease-free interval, ≥ three metastases, and age < 62 (3-year OS 38%, 95% CI 24–60%); class 5: all others (3-year OS 13%, 95% CI 5–35%). Higher biologically effective dose (BED) (p < 0.01) was associated with OS. Conclusions We identified clinical factors defining oligometastatic patients with favorable outcomes, who we hypothesize are most likely to benefit from metastasis-directed therapy.
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Nielsen K, Scheffer HJ, Volders JH, van der Vorst MJDL, van Tilborg AAJM, Comans EF, de Lange-de Klerk ESM, Sietses C, Meijer S, Meijerink MR, van den Tol MP. Radiofrequency Ablation to Improve Survival After Conversion Chemotherapy for Colorectal Liver Metastases. World J Surg 2017; 40:1951-8. [PMID: 27220509 DOI: 10.1007/s00268-016-3554-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Systemic chemotherapy is able to convert colorectal liver metastases (CRLM) that are initially unsuitable for local treatment into locally treatable disease. Surgical resection further improves survival in these patients. Our aim was to evaluate disease-free survival (DFS), overall survival, and morbidity for patients with CRLM treated with RFA following effective downstaging by chemotherapy, and to identify factors associated with recurrence and survival. MATERIALS AND METHODS Included patients had liver-dominant CRLM initially unsuitable for local treatment but eligible for RFA or RFA with resection after downstaging by systemic chemotherapy. Chemotherapeutic regimens consisted predominantly of CapOx, with or without bevacizumab. Follow-up was conducted with PET-CT or thoraco-pelvic CT. RESULTS Fifty-one patients had a total of 325 CRLM (median = 7). Following chemotherapy, 183 lesions were still visible on CT (median = 3). Twenty-six patients were treated with RFA combined with resection. During surgery, 309 CRLM were retrieved on intraoperative ultrasound (median = 5). Median survival was 49 months and was associated with extrahepatic disease at time of presentation and recurrences after treatment. Estimated cumulative survival at 1, 3 and 4 years was 90, 63 and 45 %, respectively. Median DFS was 6 months. Twelve patients remained free of recurrence after a mean follow-up of 32.6 months. CONCLUSION RFA of CRLM after conversion chemotherapy provides potential local control and a good overall survival. To prevent undertreatment, the involvement of a multidisciplinary team in follow-up imaging and assessment of local treatment possibilities after palliative chemotherapy for liver-dominant CRLM should always be considered.
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Affiliation(s)
- Karin Nielsen
- Department of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Hester J Scheffer
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - José H Volders
- Department of Surgery, Gelderse Vallei Hospital, Postbus 9025, 6716 RP, Ede, The Netherlands
| | - Maurice J D L van der Vorst
- Department of Medical Oncology, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Department of Medical Oncology, Rijnstate Hospital, Marga Klompélaan 6, 6836 TA, Arnhem, The Netherlands
| | - Aukje A J M van Tilborg
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Emile Fi Comans
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - E S M de Lange-de Klerk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Colin Sietses
- Department of Surgery, Gelderse Vallei Hospital, Postbus 9025, 6716 RP, Ede, The Netherlands
| | - Sybren Meijer
- Department of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - M Petrousjka van den Tol
- Department of Surgery, VU University Medical Center, Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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15
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Pędziwiatr M, Mizera M, Witowski J, Major P, Torbicz G, Gajewska N, Budzyński A. Primary tumor resection in stage IV unresectable colorectal cancer: what has changed? Med Oncol 2017; 34:188. [PMID: 29086041 PMCID: PMC5662673 DOI: 10.1007/s12032-017-1047-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/13/2017] [Indexed: 12/16/2022]
Abstract
Most current guidelines do not recommend primary tumor resection in stage IV unresectable colorectal cancer. Rapid chemotherapy development over the last decade has substantially changed the decision making. However, results of recently published trials and meta-analyses suggest that primary tumor resection may in fact be beneficial, principally in terms of prolonged survival. Additional factors, such as use of minimally invasive approach or protocols of enhanced recovery after surgery, affect clinical outcomes as well, but are often neglected when discussing the state of the art in this area. There are still no randomized studies determining the legitimacy of upfront surgery in asymptomatic patients. Also, quality of life also plays an important role in choosing appropriate treatment. Having said that, there is no data that would prove whether primary tumor resection has an advantage on that issue. With all the uncertainty, currently decision making in unresectable stage IV colorectal cancer is primarily up to clinicians' knowledge, common sense and patients' preferences.
