Brazilian Consensus for Multimodal Treatment of Colorectal Liver Metastases. Module 3: Controversies and Unresectable Metastases

Abstract

In the last module of this consensus, controversial topics were discussed. Management of the disease after progression during first line chemotherapy was the first discussion. Next, the benefits of liver resection in the presence of extra-hepatic disease were debated, as soon as, the best sequence of treatment. Conversion chemotherapy in the presence of unresectable liver disease was also discussed in this module. Lastly, the approach to the unresectable disease was also discussed, focusing in the best chemotherapy regimens and hole of chemo-embolization.

Brazilian Society of Surgical Oncology surgical standards for resectable colorectal cancer liver metastases

“…The selection of patients for resection of EHMD must be restricted, considering the biological behavior of the disease, localization, response to systemic treatment, possibility of R0 resection of all sites, and feasibility of multiple major procedures 83,84 …”

Evolution in the surgical management of colorectal liver metastases: Propensity score matching analysis (PSM) on the impact of specialized multidisciplinary care across two institutional eras

“…Patients with initially unresectable liver metastases or presenting with worrisome prognostic features (ie, synchronous metastases, multiple nodules, and elevated carcinoembryonic antigen [CEA]) were initially managed with systemic treatment, but otherwise, resectable patients with signs of better biological behavior were directly scheduled for hepatectomy . Limited extra‐hepatic disease, whenever deemed resectable, was not considered a contraindication . Patients were followed up on as per institutional protocol with cross‐sectional imaging and CEA levels every 4‐6 months for the first 2 years and annual screening and consultations every 6 months thereafter.…”

“…19 Limited extra-hepatic disease, whenever deemed resectable, was not considered a contraindication. 20 Patients were followed up on as per institutional protocol with cross-sectional imaging and CEA levels every 4-6 months for the first 2 years and annual screening and consultations every 6 months thereafter. Patients' clinical and oncologic characteristics were compared utilizing the above mentioned tests, with similarity between the groups on all variables except for CEA levels, presence of bilobar disease, and mean size of the largest nodule.…”

The Budget Impact of Monoclonal Antibodies Used to Treat Metastatic Colorectal Cancer in Minas Gerais, Brazil

“…The projected CRC incidence in the state of Minas Gerais (MG) in 2018 was 1,510 new cases for men and 1,650 for women, totaling 3,160 new cases, considering all cancer stages (6). It is important to highlight that between 17% and 26% of patients with CRC were diagnosed in stage IV, with the presence of metastases distant from the original tumor (7,8). The delay in diagnosis compromises the effectiveness of potential treatments and may increase overall costs, which presents a particular concern for developing countries (9)(10)(11)(12)(13).…”