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Ducreux M, Abou-Alfa GK, Bekaii-Saab T, Berlin J, Cervantes A, de Baere T, Eng C, Galle P, Gill S, Gruenberger T, Haustermans K, Lamarca A, Laurent-Puig P, Llovet JM, Lordick F, Macarulla T, Mukherji D, Muro K, Obermannova R, O'Connor JM, O'Reilly EM, Osterlund P, Philip P, Prager G, Ruiz-Garcia E, Sangro B, Seufferlein T, Tabernero J, Verslype C, Wasan H, Van Cutsem E. The management of hepatocellular carcinoma. Current expert opinion and recommendations derived from the 24th ESMO/World Congress on Gastrointestinal Cancer, Barcelona, 2022. ESMO Open 2023; 8:101567. [PMID: 37263081 PMCID: PMC10245111 DOI: 10.1016/j.esmoop.2023.101567] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 06/03/2023] Open
Abstract
This article summarises expert discussion on the management of patients with hepatocellular carcinoma (HCC), which took place during the 24th World Gastrointestinal Cancer Congress (WGICC) in Barcelona, July 2022. A multidisciplinary approach is mandatory to ensure an optimal diagnosis and staging of HCC, planning of curative and therapeutic options, including surgical, embolisation, ablative strategies, or systemic therapy. Furthermore, in many patients with HCC, underlying liver cirrhosis represents a challenge and influences the therapeutic options.
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Affiliation(s)
- M Ducreux
- Université Paris-Saclay, Gustave Roussy, Villejuif, France.
| | - G K Abou-Alfa
- Memorial Sloan Kettering Cancer Center, New York; Weill Cornell College of Medicine, New York, USA; Trinity College Dublin, Dublin, Ireland
| | | | - J Berlin
- Vanderbilt-Ingram Cancer Center, Nashville, USA
| | - A Cervantes
- INCLIVA, Biomedical Research Institute, Hospital Clínico Universitario, University of Valencia, Valencia, Spain
| | - T de Baere
- Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - C Eng
- Vanderbilt-Ingram Cancer Center, Nashville, USA
| | - P Galle
- University Medical Center Mainz, Mainz, Germany
| | - S Gill
- BC Cancer/University of British Columbia, Vancouver, Canada
| | - T Gruenberger
- Clinic Favoriten, HPB Center Health Network Vienna and Sigmund Freud University, Medical School, Vienna, Austria
| | - K Haustermans
- University Hospitals Gasthuisbergs, Leuven; Katholieke Universiteit Leuven, Leuven, Belgium
| | - A Lamarca
- Department of Oncology, OncoHealth Institute, Fundación Jiménez Díaz University Hospital, Madrid, Spain; Department of Medical Oncology, The Christie NHS Foundation, Manchester; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - P Laurent-Puig
- Institut du cancer Paris CARPEM, APHP, Georges Pompidou Hospital, Université Paris Cité, Paris, France
| | - J M Llovet
- Icahn School of Medicine at Mount Sinai, Mount Sinai Liver Cancer Program, New York, USA; Institut d'Investigacions Biomèdiques August Pi i Sunyer Hospital Clínic, Universitat de Barcelona, Barcelona; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - F Lordick
- University of Leipzig Medical Center, Comprehensive Cancer Center Central Germany, Leipzig, Germany
| | - T Macarulla
- Vall d'Hebron Hospital Campus, Barcelona, Spain; Institute of Oncology, IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - D Mukherji
- American University of Beirut, Beirut, Lebanon
| | - K Muro
- Aichi Cancer Center Hospital, Nagoya, Japan
| | - R Obermannova
- Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - J-M O'Connor
- Instituto Alexander Fleming, Buenos Aires, Argentina
| | - E M O'Reilly
- Memorial Sloan Kettering Cancer Center, New York; Weill Cornell College of Medicine, New York, USA
| | - P Osterlund
- Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Tampere University Hospital, University of Tampere, Tampere, Finland
| | - P Philip
- Henry Ford Cancer Institute, Departments of Oncology and Pharmacology, Wayne State University, Detroit, USA
| | - G Prager
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | - B Sangro
- Clinica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | | | - J Tabernero
- Vall d'Hebron Hospital Campus and Institute of Oncology, IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - C Verslype
- University Hospitals Gasthuisbergs, Leuven; Katholieke Universiteit Leuven, Leuven, Belgium
| | - H Wasan
- Hammersmith Hospital, Imperial College London, London, UK
| | - E Van Cutsem
- University Hospitals Gasthuisbergs, Leuven; Katholieke Universiteit Leuven, Leuven, Belgium
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Balakrishnan A, Jah A, Lesurtel M, Andersson B, Gibbs P, Harper SJF, Huguet EL, Kosmoliaptsis V, Liau SS, Praseedom RK, Ramia JM, Branes A, Lendoire J, Maithel S, Serrablo A, Achalandabaso M, Adham M, Ahmet A, Al-Sarireh B, Albiol Quer M, Alconchel F, Alejandro R, Alsammani M, Alseidi A, Anand A, Anselmo A, Antonakis P, Arabadzhieva E, de Aretxabala X, Aroori S, Ashley S, Ausania F, Banerjee A, Barabino M, Bartlett A, Bartsch F, Belli A, Beristain-Hernandez J, Berrevoet F, Bhatti A, Bhojwani R, Bjornsson B, Blaz T, Byrne M, Calvo M, Castellanos J, Castro M, Cavallucci D, Chang D, Christodoulis G, Ciacio O, Clavien P, Coker A, Conde-Rodriguez M, D'Amico F, D'Hondt M, Daams F, Dasari B, De Beillis M, de Meijer V, Dede K, Deiro G, Delgado F, Desai G, Di Gioia A, Di Martino M, Dixon M, Dorovinis P, Dumitrascu T, Ebata T, Eilard M, Erdmann J, Erkan M, Famularo S, Felli E, Fergadi M, Fernandez G, Fox A, Galodha S, Galun D, Ganandha S, Garcia R, Gemenetzis G, Giannone F, Gil L, Giorgakis E, Giovinazzo F, Giuffrida M, Giuliani T, Giuliante F, Gkekas I, Goel M, Goh B, Gomes A, Gruenberger T, Guevara O, Gulla A, Gupta A, Gupta R, Hakeem A, Hamid H, Heinrich S, Helton S, Heumann A, Higuchi R, Hughes D, Inarejos B, Ivanecz A, Iwao Y, Iype S, Jaen I, Jie M, Jones R, Kacirek K, Kalayarasan R, Kaldarov A, Kaman L, Kanhere H, Kapoor V, Karanicolas P, Karayiannakis A, Kausar A, Khan Z, Kim DS, Klose J, Knowles B, Koh P, Kolodziejczyk P, Komorowski A, Koong J, Kozyrin I, Krishna A, Kron P, Kumar N, van Laarhoven S, Lakhey P, Lanari J, Laurenzi A, Leow V, Limbu Y, Liu YB, Lob S, Lolis E, Lopez-Lopez V, Lozano R, Lundgren L, Machairas M, Magouliotis D, Mahamid A, Malde D, Malek A, Malik H, Malleo G, Marino M, Mayo S, Mazzola M, Memeo R, Menon K, Menzulin R, Mohan R, Morgul H, Moris D, Mulita F, Muttillo E, Nahm C, Nandasena M, Nashidengo P, Nickkholgh A, Nikov A, Noel C, O'Reilly D, O'Rourke T, Ohtsuka M, Omoshoro-Jones J, Pandanaboyana S, Pararas N, Patel R, Patkar S, Peng J, Perfecto A, Perinel J, Perivoliotis K, Perra T, Phan M, Piccolo G, Porcu A, Primavesi F, Primrose J, Pueyo-Periz E, Radenkovic D, Rammohan A, Rowcroft A, Sakata J, Saladino E, Schena C, Scholer A, Schwarz C, Serrano P, Silva M, Soreide K, Sparrelid E, Stattner S, Sturesson C, Sugiura T, Sumo M, Sutcliffe R, Teh C, Teo J, Tepetes K, Thapa P, Thepbunchonchai A, Torres J, Torres O, Torzili G, Tovikkai C, Troncoso A, Tsoulfas G, Tuzuher A, Tzimas G, Umar G, Urbani L, Vanagas T, Varga, Velayutham V, Vigano L, Wakai T, Yang Z, Yip V, Zacharoulis D, Zakharov E, Zimmitti G. Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey. HPB (Oxford) 2022; 24:2006-2012. [PMID: 35922277 DOI: 10.1016/j.hpb.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. METHODS A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. RESULTS Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. CONCLUSION Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
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Affiliation(s)
- Anita Balakrishnan
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Asif Jah
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Bodil Andersson
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Paul Gibbs
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Simon J F Harper
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel L Huguet
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Siong S Liau
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Raaj K Praseedom
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Avenida Pintor Baeza, 12 03010 Alicante, Spain
| | - Alejandro Branes
- Department of HPB Surgery, Hospital Sotero del Rio, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana, Chile
| | - Javier Lendoire
- Department of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322 USA
| | - Alejandro Serrablo
- Department of HPB Surgery, Miguel Servet University Hospital, Zaragoza, Spain
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Caballero C, Alvarez LC, Nilsson H, Ruers T, Senellart P, Rivoire M, Staettner S, Primavesi F, Troisi R, Gruenberger T, Heil J, Schnitzbauer A, Rahbari N, Swijnenburg R, Malik H, Protic M, Neven A, Mauer M, Poston G, Evrard S. EORTC 1409 GITCG / ESSO 01 - A prospective colorectal liver metastasis database with an integrated quality assurance program (CLIMB): Primary analysis of variations in European clinical practices and surgical complications after complex liver metastasis surgeries. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Pereyra D, Gyoeri G, Offensperger F, Braunwarth E, Ammann M, Jonas P, Gnant M, Staettner S, Laengle F, Gruenberger T, Starlinger P. Timely identification of patients at risk for development of postoperative liver dysfunction via CRP and ATIII - the 3-60 criteria. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.268] [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: 11/26/2022] Open
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Pereyra D, Rumpf B, Ammann M, Perrodin SF, Tamandl D, Haselmann C, Stift J, Brostjan C, Laengle F, Beldi G, Gruenberger T, Starlinger P. The Combination of APRI and ALBI Facilitates Preoperative Risk Stratification for Patients Undergoing Liver Surgery After Neoadjuvant Chemotherapy. Ann Surg Oncol 2019; 26:791-799. [PMID: 30617869 PMCID: PMC6373283 DOI: 10.1245/s10434-018-07125-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Indexed: 01/27/2023]
Abstract