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Affiliation(s)
- Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, Kraków, Poland. .,Centre for Research, Training and Innovation and Surgery (CERTAIN Surgery), Kraków, Poland.
| | - Magdalena Mizera
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, Kraków, Poland
| | - Jan Witowski
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, Kraków, Poland.,Centre for Research, Training and Innovation and Surgery (CERTAIN Surgery), Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, Kraków, Poland.,Centre for Research, Training and Innovation and Surgery (CERTAIN Surgery), Kraków, Poland
| | - Grzegorz Torbicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, Kraków, Poland
| | - Natalia Gajewska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21, Kraków, Poland.,Centre for Research, Training and Innovation and Surgery (CERTAIN Surgery), Kraków, Poland
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16
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Abstract
Liver metastases are the most common cause of death in colorectal cancer patients. Nowadays, complete resection is considered to be the only curative treatment but only approximately 25% of patients are suitable candidates for surgery; therefore, many different interventional oncology techniques have been developed in recent years for the treatment of secondary liver metastases. The aim of interventional oncological procedures is either to provide a potentially curative treatment option for locally limited metastases with local ablative techniques, to enable nonresectable tumors to become accessible to surgical or local ablative techniques using transarterial procedures or to achieve improved survival in a palliative setting. These interventional therapies include transarterial approaches, such as chemoembolization and radioembolization as well as a multitude of different ablative techniques, such as radiofrequency and microwave ablation as well as irreversible electroporation (IRE). This article describes the indications for the various procedures and the clinical results of each of these techniques are reviewed based on the currently available literature.
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Affiliation(s)
- R-T Hoffmann
- Institut und Poliklinik für Radiologische Diagnostik, Klinikum Carl-Gustav-Carus der TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
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17
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Virdee PS, Moschandreas J, Gebski V, Love SB, Francis EA, Wasan HS, van Hazel G, Gibbs P, Sharma RA. Protocol for Combined Analysis of FOXFIRE, SIRFLOX, and FOXFIRE-Global Randomized Phase III Trials of Chemotherapy +/- Selective Internal Radiation Therapy as First-Line Treatment for Patients With Metastatic Colorectal Cancer. JMIR Res Protoc 2017; 6:e43. [PMID: 28351831 PMCID: PMC5388825 DOI: 10.2196/resprot.7201] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/19/2017] [Accepted: 01/21/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In colorectal cancer (CRC), unresectable liver metastases are associated with a poor prognosis. The FOXFIRE (an open-label randomized phase III trial of 5-fluorouracil, oxaliplatin, and folinic acid +/- interventional radioembolization as first-line treatment for patients with unresectable liver-only or liver-predominant metastatic colorectal cancer), SIRFLOX (randomized comparative study of FOLFOX6m plus SIR-Spheres microspheres versus FOLFOX6m alone as first-line treatment in patients with nonresectable liver metastases from primary colorectal carcinoma), and FOXFIRE-Global (assessment of overall survival of FOLFOX6m plus SIR-Spheres microspheres versus FOLFOX6m alone as first-line treatment in patients with nonresectable liver metastases from primary colorectal carcinoma in a randomized clinical study) clinical trials were designed to evaluate the efficacy and safety of combining first-line chemotherapy with selective internal radiation therapy (SIRT) using yttrium-90 resin microspheres, also called transarterial radioembolization. OBJECTIVE The aim of this analysis is to prospectively combine clinical data from 3 trials to allow adequate power to evaluate the impact of chemotherapy with SIRT on overall survival. METHODS Eligible patients are adults with histologically confirmed CRC and unequivocal evidence of liver metastases which are not treatable by surgical resection or local ablation with curative intent at the time of study entry. Patients may also have limited extrahepatic metastases. Final analysis will take place when all participants have been followed up for a minimum of 2 years. RESULTS Efficacy and safety estimates derived using individual participant data (IPD) from SIRFLOX, FOXFIRE, and FOXFIRE-Global will be pooled using 2-stage prospective meta-analysis. Secondary outcome measures include progression-free survival (PFS), liver-specific PFS, health-related quality of life, response rate, resection rate, and adverse event profile. The large study population will facilitate comparisons of low frequency adverse events and allow for more robust safety analyses. The potential treatment benefit in those patients who present with disease confined to the liver will be investigated using 1-stage IPD meta-analysis. Efficacy will be analyzed on an intention-to-treat basis. CONCLUSIONS This analysis will assess the impact of SIRT combined with chemotherapy on overall survival in the first-line treatment of metastatic CRC. If positive, the results will change the standard of care for this disease. TRIAL REGISTRATION FOXFIRE ISRCTN Registry ISRCTN83867919; http://www.isrctn.com/ISRCTN83867919 (Archived by WebCite at http://www.webcitation.org/6oN7axrvA). SIRFLOX ClinicalTrials.gov NCT00724503; https://clinicaltrials.gov/ ct2/show/NCT00724503 (Archived by WebCite at http://www.webcitation.org/6oN7lEGbD). FOXFIRE-Global ClinicalTrials.gov NCT01721954; https://clinicaltrials.gov/ct2/show/NCT01721954 (Archived by WebCite at http://www.webcitation.org/ 6oN7vvQvG).
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Affiliation(s)
- Pradeep S Virdee
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Joanna Moschandreas
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Sharon B Love
- Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - E Anne Francis
- Oncology Clinical Trials Office, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Harpreet S Wasan
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | | | - Peter Gibbs
- Western Hospital, Footscray, Victoria, Australia
| | - Ricky A Sharma
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
- Cancer Research United Kingdom-Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
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18
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Angelsen JH, Horn A, Sorbye H, Eide GE, Løes IM, Viste A. Population-based study on resection rates and survival in patients with colorectal liver metastasis in Norway. Br J Surg 2017; 104:580-589. [DOI: 10.1002/bjs.10457] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/29/2016] [Accepted: 11/14/2016] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Detailed knowledge about the proportion of patients with colorectal liver metastases (CLM) undergoing resection is sparse. The aim of this study was to analyse cumulative resection rates and survival in patients with CLM.
Methods
For this population-based study of patients developing CLM during 2011–2013, data were extracted from the Norwegian Patient Registry and the Cancer Registry of Norway.
Results
A total of 2960 patients had CLM; their median overall survival was 10·9 months. Liver resection was performed in 538 patients. The cumulative resection rate was 20·0 per cent. The cumulative resection rate was 23·3 per cent in patients aged less than 40 years, 31·1 per cent in patients aged 40–59 years, 24·7 per cent in those aged 60–74 years, 17·9 per cent in those aged 75–79 years and 4·7 per cent in patients aged 80 years or more (P < 0·001). In multivariable analysis, resection rate was associated with age, extrahepatic metastases, disease-free interval and geographical region. Overall survival after diagnosis of CLM was affected by liver resection (hazard ratio (HR) 0·54, 95 per cent c.i. 0·34 to 0·86), rectal cancer (HR 0·82, 0·74 to 0·90), metachronous disease (HR 0·66, 0·60 to 0·74), increasing age (HR 1·32, 1·28 to 1·37), region, and extrahepatic metastases (HR 1·90, 1·74 to 2·07). Three- and 4-year overall survival rates after hepatectomy were 73·2 and 54·8 per cent respectively.
Conclusion
The cumulative resection rate in patients with CLM in Norway between 2011 and 2013 was 20 per cent. Resection rates varied across geographical regions, and with patient and disease characteristics.