Background Neoadjuvant chemotherapy (NeoCTx) is performed for most patients with colorectal cancer liver metastases (CRCLM). However, chemotherapy-associated liver injury (CALI) has been associated with poor postoperative outcome. To date, however, no clinically applicable and noninvasive tool exists to assess CALI before liver resection. Methods Routine blood parameters were assessed in 339 patients before and after completion of NeoCTx and before surgery. The study assessed the prognostic potential of the aspartate aminotransferase (AST)-to-platelet ratio index (APRI), the albumin-bilirubin grade (ALBI), and their combinations. Furthermore, an independent multi-center validation cohort (n = 161) was included to confirm the findings concerning the prediction of postoperative outcome. Results Higher ALBI, APRI, and APRI + ALBI were found in patients with postoperative morbidity (P = 0.001, P = 0.064, P = 0.001, respectively), liver dysfunction (LD) (P = 0.009, P = 0.012, P < 0.001), or mortality (P = 0.037, P = 0.045, P = 0.016), and APRI + ALBI had the highest predictive potential for LD (area under the curve [AUC], 0.695). An increase in APRI + ALBI was observed during NeoCTx (P < 0.001). Patients with longer periods between NeoCTx and surgery showed a greater decrease in APRI + ALBI (P = 0.006) and a trend for decreased CALI at surgery. A cutoff for APRI + ALBI at − 2.46 before surgery was found to identify patients with CALI (P = 0.002) and patients at risk for a prolonged hospital stay (P = 0.001), intensive care (P < 0.001), morbidity (P < 0.001), LD (P < 0.001), and mortality (P = 0.021). Importantly, the study was able to confirm the predictive potential of APRI + ALBI for postoperative LD and mortality in a multicenter validation cohort. Conclusion Determination of APRI + ALBI before surgery enables identification of high-risk patients for liver resection. The combined score seems to dynamically reflect CALI. Thus, APRI + ALBI could be a clinically relevant tool for optimizing timing of surgery in CRCLM patients after NeoCTx. Electronic supplementary material The online version of this article (10.1245/s10434-018-07125-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Pereyra
- Department of Surgery, General Hospital, Medical University of Vienna, Vienna, Austria
| | - B Rumpf
- Department of Surgery, General Hospital, Medical University of Vienna, Vienna, Austria
| | - M Ammann
- Department of Surgery, State Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - S F Perrodin
- Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern, Switzerland
| | - D Tamandl
- Department of Biomedical Imaging and Image-Guided Therapy, General Hospital, Medical University of Vienna, Vienna, Austria
| | - C Haselmann
- Department of Surgery, General Hospital, Medical University of Vienna, Vienna, Austria
| | - J Stift
- Clinical Institute of Pathology, General Hospital, Medical University of Vienna, Vienna, Austria
| | - C Brostjan
- Department of Surgery, General Hospital, Medical University of Vienna, Vienna, Austria
| | - F Laengle
- Department of Surgery, State Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - G Beldi
- Department of Visceral Surgery and Medicine, University of Bern, Inselspital, Bern, Switzerland
| | - T Gruenberger
- Department of Surgery, Rudolfstiftung Hospital, Vienna, Austria.,Department of Surgery, Kaiser Franz Josef Hospital, Vienna, Austria
| | - P Starlinger
- Department of Surgery, General Hospital, Medical University of Vienna, Vienna, Austria.
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Stremitzer S, Vermeulen P, Kockx M, Dirix L, Graver S, Scherer S, Yang D, Zhang W, Stift J, Wrba F, Gruenberger T, Lenz HJ. The inflamed immune phenotype can be induced by systemic treatment in angiogenic colorectal liver metastases in contrast to non-angiogenic liver metastases. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.090] [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: 11/13/2022] Open
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Allard MA, Adam R, Giuliante F, Lapointe R, Hubert C, Ijzermans JNM, Mirza DF, Elias D, Laurent C, Gruenberger T, Poston G, Letoublon C, Isoniemi H, Lucidi V, Popescu I, Figueras J. Long-term outcomes of patients with 10 or more colorectal liver metastases. Br J Cancer 2017; 117:604-611. [PMID: 28728167 PMCID: PMC5572175 DOI: 10.1038/bjc.2017.218] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 04/25/2017] [Accepted: 06/19/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although the number of colorectal liver metastases (CLM) is decreasingly considered as a contraindication to surgery, patients with 10 CLM or more are often denied liver surgery. This study aimed to evaluate the outcome after liver surgery and to identify prognostic factors of survival in such patients. METHODS The study population consisted of a multicentre cohort of patients with CLM (N=12 406) operated on, with intention to resect, from January 2005-June 2013 and whose data were prospectively collected in the LiverMetSurvey registry. RESULTS Overall, the group ⩾10 CLM (N=529, 4.3%) experienced a 5-year overall survival (OS) of 30%. A macroscopically complete (R0/R1) resection (72.8% of patients) was associated with a 3- and 5-year OS of 61% and 39% vs 29% and 5% for R2/no resection patients (P<0.0001). At multivariate analysis, R0/R1 resection emerged as the strongest favourable factor of OS (HR 0.35 (0.26-0.48)). Other independent favourable factors were as follows: maximal tumour size <40 mm (HR 0.67 (0.49-0.92)); age <60 years (HR 0.66 (0.50-0.88)); preoperative MRI (HR 0.65 (0.47-0.89)); and adjuvant chemotherapy (HR 0.73 (0.55-0.98)). The model showed that 5-year OS rates of 30% was possible provided R0/R1 resection associated with at least an additional favourable factor. CONCLUSIONS Liver resection might provide long-term survival in patients with ⩾10 CLM staged with preoperative MRI, provided R0/R1 resection followed by adjuvant therapy. A validation of these results in another cohort is needed.
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Affiliation(s)
- M A Allard
- Centre Hépato-biliaire, APHP Paul Brousse Hospital, Univ. Paris-Sud, INSERM U 935, Villejuif, France
| | - R Adam
- Centre Hépato-biliaire, APHP Paul Brousse Hospital, Univ. Paris-Sud, INSERM U 935, Villejuif, France
| | - F Giuliante
- Department of HBP Surgery, Catholic University of the Sacred Heart School of Medicine, Rome, Italy
| | - R Lapointe
- Department of HBP Surgery, University of Montreal, Montreal, QC, Canada
| | - C Hubert
- Department of HBP Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Louvain, Belgium
| | - J N M Ijzermans
- Department of HBP surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - D F Mirza
- Department of HBP surgery, University Hospital Birmingham, Birmingham, UK
| | - D Elias
- Department of Oncological Surgery, Gustave Roussy, Villejuif, France
| | - C Laurent
- Department of Surgery, Saint André Hospital, Bordeaux, France
| | - T Gruenberger
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - G Poston
- Department of Surgery, University Hospital Aintree, Liverpool, UK
| | - C Letoublon
- Department of Surgery, University Joseph Fournier, Grenoble, France
| | - H Isoniemi
- Department of Liver Surgery and Transplantation, Helsinki University, Helsinki, Finland
| | - V Lucidi
- Department of Surgery, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - I Popescu
- Department of Surgery and Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - J Figueras
- Department of Surgery, Dr Josep Trueta Hospital, Girona, Spain
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Valle JW, Borbath I, Khan SA, Huguet F, Gruenberger T, Arnold D. Biliary cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27:v28-v37. [PMID: 27664259 DOI: 10.1093/annonc/mdw324] [Citation(s) in RCA: 428] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- J W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - I Borbath
- Department of Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - S A Khan
- Hepatology and Gastroenterology Section, Department of Medicine, Imperial College, London, UK
| | - F Huguet
- Department of Radiation Oncology, Tenon Hospital, APHP, University Paris VI, Paris, France
| | - T Gruenberger
- 1st Department of Surgery, Rudolfstiftung Hospital, Vienna, Austria
| | - D Arnold
- Instituto CUF de Oncologia (I.C.O.), Lisbon, Portugal
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Caballero C, Carrion Alvarez L, Rivoire M, Nilsson H, Staettner S, Gruenberger T, Malik H, Rahbari N, Mauer M, Kataoka K, Atasoy A, Ducreux M, Audisio R, Poston G, Evrard S. 80. EORTC-1409: An EORTC-ESSO prospective colorectal liver metastasis database with an integrated quality assurance program (CLIMB) NCT02218801. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Jones RP, Malik HZ, Fenwick SW, Terlizzo M, O'Grady E, Stremitzer S, Gruenberger T, Rees M, Plant G, Figueras J, Albiol M, Adam R, Awad S, Poston GJ. PARAGON II - A single arm multicentre phase II study of neoadjuvant therapy using irinotecan bead in patients with resectable liver metastases from colorectal cancer. Eur J Surg Oncol 2016; 42:1866-1872. [PMID: 27561844 DOI: 10.1016/j.ejso.2016.07.142] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 04/06/2016] [Revised: 07/27/2016] [Accepted: 07/30/2016] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Perioperative chemotherapy confers a 3-year progression free survival advantage following resection of colorectal liver metastases (CRLM), but is associated with significant toxicity. Chemoembolisation using drug eluting PVA microspheres loaded with irinotecan (DEBIRI) allows sustained delivery of drug directly to tumour, maximising response whilst minimising systemic exposure. This phase II single arm study examined the safety and feasibility of DEBIRI before resection of CRLM. METHODS Patients with resectable CRLM received lobar DEBIRI 1 month prior to surgery, with a radiological endpoint of near stasis. The trial had a primary end-point of tumour resectability (R0 resection). Secondary end-points included safety, pathologic tumour response and overall survival. RESULTS 40 patients received DEBIRI, with a median dose of 103 mg irinotecan (range 64-175 mg). Morbidity was low (2.5%, CTCAE grade 2) with no evidence of systemic chemotoxicity. All patients proceeded to surgery, with 38 undergoing resection (95%, R0 resection rate 74%). 30-day post-operative mortality was 5% (n = 2), with neither death TACE related. 66 lesions were resected, with histologic major or complete pathologic response seen in 77.3% of targeted lesions. At median follow up of 40.6 months, 12 patients (34.3%) had died of recurrent disease with a median overall survival of 50.9 months. Nominal 1, 3 and 5-year OS was 93, 78 & 49% respectively. CONCLUSIONS Resection after neoadjuvant DEBIRI for CRLM is feasible and safe. Single treatment with DEBIRI resulted in tumour pathologic response and median overall survival comparable to that seen after systemic neoadjuvant chemotherapy. Registered at clinicaltrials.gov (NCT00844233).