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Affiliation(s)
- J-H Angelsen
- Department of Acute and Digestive Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - A Horn
- Department of Acute and Digestive Surgery, Haukeland University Hospital, Bergen, Norway
| | - H Sorbye
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - G E Eide
- Centre for Clinical Research, Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - I M Løes
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - A Viste
- Department of Acute and Digestive Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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19
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Tanadini-Lang S, Rieber J, Filippi AR, Fode MM, Streblow J, Adebahr S, Andratschke N, Blanck O, Boda-Heggemann J, Duma M, Eble MJ, Ernst I, Flentje M, Gerum S, Hass P, Henkenberens C, Hildebrandt G, Imhoff D, Kahl H, Klass ND, Krempien R, Lohaus F, Petersen C, Schrade E, Wendt TG, Wittig A, Høyer M, Ricardi U, Sterzing F, Guckenberger M. Nomogram based overall survival prediction in stereotactic body radiotherapy for oligo-metastatic lung disease. Radiother Oncol 2017; 123:182-188. [PMID: 28169042 DOI: 10.1016/j.radonc.2017.01.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 12/28/2016] [Accepted: 01/03/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Radical local treatment of pulmonary metastases is practiced with increasing frequency due to acknowledgment and better understanding of oligo-metastatic disease. This study aimed to develop a nomogram predicting overall survival (OS) after stereotactic body radiotherapy (SBRT) for pulmonary metastases. PATIENTS AND METHODS A multi-institutional database of 670 patients treated with SBRT for pulmonary metastases was used as training cohort. Cox regression analysis with bidirectional variable elimination was performed to identify factors to be included into the nomogram model to predict 2-year OS. The calibration rate of the nomogram was assessed by plotting the actual Kaplan-Meier 2-year OS against the nomogram predicted survival. The nomogram was externally validated using two separate monocentric databases of 145 and 92 patients treated with SBRT for pulmonary metastases. RESULTS The median follow up of the trainings cohort was 14.3months, the 2-year and 5-year OS was 52.6% and 23.7%, respectively. Karnofsky performance index, type of the primary tumor, control of the primary tumor, maximum diameter of the largest treated metastasis and number of metastases (1 versus >1) were significant prognostic factors in the Cox model (all p<0.05). The calculated concordance-index for the nomogram was 0.73 (concordance indexes of all prognostic factors between 0.54 and 0.6). Based on the nomogram the training cohort was divided into 4 groups and 2-year OS ranged between 24.2% and 76.1% (predicted OS between 30.2% and 78.4%). The nomogram discriminated between risk groups in the two validation cohorts (concordance index 0.68 and 0.67). CONCLUSIONS A nomogram for prediction of OS after SBRT for pulmonary metastases was generated and externally validated. This tool might be helpful for interdisciplinary discussion and evaluation of local and systemic treatment options in the oligo-metastatic setting. KEY MESSAGE A nomogram for prediction of overall survival after stereotactic body radiotherapy (SBRT) for pulmonary metastases was developed and externally validated. This tool might be helpful for interdisciplinary discussion and evaluation of local and systemic treatment options in the oligo-metastatic setting.
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Affiliation(s)
- S Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - J Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany
| | - A R Filippi
- Department of Oncology, University of Torino, Torino, Italy
| | - M M Fode
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - J Streblow
- Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany
| | - S Adebahr
- Department of Radiation Oncology, University Hospital Freiburg, Germany
| | - N Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland; Department of Radiation Oncology, University of Rostock, Germany
| | - O Blanck
- Department of Radiation Oncology, UKSH Universitätsklinikum Schleswig Holstein, Kiel, Germany
| | - J Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany
| | - M Duma
- Department of Radiation Oncology, Technical University Munich, Germany
| | - M J Eble
- Department of Radiation Oncology, University Hospital Aachen, Germany
| | - I Ernst
- Department of Radiation Oncology, University Hospital Münster, Germany
| | - M Flentje
- Department of Radiation Oncology, University Hospital Wuerzburg, Germany
| | - S Gerum
- Department of Radiation Oncology, 11 Ludwig Maximilians University Munich, Germany
| | - P Hass
- Department of Radiation Oncology, University Hospital Magdeburg, Germany
| | - C Henkenberens
- Department of Radiotherapy and Special Oncology, Medical School Hannover, Germany
| | - G Hildebrandt
- Department of Radiation Oncology, University of Rostock, Germany
| | - D Imhoff
- Department of Radiation Oncology, University Hospital Frankfurt, Germany
| | - H Kahl
- Department of Radiation Oncology, Hospital Augsburg, Germany
| | - N D Klass
- Department of Radiation Oncology, Bern University Hospital, Bern, Switzerland
| | - R Krempien
- Department of Radiation Oncology, Helios Klinikum Berlin Buch, Germany
| | - F Lohaus
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg Germany and German Cancer Consortium (DKTK), Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology (NCRO), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - C Petersen
- Department of Radiation Oncology, University Hospital Hamburg, Germany
| | - E Schrade
- Department of Radiation Oncology, Hospital Heidenheim, Germany
| | - T G Wendt
- Department of Radiation Oncology, University Hospital Jena, Germany
| | - A Wittig
- Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg, University Hospital Giessen and Marburg, Germany
| | - M Høyer
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - U Ricardi
- Department of Oncology, University of Torino, Torino, Italy
| | - F Sterzing
- Department of Radiation Oncology, University Hospital Heidelberg, Germany; Heidelberg Institute of Radiation Oncology, Germany; German Cancer Research Center, Clinical Cooperation Unit Radiation Oncology, Heidelberg, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland.