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Affiliation(s)
- R P Jones
- School of Cancer Studies, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK.
| | - H Z Malik
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
| | - S W Fenwick
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
| | - M Terlizzo
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
| | - E O'Grady
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
| | | | | | - M Rees
- Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - G Plant
- Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - J Figueras
- Dr. Josep Trueta Hospital, Institut d'Investigacions Biomediques de Girona (IdIBGi), Girona, Spain
| | - M Albiol
- Dr. Josep Trueta Hospital, Institut d'Investigacions Biomediques de Girona (IdIBGi), Girona, Spain
| | - R Adam
- Hôpital Universitaire Paul Brousse, Unité Inserm U935, Université Paris Sud, Villejuif, France
| | - S Awad
- Hôpital Universitaire Paul Brousse, Unité Inserm U935, Université Paris Sud, Villejuif, France
| | - G J Poston
- North Western Hepatobiliary Unit, Aintree University Hospital, Liverpool, UK
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11
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Van Cutsem E, Cervantes A, Adam R, Sobrero A, Van Krieken JH, Aderka D, Aranda Aguilar E, Bardelli A, Benson A, Bodoky G, Ciardiello F, D'Hoore A, Diaz-Rubio E, Douillard JY, Ducreux M, Falcone A, Grothey A, Gruenberger T, Haustermans K, Heinemann V, Hoff P, Köhne CH, Labianca R, Laurent-Puig P, Ma B, Maughan T, Muro K, Normanno N, Österlund P, Oyen WJG, Papamichael D, Pentheroudakis G, Pfeiffer P, Price TJ, Punt C, Ricke J, Roth A, Salazar R, Scheithauer W, Schmoll HJ, Tabernero J, Taïeb J, Tejpar S, Wasan H, Yoshino T, Zaanan A, Arnold D. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 2016; 27:1386-422. [PMID: 27380959 DOI: 10.1093/annonc/mdw235] [Citation(s) in RCA: 2158] [Impact Index Per Article: 269.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 05/31/2016] [Indexed: 02/11/2024] Open
Abstract
Colorectal cancer (CRC) is one of the most common malignancies in Western countries. Over the last 20 years, and the last decade in particular, the clinical outcome for patients with metastatic CRC (mCRC) has improved greatly due not only to an increase in the number of patients being referred for and undergoing surgical resection of their localised metastatic disease but also to a more strategic approach to the delivery of systemic therapy and an expansion in the use of ablative techniques. This reflects the increase in the number of patients that are being managed within a multidisciplinary team environment and specialist cancer centres, and the emergence over the same time period not only of improved imaging techniques but also prognostic and predictive molecular markers. Treatment decisions for patients with mCRC must be evidence-based. Thus, these ESMO consensus guidelines have been developed based on the current available evidence to provide a series of evidence-based recommendations to assist in the treatment and management of patients with mCRC in this rapidly evolving treatment setting.
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Affiliation(s)
- E Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - A Cervantes
- Medical Oncology Department, INCLIVA University of Valencia, Valencia, Spain
| | - R Adam
- Hepato-Biliary Centre, Paul Brousse Hospital, Villejuif, France
| | - A Sobrero
- Medical Oncology, IRCCS San Martino Hospital, Genova, Italy
| | - J H Van Krieken
- Research Institute for Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - D Aderka
- Division of Oncology, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - E Aranda Aguilar
- Medical Oncology Department, University Hospital Reina Sofia, Cordoba, Spain
| | - A Bardelli
- School of Medicine, University of Turin, Turin, Italy
| | - A Benson
- Division of Hematology/Oncology, Northwestern Medical Group, Chicago, USA
| | - G Bodoky
- Department of Oncology, St László Hospital, Budapest, Hungary
| | - F Ciardiello
- Division of Medical Oncology, Seconda Università di Napoli, Naples, Italy
| | - A D'Hoore
- Abdominal Surgery, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - E Diaz-Rubio
- Medical Oncology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - J-Y Douillard
- Medical Oncology, Institut de Cancérologie de l'Ouest (ICO), St Herblain
| | - M Ducreux
- Department of Medical Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - A Falcone
- Department of Medical Oncology, University of Pisa, Pisa, Italy Division of Medical Oncology, Department of Oncology, University Hospital 'S. Chiara', Istituto Toscano Tumori, Pisa, Italy
| | - A Grothey
- Division of Medical Oncology, Mayo Clinic, Rochester, USA
| | - T Gruenberger
- Department of Surgery I, Rudolfstiftung Hospital, Vienna, Austria
| | - K Haustermans
- Department of Radiation Oncology, University Hospitals Gasthuisberg and KU Leuven, Leuven, Belgium
| | - V Heinemann
- Comprehensive Cancer Center, University Clinic Munich, Munich, Germany
| | - P Hoff
- Instituto do Câncer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil
| | - C-H Köhne
- Northwest German Cancer Center, University Campus Klinikum Oldenburg, Oldenburg, Germany
| | - R Labianca
- Cancer Center, Ospedale Giovanni XXIII, Bergamo, Italy
| | - P Laurent-Puig
- Digestive Oncology Department, European Hospital Georges Pompidou, Paris, France
| | - B Ma
- Department of Clinical Oncology, Prince of Wales Hospital, State Key Laboratory in Oncology in South China, Chinese University of Hong Kong, Shatin, Hong Kong
| | - T Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - K Muro
- Department of Clinical Oncology and Outpatient Treatment Center, Aichi Cancer Center Hospital, Nagoya, Japan
| | - N Normanno
- Cell Biology and Biotherapy Unit, I.N.T. Fondazione G. Pascale, Napoli, Italy
| | - P Österlund
- Helsinki University Central Hospital, Comprehensive Cancer Center, Helsinki, Finland Department of Oncology, University of Helsinki, Helsinki, Finland
| | - W J G Oyen
- The Institute of Cancer Research and The Royal Marsden Hospital, London, UK
| | - D Papamichael
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus
| | - G Pentheroudakis
- Department of Medical Oncology, University of Ioannina, Ioannina, Greece
| | - P Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - T J Price
- Haematology and Medical Oncology Unit, Queen Elizabeth Hospital, Woodville, Australia
| | - C Punt
- Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Ricke
- Department of Radiology and Nuclear Medicine, University Clinic Magdeburg, Magdeburg, Germany
| | - A Roth
- Digestive Tumors Unit, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - R Salazar
- Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - W Scheithauer
- Department of Internal Medicine I and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - H J Schmoll
- Department of Internal Medicine IV, University Clinic Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - J Tabernero
- Medical Oncology Department, Vall d' Hebron University Hospital, Vall d'Hebron Institute of Oncology (V.H.I.O.), Barcelona, Spain
| | - J Taïeb
- Digestive Oncology Department, European Hospital Georges Pompidou, Paris, France
| | - S Tejpar
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - H Wasan
- Department of Cancer Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - A Zaanan
- Digestive Oncology Department, European Hospital Georges Pompidou, Paris, France
| | - D Arnold
- Instituto CUF de Oncologia (ICO), Lisbon, Portugal
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Gruenberger B, Starlinger P, Messinger E, Weibrecht S, Jonas Jan P, Weitmayr B, Gruenberger T. P-161 5-FU based chemotherapy with Bevacizumab in synchronous metastatic colorectal cancer patients with bleeding primary tumor. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw199.155] [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: 11/13/2022] Open
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13
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Starlinger P, Assinger A, Gruenberger T, Brostjan C. The role of platelets and portal venous pressure fluctuations in postoperative liver regeneration. Eur Surg 2015. [DOI: 10.1007/s10353-015-0352-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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14
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Padickakudy R, Haegele S, Offensperger F, Pereyra D, Ohlberger L, Assinger A, Fleischmann E, Brostjan C, Gruenberger T, Starlinger P. 252 Intra platelet serotonin and oncological outcome. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30138-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Stremitzer S, Zhang W, Yang D, Ning Y, Stintzing S, Sunakawa Y, Sebio A, Yamauchi S, Matsusaka S, Parekh A, Barzi A, El-Khoueiry R, Stift J, Wrba F, Gruenberger T, Lenz HJ. Variations in genes involved in dormancy associated with outcome in patients with resected colorectal liver metastases. Ann Oncol 2015; 26:1728-33. [PMID: 25957329 DOI: 10.1093/annonc/mdv224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 03/10/2015] [Accepted: 04/30/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Tumor dormancy has been described as a state of hibernation. Dormancy can be switched to proliferation by different pathways, which may play a critical role in tumor recurrence. In this study, we investigated genetic variations within genes involved in tumor dormancy and their association with recurrence and outcome in patients with colorectal liver metastases (CLM) who underwent neoadjuvant bevacizumab-based chemotherapy. PATIENTS AND METHODS Genomic DNA was extracted from resected CLM (FFPE) from 149 patients. Single-nucleotide polymorphisms (SNPs) in 14 genes associated with dormancy were analyzed by direct Sanger DNA sequencing and evaluated for response, recurrence-free survival (RFS), overall survival (OS) and recurrence patterns. RESULTS NME1 rs34214448 C>A was significantly associated with RFS in univariable analysis (P = 0.039) and with intrahepatic recurrence (P = 0.014). NOTCH3 rs1044009 T>C and CD44 rs8193 C>T showed a significant difference in 3-year OS rates (P = 0.004 and P = 0.042, respectively). With respect to radiological response, CD44 rs8193 C>T variant genotypes were associated with a significantly higher response rate (P = 0.033). Recursive partitioning analyses revealed that Dll4 rs12441495 C>G, NME1 rs34214448 C>A and NOTCH3 rs1044009 T>C were the dominant SNPs predicting histological response, RFS and OS, respectively. CONCLUSION Our data suggest that gene variations within genes involved in tumor dormancy pathways are associated with response and outcome in patients with resected CLM. These data may lead to new and more effective treatment strategies targeting tumor dormancy.
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Affiliation(s)
- S Stremitzer
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, USA Department of Surgery, Medical University Vienna, Vienna, Austria
| | - W Zhang
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - D Yang
- Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Y Ning
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - S Stintzing
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Y Sunakawa
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - A Sebio
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - S Yamauchi
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - S Matsusaka
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - A Parekh
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - A Barzi
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - R El-Khoueiry
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - J Stift
- Clinical Institute of Pathology, Medical University Vienna, Vienna
| | - F Wrba
- Clinical Institute of Pathology, Medical University Vienna, Vienna
| | - T Gruenberger
- Department of Surgery I, Rudolfstiftung Hospital, Vienna, Austria
| | - H-J Lenz
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
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16
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Starlinger P, Haegele S, Wanek D, Zikeli S, Schauer D, Alidzanovic L, Fleischmann E, Gruenberger B, Gruenberger T, Brostjan C. Plasma thrombospondin 1 as a predictor of postoperative liver dysfunction. Br J Surg 2015; 102:826-36. [PMID: 25871570 DOI: 10.1002/bjs.9814] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/15/2015] [Accepted: 02/26/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Liver regeneration following liver resection involves a complex interplay of growth factors and their antagonists. Thrombospondin 1 has recently been identified as a critical inhibitor of liver regeneration by the activation of transforming growth factor β1 in mice, and preliminary data seem to confirm its relevance in humans. This study aimed to confirm these observations in an independent validation cohort. METHODS Perioperative circulating levels of thrombospondin 1 were measured in patients undergoing liver resection between January 2012 and September 2013. Postoperative liver dysfunction was defined according to the International Study Group of Liver Surgery and classification of morbidity was based on the criteria by Dindo et al. RESULTS In 85 patients (44 major and 41 minor liver resections), plasma levels of thrombospondin 1 increased 1 day after liver resection (mean 51·6 ng/ml before surgery and 68·3 ng/ml on postoperative day 1; P = 0·001). Circulating thrombospondin 1 concentration on the first postoperative day specifically predicted liver dysfunction (area under the receiver operating characteristic (ROC) curve 0·818, P = 0·003) and was confirmed as a significant predictor in multivariable analysis (Exp(B) 1·020, 95 per cent c.i. 1·005 to 1·035; P = 0·009). Patients with a high thrombospondin 1 concentration (over 80 ng/ml) on postoperative day 1 more frequently had postoperative liver dysfunction than those with a lower level (28 versus 2 per cent) and severe morbidity (44 versus 15 per cent), and their length of hospital stay was more than doubled (19·7 versus 9·9 days). CONCLUSION Thrombospondin 1 may prove a helpful clinical marker to predict postoperative liver dysfunction as early as postoperative day 1.
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Affiliation(s)
- P Starlinger
- Departments of Surgery, General Hospital, Vienna, Austria
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17
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Stremitzer S, Stift J, Singh J, Starlinger P, Gruenberger B, Tamandl D, Gruenberger T. Histological response, pattern of tumor destruction and clinical outcome after neoadjuvant chemotherapy including bevacizumab or cetuximab in patients undergoing liver resection for colorectal liver metastases. Eur J Surg Oncol 2015; 41:868-74. [PMID: 25865557 DOI: 10.1016/j.ejso.2015.03.223] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 02/03/2015] [Revised: 02/27/2015] [Accepted: 03/05/2015] [Indexed: 02/07/2023] Open
Abstract
AIM We investigated whether the type of antibody [bevacizumab (bev) or cetuximab (cet)] added to neoadjuvant combination chemotherapy before curative liver resection was associated with histological response, the pattern of tumor destruction and clinical outcome in patients with colorectal liver metastases (CLM). METHODS We investigated 138 patients with KRAS wild-type status (codon 12, 13 and 61) who received neoadjuvant chemotherapy including bev (n = 101) or cet (n = 37). The primary endpoint was histological response. Secondary endpoints were necrosis and fibrosis of metastases, radiological response, recurrence-free survival (RFS) and overall survival (OS). RESULTS Histological response was not significantly different between the two groups (P = 0.19). A significantly higher fraction of patients in the bev group showed necrosis of the metastases of ≥ 50% (P < 0.001), while a higher fraction of patients in the cet group showed fibrosis of ≥ 40% (P = 0.030). Radiological response was not significantly different (P = 0.17). Median RFS was significantly shorter in the cet group in univariable analysis (HR 1.59 (95% CI 1.00, 2.51), P = 0.049), but this difference did not remain significant in multivariable analysis (P = 0.45). The 3-year OS rate was not significantly different (P = 0.73). CONCLUSIONS The addition of bevacizumab to combination chemotherapy showed more necrosis but less fibrosis of metastases compared to cetuximab and a trend towards higher histological and radiological response and longer RFS. Further investigations of biological tumor characteristics are required to individualize treatment combinations.
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Affiliation(s)
- S Stremitzer
- Department of General Surgery, Medical University Vienna, Vienna, Austria
| | - J Stift
- Clinical Institute of Pathology, Medical University Vienna, Vienna, Austria
| | - J Singh
- Department of General Surgery, Medical University Vienna, Vienna, Austria
| | - P Starlinger
- Department of General Surgery, Medical University Vienna, Vienna, Austria
| | - B Gruenberger
- Department of Internal Medicine, St. John of God's Hospital, Vienna, Austria
| | - D Tamandl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - T Gruenberger
- Department of Surgery I, Rudolfstiftung Hospital, Vienna, Austria.
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Gruenberger T, Bridgewater J, Chau I, García Alfonso P, Rivoire M, Mudan S, Lasserre S, Hermann F, Waterkamp D, Adam R. Bevacizumab plus mFOLFOX-6 or FOLFOXIRI in patients with initially unresectable liver metastases from colorectal cancer: the OLIVIA multinational randomised phase II trial. Ann Oncol 2014; 26:702-708. [PMID: 25538173 DOI: 10.1093/annonc/mdu580] [Citation(s) in RCA: 224] [Impact Index Per Article: 22.4] [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: 12/22/2022] Open
Abstract
BACKGROUND For patients with initially unresectable liver metastases from colorectal cancer, chemotherapy can downsize metastases and facilitate secondary resection. We assessed the efficacy of bevacizumab plus modified FOLFOX-6 (5-fluorouracil/folinic acid, oxaliplatin) or FOLFOXIRI (5-fluorouracil/folinic acid, oxaliplatin, irinotecan) in this setting. PATIENTS AND METHODS OLIVIA was a multinational open-label phase II study conducted at 16 centres in Austria, France, Spain, and the UK. Patients with unresectable liver metastases were randomised to bevacizumab (5 mg/kg) plus mFOLFOX-6 [oxaliplatin 85 mg/m(2), folinic acid 400 mg/m(2), 5-fluorouracil 400 mg/m(2) (bolus) then 2400 mg/m(2) (46-h infusion)] or FOLFOXIRI [oxaliplatin 85 mg/m(2), irinotecan 165 mg/m(2), folinic acid 200 mg/m(2), 5-fluorouracil 3200 mg/m(2) (46-h infusion)] every 2 weeks. Unresectability was defined as ≥1 of the following criteria: no possibility of upfront R0/R1 resection of all lesions; <30% residual liver volume after resection; metastases in contact with major vessels of the remnant liver. Resectability was evaluated by multidisciplinary review. The primary end point was overall resection rate (R0/R1/R2). Efficacy end points were analysed by intention-to-treat analysis. RESULTS In patients assigned to bevacizumab-FOLFOXIRI (n = 41) or bevacizumab-mFOLFOX-6 (n = 39), the overall resection rate was 61% [95% confidence interval (CI) 45% to 76%] and 49% (95% CI 32% to 65%), respectively (difference 12%; 95% CI -11% to 36%). R0 resection rates were 49% and 23%, respectively. Overall tumour response rates were 81% (95% CI 65% to 91%) with bevacizumab-FOLFOXIRI and 62% (95% CI 45% to 77%) with bevacizumab-mFOLFOX-6. Median progression-free survival (PFS) was 18·6 (95% CI 12.9-22.3) months and 11·5 (95% CI 9.6-13.6) months, respectively. The most common grade 3-5 adverse events were neutropenia (bevacizumab-FOLFOXIRI, 50%; bevacizumab-mFOLFOX-6, 35%) and diarrhoea (30% and 14%, respectively). CONCLUSIONS Bevacizumab-FOLFOXIRI was associated with higher response and resection rates and prolonged PFS versus bevacizumab-mFOLFOX-6 in patients with initially unresectable liver metastases from colorectal cancer. Toxicity was increased but manageable with bevacizumab-FOLFOXIRI. CLINICALTRIALSGOV NCT00778102.