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Abstract
Resection of colorectal liver metastases is a treatment standard because patients experience long-term disease-free survival or are even cured after undergoing this procedure. Improved surgical techniques for liver resection in combination with downsizing liver metastases by chemotherapy, interventions to induce liver hypertrophy before resection, and the use of ablative techniques have allowed us to expand the indications for liver surgery and local treatment in situations with limited metastatic colorectal cancer. Resectability and identification of patients who might benefit from liver surgery and local ablative techniques are key factors for the treatment of patients with colorectal cancer. Despite the wide acceptance of liver surgery and ablative techniques, there are many open questions on the management of limited metastatic disease, such as which patients benefit from an aggressive surgical approach, what the indications for ablative and other local techniques are, and what the role of chemotherapy is for patients with resectable or resected disease. Unfortunately, results of randomized trials are only available for a limited number of these questions.
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Affiliation(s)
- Gunnar Folprecht
- From the University Hospital Carl Gustav Carus, University Cancer Center, Medical Department I, Dresden, Germany
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21
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Vogel A, Gupta S, Zeile M, von Haken R, Brüning R, Lotz G, Vahrmeijer A, Vogl T, Wacker F. Chemosaturation Percutaneous Hepatic Perfusion: A Systematic Review. Adv Ther 2017; 33:2122-2138. [PMID: 27798773 PMCID: PMC5126197 DOI: 10.1007/s12325-016-0424-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Indexed: 12/11/2022]
Abstract
The Hepatic CHEMOSAT® Delivery System is an innovative medical device for the treatment of patients with unresectable primary liver tumors or unresectable hepatic metastases from solid organ malignancies. This system is used to perform chemosaturation percutaneous hepatic perfusion (CS-PHP), a procedure in which a high dose of the chemotherapeutic agent melphalan is delivered directly to the liver while limiting systemic exposure. In a clinical trial program, CS-PHP with melphalan significantly improved hepatic progression-free survival in patients with unresectable hepatic metastases from ocular or cutaneous melanoma. Clinically meaningful hepatic responses were also observed in patients with hepatocellular carcinoma or neuroendocrine tumors. Furthermore, the results of published studies and case reports demonstrated that CS-PHP with melphalan resulted in favorable tumor response rates in a range of tumor histologies (ocular or cutaneous melanoma, colorectal cancer, and hepatobiliary tumors). Analyses of the safety profile of CS-PHP revealed that the most common adverse effects were hematologic events (thrombocytopenia, anemia, and neutropenia), which were clinically manageable. Taken together, these findings indicate that CS-PHP is a promising locoregional therapy for patients with primary and secondary liver tumors and has a acceptable safety profile. FUNDING Delcath Systems Inc., New York, NY, USA.
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Affiliation(s)
- Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Hannover, Germany.
| | - Sanjay Gupta
- Department of Anaesthesiology, University Hospital Southampton, Tremona Road, Southampton, Hampshire, UK
| | - Martin Zeile
- Department of Radiology and Neuroradiology, Asklepios Clinic Hamburg-Barmbek, Hamburg, Germany
| | - Rebecca von Haken
- Department of Anaesthesiology, University Clinic Heidelberg, Heidelberg, Germany
| | - Roland Brüning
- Department of Radiology and Neuroradiology, Asklepios Clinic Hamburg-Barmbek, Hamburg, Germany
| | - Gösta Lotz
- Department of Anaesthesiology, University Clinic Frankfurt, Frankfurt am Main, Germany
| | - Alexander Vahrmeijer
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Thomas Vogl
- Institute of Diagnostic and Interventional Radiology, University Clinic Frankfurt, Frankfurt am Main, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Medizinische Hochschule Hannover, Hannover, Germany
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Hong JC, Salama JK. The expanding role of stereotactic body radiation therapy in oligometastatic solid tumors: What do we know and where are we going? Cancer Treat Rev 2017; 52:22-32. [PMID: 27886588 DOI: 10.1016/j.ctrv.2016.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 02/07/2023]
Abstract
The spectrum hypothesis posits that there are distinct clinical states of metastatic progression. Early data suggest that aggressive treatment of more biologically indolent metastatic disease, characterized by metastases limited in number and destination organ, may offer an opportunity to alter the disease course, potentially allowing for longer survival, delay of systemic therapy, or even cure. The development of stereotactic body radiation therapy (SBRT) has opened new avenues for the treatment of oligometastatic disease. Early data support the use of SBRT for treating oligometastases in a number of organs, with promising rates of treated metastasis control and overall survival. Ongoing investigation is required to definitively establish benefit, determine the appropriate treatment regimen, refine patient selection, and incorporate SBRT with systemic therapies.