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Affiliation(s)
- T Gruenberger
- Department of Surgery I, Rudolfstiftung Hospital, Vienna, Austria.
| | - J Bridgewater
- Department of Oncology, University College London Cancer Institute, London
| | - I Chau
- Department of Medicine, The Royal Marsden Hospital, Sutton, UK
| | - P García Alfonso
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Rivoire
- Department of Surgical Oncology, Léon Bérard Cancer Center, Université Claude Bernard Lyon I, Lyon, France
| | - S Mudan
- Department of Surgery, The Royal Marsden Hospital, Sutton, UK
| | - S Lasserre
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - F Hermann
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - R Adam
- Centre Hepato-Biliaire, AP-HP Hôpital Paul Brousse, UMR-S 776, Université Paris-Sud, Villejuif, France
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Tanis E, Nordlinger B, Mauer M, Sorbye H, van Coevorden F, Gruenberger T, Schlag PM, Punt CJA, Ledermann J, Ruers TJM. Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983. Eur J Cancer 2014; 50:912-9. [PMID: 24411080 DOI: 10.1016/j.ejca.2013.12.008] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/07/2013] [Accepted: 12/10/2013] [Indexed: 01/03/2023]
Abstract
AIM The aim of this study is to describe local tumour control after radiofrequency ablation (RFA) and surgical resection (RES) of colorectal liver metastases (CLM) in two independent European Organisations for Research and Treatment of Cancer (EORTC) studies. BACKGROUND Only 10-20% of patients with newly diagnosed CLM are eligible for curative RES. RFA has found a place in daily practice for unresectable CLM. There are no prospective trials comparing RFA to RES for resectable CLM. METHODS The CLOCC trial randomised 119 patients with unresectable CLM between RFA (±RES)+adjuvant FOLFOX (±bevacizumab) versus FOLFOX (±bevacizumab) alone. The EPOC trial randomised 364 patients with resectable CLM between RES±perioperative FOLFOX. We describe the local control of resected patients with lesions ≤4 cm in the perioperative chemotherapy arm of the EPOC trial (N=81) and the RFA arm of the CLOCC trial (N=55). RESULTS Local recurrence (LR) rate for RES was 7.4% per patient and 5.5% per lesion. LR rate for RFA was 14.5% per patient and 6.0% per lesion. When lesion size was limited to 30 mm, LR rate for RFA lesions was 2.9% per lesion. Non-local hepatic recurrences were more often observed in RFA patients than in RES patients, 30.9% and 22.3% respectively. Patients receiving RFA had a more advanced disease. CONCLUSIONS LR rate after RFA for lesions with a limited size is low. The local control per lesion does not appear to differ greatly between RFA and surgical resection. This study supports the local control of RFA in patients with limited liver metastases. Future studies should evaluate in which patients RFA could be an equal alternative to liver resection.
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Affiliation(s)
- E Tanis
- EORTC Headquarters, Brussels, Belgium.
| | - B Nordlinger
- Department of Surgery, Centre Hospitalier Universitaire Ambroise Pare, Assistance Publique Hopitaux de Paris, Boulogne-Billancourt, France
| | - M Mauer
- Department of Statistics, EORTC Headquarters, Brussels, Belgium
| | - H Sorbye
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - F van Coevorden
- Department of Surgery, The Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
| | - T Gruenberger
- Department of Surgery, Medical University Vienna, Vienna, Austria
| | - P M Schlag
- Department of Surgery, Robert-Roessle-Klinik, Humboldt-Universitat Berlin, Berlin, Germany
| | - C J A Punt
- Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Ledermann
- UCL and UCL Hospitals Comprehensive Biomedical Research Centre, University College London, London, United Kingdom
| | - T J M Ruers
- Department of Surgery, The Netherlands Cancer Institute (NKI), Amsterdam, The Netherlands
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Ruers T, Tanis E, Nordlinger B, Mauer M, Sorbye H, van Coevorden F, Gruenberger T, Schlag P, Punt C, Ledermann J. PG 8.2 Surgery versus radiofrequency ablation (Lessons from the CLOCC trial). Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70029-2] [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: 10/25/2022]
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21
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Sorbye H, Mauer M, Gruenberger T, Glimelius B, Poston G, Rougier P, Schlag P, Bechstein W, Primrose J, Walpole E, Nordlinger B. PG 8.3 Recurrence patterns after resection of liver metastases. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70030-9] [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: 10/25/2022]
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Folprecht G, Gruenberger T, Bechstein W, Raab HR, Weitz J, Lordick F, Hartmann JT, Stoehlmacher-Williams J, Lang H, Trarbach T, Liersch T, Ockert D, Jaeger D, Steger U, Suedhoff T, Rentsch A, Köhne CH. Survival of patients with initially unresectable colorectal liver metastases treated with FOLFOX/cetuximab or FOLFIRI/cetuximab in a multidisciplinary concept (CELIM study). Ann Oncol 2014; 25:1018-25. [PMID: 24585720 DOI: 10.1093/annonc/mdu088] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [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] Open
Abstract
BACKGROUND Initially, unresectable colorectal liver metastases can be resected after response to chemotherapy. While cetuximab has been shown to increase response and resection rates, the survival outcome for this conversion strategy needs further evaluation. PATIENTS AND METHODS Patients with technically unresectable and/or ≥5 liver metastases were treated with FOLFOX/cetuximab (arm A) or FOLFIRI/cetuximab (arm B) and evaluated with regard to resectability every 2 months. Tumour response and secondary resection data have been reported previously. A final analysis of overall survival (OS) and progression-free survival (PFS) was carried out in December 2012. RESULTS Between December 2004 and March 2008, 56 patients were randomised to arm A, 55 to arm B. The median OS was 35.7 [95% confidence interval (CI) 27.2-44.2] months [arm A: 35.8 (95% CI 28.1-43.6), arm B: 29.0 (95% CI 16.0-41.9) months, HR 1.03 (95% CI 0.66-1.61), P = 0.9]. The median PFS was 10.8 (95% CI 9.3-12.2) months [arm A: 11.2 (95% CI 7.2-15.3), arm B: 10.5 (95% CI 8.9-12.2) months, HR 1.18 (95% CI 0.79-1.74), P = 0.4]. Patients who underwent R0 resection (n = 36) achieved a better median OS [53.9 (95% CI 35.9-71.9) months] than those who did not [21.9 (95% CI 17.1-26.7) months, P < 0.001]. The median disease-free survival for R0 resected patients was 9.9 (95% CI 5.8-14.0) months, and the 5-year OS rate was 46.2% (95% CI 29.5% to 62.9%). CONCLUSIONS This study confirms a favourable long-term survival for patients with initially sub-optimal or unresectable colorectal liver metastases who respond to conversion therapy and undergo secondary resection. Both FOLFOX/FOLFIRI plus cetuximab, appear to be appropriate regimens for 'conversion' treatment in patients with K-RAS codon 12/13/61 wild-type tumours. Thus, liver surgery can be considered curative or alternatively as an additional 'line of therapy' in those patients who are not cured. CLINICAL TRIAL NUMBER NCT00153998, www.clinicaltrials.gov.
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Affiliation(s)
- G Folprecht
- University Cancer Center/Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany
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Nordlinger B, Adam R, Arnold D, Zalcberg JR, Gruenberger T. The role of biological agents in the resection of colorectal liver metastases. Clin Oncol (R Coll Radiol) 2013; 24:432-42. [PMID: 22794325 DOI: 10.1016/j.clon.2012.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 11/15/2011] [Accepted: 01/11/2012] [Indexed: 02/08/2023]
Abstract
Surgically resecting liver metastases from colorectal cancer (CLMs) offers the only potentially curative option. Chemotherapy-induced downsizing of CLMs increases the proportion of patients with resectable metastases. Several recent studies have reported that adding a biological agent such as cetuximab, panitumumab or bevacizumab to chemotherapy could further increase response and resectability rates. This overview discusses the reported resection rates for biological agents combined with chemotherapy and the difficulties of cross-trial comparisons, the pre-, peri- and postoperative roles of biological agents, particularly with regards to comparisons of surgical complications, and ongoing clinical trials in which the resectability of CLMs is a predefined end point. Currently, targeted therapies combined with chemotherapy probably increase the resection rate of CLMs, although this has been shown in only one phase III randomised study and it is difficult to draw definitive conclusions about the relative efficacy and safety of the different available biological agents in terms of converting unresectable CLMs to resectable lesions. Available data for each of them are discussed. More data from phase III trials are expected to confirm the utility of the different biological agents in converting patients with unresectable CLMs to a resectable status.
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Affiliation(s)
- B Nordlinger
- Department of Oncology and Surgery, Ambroise Paré Hospital, Boulogne, France.
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Stremitzer S, Stift J, Gruenberger B, Tamandl D, Aschacher T, Wolf B, Wrba F, Gruenberger T. KRAS status and outcome of liver resection after neoadjuvant chemotherapy including bevacizumab. Br J Surg 2012; 99:1575-82. [DOI: 10.1002/bjs.8909] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract
Background
The prognostic value of KRAS mutation in patients with colorectal cancer liver metastases (CLM) receiving neoadjuvant chemotherapy including bevacizumab before liver resection is unclear.
Methods
The KRAS and BRAF status of resected CLM was assessed in prospectively studied patients. Mutations were correlated with recurrence-free and overall survival. Only patients with remaining vital tumour cells in the resected specimen and those without disease progression were analysed; those with progressive disease did not undergo resection.