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Affiliation(s)
- Julian C Hong
- Department of Radiation Oncology, Duke University, Durham, NC, United States
| | - Joseph K Salama
- Department of Radiation Oncology, Duke University, Durham, NC, United States.
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23
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van Hazel GA, Heinemann V, Sharma NK, Findlay MP, Ricke J, Peeters M, Perez D, Robinson BA, Strickland AH, Ferguson T, Rodríguez J, Kröning H, Wolf I, Ganju V, Walpole E, Boucher E, Tichler T, Shacham-Shmueli E, Powell A, Eliadis P, Isaacs R, Price D, Moeslein F, Taieb J, Bower G, Gebski V, Van Buskirk M, Cade DN, Thurston K, Gibbs P. SIRFLOX: Randomized Phase III Trial Comparing First-Line mFOLFOX6 (Plus or Minus Bevacizumab) Versus mFOLFOX6 (Plus or Minus Bevacizumab) Plus Selective Internal Radiation Therapy in Patients With Metastatic Colorectal Cancer. J Clin Oncol 2016; 34:1723-31. [PMID: 26903575 DOI: 10.1200/jco.2015.66.1181] [Citation(s) in RCA: 242] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose SIRFLOX was a randomized, multicenter trial designed to assess the efficacy and safety of adding selective internal radiation therapy (SIRT) using yttrium-90 resin microspheres to standard fluorouracil, leucovorin, and oxaliplatin (FOLFOX)–based chemotherapy in patients with previously untreated metastatic colorectal cancer. Patients and Methods Chemotherapy-naïve patients with liver metastases plus or minus limited extrahepatic metastases were randomly assigned to receive either modified FOLFOX (mFOLFOX6; control) or mFOLFOX6 plus SIRT (SIRT) plus or minus bevacizumab. The primary end point was progression-free survival (PFS) at any site as assessed by independent centralized radiology review blinded to study arm. Results Between October 2006 and April 2013, 530 patients were randomly assigned to treatment (control, 263; SIRT, 267). Median PFS at any site was 10.2 v 10.7 months in control versus SIRT (hazard ratio, 0.93; 95% CI, 0.77 to 1.12; P = .43). Median PFS in the liver by competing risk analysis was 12.6 v 20.5 months in control versus SIRT (hazard ratio, 0.69; 95% CI, 0.55 to 0.90; P = .002). Objective response rates (ORRs) at any site were similar (68.1% v 76.4% in control v SIRT; P = .113). ORR in the liver was improved with the addition of SIRT (68.8% v 78.7% in control v SIRT; P = .042). Grade ≥ 3 adverse events, including recognized SIRT-related effects, were reported in 73.4% and 85.4% of patients in control versus SIRT. Conclusion The addition of SIRT to FOLFOX-based first-line chemotherapy in patients with liver-dominant or liver-only metastatic colorectal cancer did not improve PFS at any site but significantly delayed disease progression in the liver. The safety profile was as expected and was consistent with previous studies.
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Affiliation(s)
- Guy A. van Hazel
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Volker Heinemann
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Navesh K. Sharma
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Michael P.N. Findlay
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Jens Ricke
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Marc Peeters
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - David Perez
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Bridget A. Robinson
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Andrew H. Strickland
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Tom Ferguson
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Javier Rodríguez
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Hendrik Kröning
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Ido Wolf
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Vinod Ganju
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Euan Walpole
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Eveline Boucher
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Thomas Tichler
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Einat Shacham-Shmueli
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Alex Powell
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Paul Eliadis
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Richard Isaacs
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - David Price
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Fred Moeslein
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Julien Taieb
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Geoff Bower
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Val Gebski
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Mark Van Buskirk
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - David N. Cade
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Kenneth Thurston
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
| | - Peter Gibbs
- Guy A. van Hazel, University of Western Australia; Tom Ferguson, Royal Perth Hospital; David Price and Geoff Bower, Mount Medical Center, Perth; Alex Powell, Hollywood Private Hospital, Nedlands, Western Australia; Andrew H. Strickland, Monash Medical Centre, Bentleigh, East Victoria; Vinod Ganju, Frankston Private Hospital Peninsula Oncology Centre, Frankston; Peter Gibbs, Western Hospital, Footscray, Victoria; Euan Walpole, Princess Alexandra Hospital, Woolloongabba; Paul Eliadis, Wesley Medical Centre
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Thillai K, Repana D, Korantzis I, Kane P, Prachalias A, Ross P. Clinical outcomes for patients with liver-limited metastatic colorectal cancer: Arguing the case for specialist hepatobiliary multidisciplinary assessment. Eur J Surg Oncol 2016; 42:1331-6. [PMID: 27174600 DOI: 10.1016/j.ejso.2016.03.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 03/22/2016] [Accepted: 03/31/2016] [Indexed: 12/18/2022] Open
Abstract
In patients with liver-limited metastatic colorectal cancer, hepatic resection can offer a significant survival benefit over systemic therapy alone. Specialist hepatobiliary multidisciplinary meetings are currently believed to provide the best forum to discuss the management for these patients. A retrospective analysis was undertaken of patients diagnosed with liver-limited metastatic colorectal cancer over 6 months within a cancer network in the United Kingdom. In addition, patients who were diagnosed but not referred to the hepatobiliary meeting were discussed within a virtual multi-disciplinary setting. Contributors were blinded and proposed management recorded. 159 newly diagnosed patients with liver-limited metastatic colorectal cancer were identified. 68 (43%) were referred at initial diagnosis and 38 (24%) referred following systemic treatment. 35 (51%) who were discussed at baseline underwent a subsequent hepatectomy or radiofrequency ablation, as did 18 (47%) patients referred after chemotherapy. Of the remaining 53 (33%) patients not referred, imaging was available for 31 (58%). Decisions regarding potential liver-directed therapy were discussed within a multi-disciplinary setting. 13 (42%) were identified as resectable or potentially resectable and 11 (36%) may have been suitable for a clinical trial. In reality, none of these 31 patients (100%) underwent surgery or ablation. Whilst the majority of patients with liver-limited metastatic colorectal cancer were referred appropriately, this study demonstrates that a significant number with potentially resectable disease are not being discussed at specialist meetings. A review of all diagnosed cases would ensure that an increased number of patients are offered hepatic resection or ablation.
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Affiliation(s)
- K Thillai
- Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - D Repana
- Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - I Korantzis
- Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - P Kane
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - A Prachalias
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - P Ross
- Department of Medical Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom; Institute of Liver Studies, King's College Hospital, London, United Kingdom.
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25
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Wilson A, Ronnekliev-Kelly S, Winner M, Pawlik TM. Liver-Directed Therapy in Metastatic Colorectal Cancer. Curr Colorectal Cancer Rep 2016. [DOI: 10.1007/s11888-016-0311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Aranda E, Aparicio J, Alonso V, Garcia-Albeniz X, Garcia-Alfonso P, Salazar R, Valladares M, Vera R, Vieitez JM, Garcia-Carbonero R. SEOM clinical guidelines for diagnosis and treatment of metastatic colorectal cancer 2015. Clin Transl Oncol 2015; 17:972-81. [PMID: 26669312 DOI: 10.1007/s12094-015-1434-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer dead in Spain. About half the patients will eventually develop distant metastases. However, as treatment options are expanding, prognosis has steadily improved over the last decades. Management of advanced CRC should be discussed within an experienced multidisciplinary team to select the most appropriate systemic treatment (chemotherapy and targeted agents) and to integrate surgical or ablative procedures when indicated. Disease site and extent, resectability, tumor biology and gene mutations, clinical presentation, patient preferences, and comorbidities are key factors to design a customized treatment plan. The aim of these guidelines is to provide synthetic recommendations for managing advanced CRC patients.
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Semrad TJ. ASCO 2015 update on gastrointestinal cancer: Checkpoint inhibition, multimodality strategies and secondary prevention. Surg Oncol 2015; 24:371-4. [PMID: 26646090 PMCID: PMC4688068 DOI: 10.1016/j.suronc.2015.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 11/06/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas J Semrad
- Division of Hematology/Oncology, Department of Internal Medicine, University of California Davis Comprehensive Cancer Center, 4501 X Street, Suite 3016, Sacramento, CA 95817, USA.
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Evrard S, Mckelvie-sebileau P, van de Velde C, Nordlinger B, Poston G. What can we learn from oncology surgical trials? Nat Rev Clin Oncol 2016; 13:55-62. [DOI: 10.1038/nrclinonc.2015.176] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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