Results
A total of 60 patients were enrolled. Fifteen (25 per cent) had a KRAS mutation, but none of the 60 patients had a BRAF mutation. The radiological response to neoadjuvant chemotherapy including bevacizumab, assessed according to the Response Evaluation Criteria In Solid Tumours, was partial in 52 patients (87 per cent) and the remaining eight had stable disease. The partial response rate was similar in patients with a KRAS mutation and those with the wild-type gene (12 of 15 versus 40 of 45 patients; P = 0·400). KRAS mutation had a negative prognostic effect on recurrence-free survival (hazard ratio (HR) 2·48, 95 per cent confidence interval 1·26 to 4·89; P = 0·009) and overall survival (HR 3·51, 1·30 to 9·45; P = 0·013).
Conclusion
This study provided further evidence for the prognostic importance of KRAS status in terms of recurrence-free and overall survival. Neoadjuvant chemotherapy including bevacizumab elicited a response, irrespective of KRAS status, in this selected group of patients with CLM.
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Affiliation(s)
- S Stremitzer
- Department of General Surgery, Medical University Vienna, Austria
| | - J Stift
- Clinical Institute of Pathology, Medical University Vienna, Austria
| | - B Gruenberger
- Department of Internal Medicine, St John of God's Hospital, Vienna, Austria
| | - D Tamandl
- Department of General Surgery, Medical University Vienna, Austria
| | - T Aschacher
- Department of General Surgery, Medical University Vienna, Austria
| | - B Wolf
- Department of General Surgery, Medical University Vienna, Austria
| | - F Wrba
- Clinical Institute of Pathology, Medical University Vienna, Austria
| | - T Gruenberger
- Department of General Surgery, Medical University Vienna, Austria
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Gruenberger T. 199. To be a principal investigator in clinical trials. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.196] [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: 11/30/2022] Open
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26
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Tanis E, Nordlinger B, Mauer M, Sorbye H, van Coevorden F, Gruenberger T, Punt C, Schlag P, Lederman J, Ruers T. 189. Local recurrence rates after RFA and resection of colorectal liver metastases – A descriptive analysis of EORTC CLOCC and EPOC databases. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.186] [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: 10/27/2022] Open
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Starlinger P, Alidzanovic L, Schauer D, Maier T, Nemeth C, Perisanidis B, Tamandl D, Gruenberger B, Gruenberger T, Brostjan C. Neoadjuvant bevacizumab persistently inactivates VEGF at the time of surgery despite preoperative cessation. Br J Cancer 2012; 107:961-6. [PMID: 22850548 PMCID: PMC3464762 DOI: 10.1038/bjc.2012.342] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND When anti-VEGF (vascular endothelial growth factor) antibody bevacizumab is applied in neoadjuvant treatment of colorectal cancer patients with liver metastasis, 5-6 weeks between last bevacizumab dose and liver resection are currently recommended to avoid complications in wound and liver regeneration. In this context, we aimed to determine whether VEGF is inactivated by bevacizumab at the time of surgery. METHODS Fifty colorectal cancer patients with liver metastases received neoadjuvant chemotherapy ± bevacizumab supplementation. The last dose of bevacizumab was administered 6 weeks before surgery. Plasma, subcutaneous and intraabdominal wound fluid were analysed for VEGF content before and after liver resection (day 1-3). Immunoprecipitation was applied to determine the amount of bevacizumab-bound VEGF. RESULTS Bevacizumab-treated individuals showed no increase in perioperative complications. During the entire monitoring period, plasma VEGF was inactivated by bevacizumab. In wound fluid, VEGF was also completely bound by bevacizumab and was remarkably low compared with the control chemotherapy group. CONCLUSION These data document that following a cessation time of 6 weeks, bevacizumab is fully active and blocks circulating and local VEGF at the time of liver resection. However, despite effective VEGF inactivation no increase in perioperative morbidity is recorded suggesting that VEGF activity is not essential in the immediate postoperative recovery period.
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Affiliation(s)
- P Starlinger
- Department of Surgery, Medical University of Vienna, General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Berger-Kulemann V, Schima W, Baroud S, Koelblinger C, Kaczirek K, Gruenberger T, Schindl M, Maresch J, Weber M, Ba-Ssalamah A. Gadoxetic acid-enhanced 3.0 T MR imaging versus multidetector-row CT in the detection of colorectal metastases in fatty liver using intraoperative ultrasound and histopathology as a standard of reference. Eur J Surg Oncol 2012; 38:670-6. [PMID: 22652037 DOI: 10.1016/j.ejso.2012.05.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 05/07/2012] [Accepted: 05/10/2012] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To compare the diagnostic value of gadoxetic acid-enhanced MRI at 3.0 T with 64-row MDCT in the detection of colorectal liver metastases in diffuse fatty infiltration of the liver after neoadjuvant chemotherapy. METHODS Twenty-three patients with colorectal liver metastases and at moderate to severe steatosis (25-90%) underwent prospectively preoperative tri-phasic MDCT (Somatom Sensation 64, Siemens) and gadoxetic acid-enhanced MRI (3-T Magnetom Trio, Siemens). All patients underwent surgical resection of liver metastases. Intraoperative ultrasound (IOUS) was carried out, which served as the standard of reference, together with histopathology. RESULTS Overall, 68 metastases (range, 0.4-6 cm; 31/68 metastases [46%] ≤ 1 cm) were found at histology. MDCT detected 49/68 lesions (72%), and MRI 66/68 (97%, p < 0.001). For lesions ≤ 1 cm, MDCT detected only 13/31 (41.9%) and MRI 29/31 (93%, p < 0.001). Eight false-positive lesions were detected by MDCT, seven small lesions by MRI. There was no statistically significant difference between the two modalities in the detection of lesions > 1 cm (p = 0.250). IOUS detected all metastases and revealed two false-positive diagnoses. CONCLUSION Gadoxetic acid-enhanced 3.0 T MRI is superior to 64-row MDCT in detecting colorectal liver metastases ≤ 1 cm during preoperative staging in patients with liver steatosis. A combination of MRI and IOUS may further improve the outcome of surgical treatment.
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Affiliation(s)
- V Berger-Kulemann
- Department of Radiology, Medical University of Vienna, AKH, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Stremitzer S, Tamandl D, Kaczirek K, Maresch J, Abbasov B, Payer BA, Ferlitsch A, Gruenberger T. Value of hepatic venous pressure gradient measurement before liver resection for hepatocellular carcinoma. Br J Surg 2011; 98:1752-8. [PMID: 22009385 DOI: 10.1002/bjs.7672] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Portal hypertension associated with liver cirrhosis increases the risk of postoperative complications after liver resection for hepatocellular carcinoma (HCC). This study assessed the role of preoperative hepatic venous pressure gradient (HVPG) assessment in identifying portal hypertension. METHODS All patients who underwent liver resection for HCC between January 2000 and December 2009 at the Department of General Surgery, Medical University Vienna, were analysed retrospectively. HVPG was assessed prospectively in a subset of patients before liver resection. The influence of this assessment on postoperative complications was investigated. RESULTS A total of 132 patients were enrolled, of whom 39 underwent HVPG measurement. Mean(s.d.) HVPG was 6·4(3·0) and 4·3(1·4) mmHg in patients with and without postoperative complications respectively (P = 0·028). Complication rates differed significantly at a cut-off HVPG value of 5 mmHg: 11 of 21 patients with a gradient of 1-5 mmHg developed complications versus 12 of 14 patients with a higher value (P = 0·045). HVPG exceeding 5 mmHg was associated with worse liver fibrosis (P = 0·004), higher rates of postoperative liver dysfunction (5 of 13 versus 1 of 18; P = 0·022) and ascites (7 of 14 versus 3 of 21; P = 0·022), and a longer hospital stay (median (range) 11 (7-26) versus 8 (4-20) days; P = 0·034). Overall postoperative morbidity did not differ between patients who had preoperative HVPG assessment and those who did not (P = 0·142). CONCLUSION Preoperative HVPG assessment predicted liver fibrosis and postoperative complications.
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Affiliation(s)
- S Stremitzer
- Department of General Surgery, Medical University Vienna, Vienna, Austria
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Stremitzer S, Tamandl D, Kaczirek K, Maresch J, Abbasov B, Payer BA, Ferlitsch A, Gruenberger T. Value of hepatic venous pressure gradient measurement before liver resection for hepatocellular carcinoma. Br J Surg 2011. [PMID: 22009385 DOI: 10.1002/bjs.7672.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Portal hypertension associated with liver cirrhosis increases the risk of postoperative complications after liver resection for hepatocellular carcinoma (HCC). This study assessed the role of preoperative hepatic venous pressure gradient (HVPG) assessment in identifying portal hypertension. METHODS All patients who underwent liver resection for HCC between January 2000 and December 2009 at the Department of General Surgery, Medical University Vienna, were analysed retrospectively. HVPG was assessed prospectively in a subset of patients before liver resection. The influence of this assessment on postoperative complications was investigated. RESULTS A total of 132 patients were enrolled, of whom 39 underwent HVPG measurement. Mean(s.d.) HVPG was 6·4(3·0) and 4·3(1·4) mmHg in patients with and without postoperative complications respectively (P = 0·028). Complication rates differed significantly at a cut-off HVPG value of 5 mmHg: 11 of 21 patients with a gradient of 1-5 mmHg developed complications versus 12 of 14 patients with a higher value (P = 0·045). HVPG exceeding 5 mmHg was associated with worse liver fibrosis (P = 0·004), higher rates of postoperative liver dysfunction (5 of 13 versus 1 of 18; P = 0·022) and ascites (7 of 14 versus 3 of 21; P = 0·022), and a longer hospital stay (median (range) 11 (7-26) versus 8 (4-20) days; P = 0·034). Overall postoperative morbidity did not differ between patients who had preoperative HVPG assessment and those who did not (P = 0·142). CONCLUSION Preoperative HVPG assessment predicted liver fibrosis and postoperative complications.
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Affiliation(s)
- S Stremitzer
- Department of General Surgery, Medical University Vienna, Vienna, Austria
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Folprecht G, Gruenberger T, Bechstein W, Lordick T, Lang H, Weitz J, Suedhoff T, Hartmann J, Liersch T, Koehne C. 6009 POSTER DISCUSSION Progression Free and Overall Survival After Neoadjuvant Treatment of Colorectal Liver Metastases With Cetuximab Plus FOLFOX or FOLFIRI – Results of the CELIM Study. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71654-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Adam R, Barroso E, Laurent C, Nuzzo G, Hubert C, Mentha G, Ijzermans J, Capussotti L, Lopezben S, Mirza D, Kaiser G, Oussoultzoglou E, Gruenberger T, Poston GJ, Skipenko O. Impact of the type and modalities of preoperative chemotherapy on the outcome of liver resection for colorectal metastases. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3519] [Citation(s) in RCA: 11] [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] [Indexed: 11/20/2022] Open
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Stremitzer S, Maresch J, Aschacher T, Wolf B, Wrba F, Gruenberger T, Gruenberger B. Influence of KRAS status of colorectal cancer liver metastases in patients receiving neoadjuvant chemotherapy including bevacizumab prior liver resection. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Maresch J, Stremitzer S, Tamandl D, Wrba F, Gruenberger T. Pathologic indicators of chemotherapy response in colorectal liver metastases: A comparative study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14159] [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: 11/20/2022] Open
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Starlinger P, Alidzanovic L, Schauer D, Maier T, Nemeth C, Herberger B, Pop L, Gruenberger B, Gruenberger T, Brostjan C. The effect of bevacizumab on wound healing after resection of colorectal liver metastases despite persistent VEGF inactivation at wound sites. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14005] [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: 11/20/2022] Open
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Pokorny H, Gruenberger T, Soliman T, Rockenschaub S, Längle F, Steininger R. Organ survival after primary dysfunction of liver grafts in clinical orthotopic liver transplantation. Transpl Int 2011. [DOI: 10.1111/j.1432-2277.2000.tb02009.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Starlinger P, Moll HP, Assinger A, Nemeth C, Hoetzenecker K, Gruenberger B, Gruenberger T, Kuehrer I, Schoppmann SF, Gnant M, Brostjan C. Thrombospondin-1: a unique marker to identify in vitro platelet activation when monitoring in vivo processes. J Thromb Haemost 2010; 8:1809-19. [PMID: 20492458 DOI: 10.1111/j.1538-7836.2010.03908.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [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: 01/20/2023]
Abstract
BACKGROUND Measuring platelet activation in patients has become a potent method to investigate pathophysiological processes. However, the commonly applied markers are sensitive to detrimental influences by in vitro platelet activation during blood analysis. OBJECTIVES Protein isoforms of platelet-derived thrombospondin-1 (TSP-1) were investigated for their potential to identify in vitro platelet activation when monitoring in vivo processes. METHODS TSP-1 was determined in plasma, serum or supernatant of purified platelets by ELISA and immunoblotting and was compared with standard markers of platelet activation. A collective of 20 healthy individuals and 30 cancer patients was analyzed. RESULTS While in vitro platelet degranulation led to a selective increase in the 200-kDa full-length molecule, an in vivo process involving platelet activation such as wound healing resulted in the predominant rise of the 140-kDa TSP-1 protein. The physiological ratio of circulating TSP-1 variants was determined and a cut-off level at 1.0 was defined to identify plasma samples with artificial in vitro platelet activation exceeding the cut-off level. In contrast, cancer patients known to frequently exhibit increased in vivo activation of platelets presented with a significantly decreased ratio of TSP-1 variants as compared with healthy volunteers. CONCLUSIONS In comparison to standard platelet markers, TSP-1 constitutes a sensitive and stable parameter suited to monitor in vitro platelet activation. The analysis of TSP-1 protein isoforms further offers a valuable tool to reliably discriminate between in vitro and in vivo effects, to exclude variability introduced during blood processing and improve clinical monitoring.
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Affiliation(s)
- P Starlinger
- Department of Surgery, General Hospital Institute of Physiology, Medical University of Vienna, Vienna, Austria
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Van Cutsem E, Dicato M, Arber N, Berlin J, Cervantes A, Ciardiello F, De Gramont A, Diaz-Rubio E, Ducreux M, Geva R, Glimelius B, Jones RG, Grothey A, Gruenberger T, Haller D, Haustermans K, Labianca R, Lenz H, Minsky B, Nordlinger B, Ohtsu A, Pavlidis N, Rougier P, Schmiegel W, Van de Velde C, Schmoll H, Sobrero A, Tabernero J. Molecular markers and biological targeted therapies in metastatic colorectal cancer: expert opinion and recommendations derived from the 11th ESMO/World Congress on Gastrointestinal Cancer, Barcelona, 2009. Ann Oncol 2010; 21 Suppl 6:vi1-10. [DOI: 10.1093/annonc/mdq273] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Gruenberger T, Laengle F, Thaler J, Eisterer W, Tamandl D, Herberger B, Lenauer A, Gruenberger B. Pre- and postoperative chemotherapy including bevacizumab in potentially curable metastatic colorectal cancer: A multicenter, single-arm phase II trial—Results of ASSO LM1. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14032] [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: 11/20/2022] Open
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Niedersuess-Beke D, Gruenberger T, Tamandl D, Wrba F, Feichtinger H, Kaczirek K, Meran JG, Gruenberger B. Influence of the K-ras status on outcome in cholangiocarcinoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e21076] [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: 11/20/2022] Open
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Starlinger P, Maier T, Schauer D, Nemeth C, Alidzanovic L, Gruenberger B, Gruenberger T, Brostjan C. Association of VEGF feedback production in bevacizumab therapy with systemic response. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3056] [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: 11/20/2022] Open
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42
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Sorbye H, Mauer M, Gruenberger T, Glimelius B, Poston GJ, Schlag PM, Rougier P, Primrose JN, Walpole ET, Nordlinger B. Predictive factors for the effect of perioperative FOLFOX for resectable liver metastasis in colorectal cancer patients (EORTC phase III study 40983). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tamandl D, Kaczirek K, Gruenberger B, Koelblinger C, Maresch J, Jakesz R, Gruenberger T. Lymph node ratio after curative surgery for intrahepatic cholangiocarcinoma. Br J Surg 2009; 96:919-25. [PMID: 19591163 DOI: 10.1002/bjs.6654] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma (ICC) is rare but its incidence is rising worldwide. The value of lymph node dissection for ICC is under discussion; the current staging systems do not differentiate between numbers of involved nodes. METHODS Ninety-three patients who underwent laparotomy for ICC between 1997 and 2007 were identified retrospectively; 46 who underwent curative resection and systematic lymphadenectomy around the hepatoduodenal ligament were analysed further. Univariable and multivariable regression analysis was performed to identify prognostic factors. RESULTS Tumour size and advanced tumour stage were associated with worse overall and recurrence-free survival in univariable analysis. An increased ratio of positive to total harvested lymph nodes (LNR) was also prognostic for adverse outcome in lymph node-positive patients: crude hazard ratio 8.93 (95 per cent confidence interval (c.i.) 1.52 to 32.50) for overall survival and 8.76 (1.96 to 39.22) for recurrence-free survival. Adjusted hazard ratios for LNR in multivariable regression analysis were 9.81 (1.52 to 43.44) and 10.63 (2.04 to 55.31) respectively. The total number of retrieved lymph nodes was not related to survival or recurrence. CONCLUSION LNR appears to be a good prognostic factor for survival or recurrence after curative resection for ICC.
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Affiliation(s)
- D Tamandl
- Departments of Surgery, Medical University of Vienna, Vienna, Austria
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Verslype C, Van Cutsem E, Dicato M, Arber N, Berlin JD, Cunningham D, De Gramont A, Diaz-Rubio E, Ducreux M, Gruenberger T, Haller D, Haustermans K, Hoff P, Kerr D, Labianca R, Moore M, Nordlinger B, Ohtsu A, Rougier P, Scheithauer W, Schmoll HJ, Sobrero A, Tabernero J, van de Velde C. The management of hepatocellular carcinoma. Current expert opinion and recommendations derived from the 10th World Congress on Gastrointestinal Cancer, Barcelona, 2008. Ann Oncol 2009; 20 Suppl 7:vii1-vii6. [PMID: 19497945 DOI: 10.1093/annonc/mdp281] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This article summarizes the expert discussion on the management of hepatocellular carcinoma (HCC), which took place during the 10th World Gastrointestinal Cancer Congress (WGICC) in Barcelona, June 2008. A multidisciplinary approach to a patient with HCC is essential, to guarantee optimal diagnosis and staging, planning of surgical options and selection of embolisation strategies or systemic therapies. In many patients, the underlying cirrhosis represents a challenge and determines therapeutic options. There is now robust evidence in favour of systemic therapy with sorafenib in patients with advanced HCC with preserved liver function. Those involved in the care for patients with HCC should be encouraged to participate in well-designed clinical trials, to increase evidence-based knowledge and to make further progress.
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Affiliation(s)
- C Verslype
- Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium
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Gruenberger T. The role of conversion chemotherapy in initially non-optimal resectable liver metastases. Eur Surg 2009. [DOI: 10.1007/s10353-009-0472-y] [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: 10/20/2022]
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Gruenberger B, Schueller J, Tamandl D, Kaczirek K, Schernthaner G, Gruenberger T. K-ras status and response in patients with advanced or metastatic cholangiocarcinoma treated with cetuximab plus gemcitabine-oxaliplatin (GEMOX): a single center phase II study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4586 Background: As known, the mutation status of the K-ras gene affects the response to cetuximab in colorectal cancer. Less is known about K-ras status and outcome in cholangiocarcinoma. Patients with advanced cholangiocarcinoma have a poor prognosis and until now, no standard palliative chemotherapy has been defined. The purpose of this prospective single-centre phase II study was to investigate the therapeutic efficacy and K-ras status dependence of cetuximab in combination with gemcitabine and oxaliplatin in the palliative first line treatment of these patients. Methods: Patients with locally advanced or metastatic cholangiocarcinoma or gallbladder cancer were treated with cetuximab 500 mg/m2 followed by 1000mg/m2 gemcitabine (day 1) and 100mg/m2 oxaliplatin (day 2) biweekly as first line therapy. Tumour samples were obtained from 25 of 30 patients (83%). We studied the k-ras mutation status and analyzed the association between k-ras mutation and tumor response, progression-free survival (PFS) and overall survival (OS). Results: From October 2006 until July 2008 thirty patients (15 male, 15 female) with a median age of 68 were enrolled. The overall response rate of evaluable patients (30) was 63,3%, including three patient with a complete response. 5 patients (16,7%) achieved stable disease and only 6 patients (20%) progressed under chemotherapy. K-ras mutation was detected in 3 patients (12%). All three patients did not progressed under chemotherapy. Neither PFS nor OS were affected by K-ras status. The median PFS of all 30 patients was 8.3 months (95% CI 5.85–10.81) and median OS was 12.7 months (95 CI 7.96–17.37). After a mean number of 7.5 cycles any WHO grade 3 drug-related adverse events occurred in 13 patients (43%), consisting of skin toxicity in 4 patients, thrombopenia in 3, neutropenia in 1, nausea in 1, diarrhoe in 1 and PNP in 4 patients; no grade 4 side effects were noticed Conclusions: Cetuximab in combination with GEMOX induces impressive response rates which were unrelated to k-ras status. PFS and OS were remarkably improved and therefore cetuximab in combination with GEMOX deserves further evaluation in prospective randomized trials. [Table: see text]
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Affiliation(s)
- B. Gruenberger
- Hospital Rudolfstiftung, Vienna, Austria; Medical University Vienna, Vienna, Austria
| | - J. Schueller
- Hospital Rudolfstiftung, Vienna, Austria; Medical University Vienna, Vienna, Austria
| | - D. Tamandl
- Hospital Rudolfstiftung, Vienna, Austria; Medical University Vienna, Vienna, Austria
| | - K. Kaczirek
- Hospital Rudolfstiftung, Vienna, Austria; Medical University Vienna, Vienna, Austria
| | - G. Schernthaner
- Hospital Rudolfstiftung, Vienna, Austria; Medical University Vienna, Vienna, Austria
| | - T. Gruenberger
- Hospital Rudolfstiftung, Vienna, Austria; Medical University Vienna, Vienna, Austria
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Kandioler D, Pilat N, Kappel S, Gruenberger T, Laengle F, Mittlboeck M, Herberger B, Kuehrer I, Jakesz R, Muehlbacher F. A prospective study of the interaction between p53 genotype and overall survival in patients with colorectal cancer liver metastases (CRCLM) with and without neoadjuvant therapy (oxaliplatin and capecitabine/5-FU): A p53 research group study. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15003 Background: Mutations in the p53 gene have been suggested as both a marker of tumour aggressiveness and a means of predicting response to chemotherapy. Unfortunately, there remains no clear evidence that p53 gene mutation affects cancer survival rates. Methods: We sought to evaluate whether mutation in the p53 gene is a marker of more aggressive tumours or of chemotherapeutic failure. Between 2001 and 2003 we collected data prospectively on 76 patients with CRCLM at a single institution. Patients considered to be technically operable were included. 51 patients received preoperative therapy with oxaliplatin plus 5-FU or capetcitabine and 25 were treated with surgery only. Treatment decision was based on the preference of the surgeon or the patient. The groups did not differ in age, chronicity of CRCLM, staging and grading of the primary colorectal cancer. The p53 gene was assessed in all tumours through complete direct gene sequencing (Exon 2–11 including splice sites). Results: For entire cohort the p53 gene mutation rate was 55%, and the median survival was 44.2 months. The overall death rate was 51%. There were 14 (41%) deaths in patients with a normal p53 gene compared to 25 (60%) deaths in patients with mutations in this gene (Logrank P=0.079). For patients that received only surgical treatment the overall death rate was 48% and was unaffected by the presence of p53 gene mutation (Logrank P=0.54). For patients who received neoadjuvant chemotherapy, median survival was 44 months if they had a normal p53 gene compared to only 20 months in patients with p53 gene mutations. The unadjusted hazard ratio for death was 3.24 in the p53 mutation group compared those with a normal p53 gene (95 percent confidence interval 1.5 to 7.0; P=0.045). The adjusted hazard ratio for death in patients with a p53 gene mutation receiving neoadjuvant chemotherapy was 5.5 (95% CI 2.3 to 13.2; P=0.0042). Conclusions: In CRCLM patients receiving neoadjuvant chemotherapy, the p53 gene mutation predicts overall survival. Our data suggests an interaction between the p53 gene and chemotherapy in patients with colorectal liver metastasis. No significant financial relationships to disclose.
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Affiliation(s)
- D. Kandioler
- University of Vienna Medical School, Vienna, Austria; Landeskrankenhaus Wiener Neustadt, Wiener Neustadt, Austria
| | - N. Pilat
- University of Vienna Medical School, Vienna, Austria; Landeskrankenhaus Wiener Neustadt, Wiener Neustadt, Austria
| | - S. Kappel
- University of Vienna Medical School, Vienna, Austria; Landeskrankenhaus Wiener Neustadt, Wiener Neustadt, Austria
| | - T. Gruenberger
- University of Vienna Medical School, Vienna, Austria; Landeskrankenhaus Wiener Neustadt, Wiener Neustadt, Austria
| | - F. Laengle
- University of Vienna Medical School, Vienna, Austria; Landeskrankenhaus Wiener Neustadt, Wiener Neustadt, Austria
| | - M. Mittlboeck
- University of Vienna Medical School, Vienna, Austria; Landeskrankenhaus Wiener Neustadt, Wiener Neustadt, Austria
| | - B. Herberger
- University of Vienna Medical School, Vienna, Austria; Landeskrankenhaus Wiener Neustadt, Wiener Neustadt, Austria
| | - I. Kuehrer
- University of Vienna Medical School, Vienna, Austria; Landeskrankenhaus Wiener Neustadt, Wiener Neustadt, Austria
| | - R. Jakesz
- University of Vienna Medical School, Vienna, Austria; Landeskrankenhaus Wiener Neustadt, Wiener Neustadt, Austria
| | - F. Muehlbacher
- University of Vienna Medical School, Vienna, Austria; Landeskrankenhaus Wiener Neustadt, Wiener Neustadt, Austria
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Klinger M, Eipeldauer S, Hacker S, Herberger B, Tamandl D, Dorfmeister M, Koelblinger C, Gruenberger B, Gruenberger T. Bevacizumab protects against sinusoidal obstruction syndrome and does not increase response rate in neoadjuvant XELOX/FOLFOX therapy of colorectal cancer liver metastases. Eur J Surg Oncol 2009; 35:515-20. [PMID: 19200687 DOI: 10.1016/j.ejso.2008.12.013] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 12/19/2008] [Accepted: 12/23/2008] [Indexed: 01/16/2023] Open
Abstract
AIM In patients suffering from colorectal cancer liver metastases, 5-fluorouracil-based chemotherapy plus oxaliplatin ensures superior response rates at the cost of hepatic injury. Knowledge about the consequences of bevacizumab on chemotherapy-induced hepatic injury and tumor response is limited. METHODS Resected liver specimens from patients of two prospective, non-randomized trials (5-fluorouracil/oxaliplatin+/-bevacizumab) were analyzed retrospectively. Hepatotoxicity to the non-tumor bearing liver was evaluated for sinusoidal obstruction syndrome, hepatic steatosis and fibrosis. Tumor response under chemotherapy was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST). RESULTS Bevacizumab decreased the severity of the sinusoidal obstruction syndrome. Bevacizumab had no impact on hepatic steatosis and fibrosis. The addition of bevacizumab to chemotherapy had no effect on tumor response compared to combination chemotherapy alone. CONCLUSIONS This analysis shows that bevacizumab protects against the sinusoidal obstruction syndrome and thus provides the histological explanation of the safe use of bevacizumab prior to liver resection. Furthermore, we show that bevacizumab does not improve tumor response according to RECIST.
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Affiliation(s)
- M Klinger
- Department of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Nordlinger B, Van Cutsem E, Gruenberger T, Glimelius B, Poston G, Rougier P, Sobrero A, Ychou M. Combination of surgery and chemotherapy and the role of targeted agents in the treatment of patients with colorectal liver metastases: recommendations from an expert panel. Ann Oncol 2009; 20:985-92. [PMID: 19153115 DOI: 10.1093/annonc/mdn735] [Citation(s) in RCA: 259] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The past 5 years have seen the clear recognition that the administration of chemotherapy to patients with initially unresectable colorectal liver metastases can increase the number of patients who can undergo potentially curative secondary liver resection. Coupled with this, recent data have emerged that show that perioperative chemotherapy confers a disease-free survival advantage over surgery alone in colorectal cancer (CRC) patients with initially resectable liver disease. The purpose of this paper is to build on the existing knowledge and review the issues surrounding the use of chemotherapy +/- targeted agents combined with surgery in the treatment of CRC patients with liver metastases, with a view to providing clinical recommendations. An international panel of 21 experts in colorectal oncology comprising liver surgeons and medical oncologists reviewed the available evidence. In a major change to clinical practice, the panel's recommendation was that the majority of patients with CRC liver metastases should be treated up front with chemotherapy, irrespective of the initial resectability status of their metastases.
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Affiliation(s)
- B Nordlinger
- Department of Digestive Surgery, Ambroise Paré Hospital, Boulogne, France.
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Gruenberger T, Kaczirek K, Bergmann M, Zielinski CC, Gruenberger B. Progression-free survival in a phase II study of perioperative bevacizumab plus XELOX in patients with potentially curable metastatic colorectal cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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