Curable metastatic colorectal cancer: Recommended paradigms

Abstract

"Cure" for patients with stage IV colorectal cancer remains elusive, but for a growing subset of patients with colorectal liver metastases (CLMs), cure (ie, > 10-year survival without evidence of disease) is achieved in at least 17% of resected patients. Candidates for resection include those with limited and in some cases extensive hepatic disease, and in highly selected cases, patients with extrahepatic disease. Number, size, and bilaterality of CLMs no longer stand as absolute contraindications to surgery. Chemotherapy has further advanced the field of surgery for CLMs, enabling an additional group of patients who present with unresectable disease to undergo surgery after downsizing with chemotherapy. Modern surgical techniques and liver preparation allow resection after chemotherapy, with excellent results. This article summarizes the current multidisciplinary approach to treatment of CLMs. The definition of resectability, conversion of unresectable CLMs to resectable ones, advances in surgical techniques, advances in chemotherapy, and predictors of outcome are detailed.

Oridonin induces apoptosis and senescence in colorectal cancer cells by increasing histone hyperacetylation and regulation of p16, p21, p27 and c-myc

“…Although curative resection is the major treatment option, approximately half of all patients eventually develop distant metastases. Liver metastases (LM) occur in more than 50% of CRC patients, but curative liver resection is possible only in 15% of them, resulting in 5-year survival rates of 30% on average [2-4]. Improving resectability rates and hopefully patient's prognosis by adding up front active chemotherapy and biological agents in metastatic CRC is a challenging opportunity for both medical and surgical oncologists [5].…”

Shifting trends in liver-directed management of patients with colorectal liver metastasis: A population-based analysis

“…8-10 The treatment paradigm for CRLM has evolved with expanding indications for hepatic resection and new treatment strategies to compliment resection/ablation and increase the number of patients who are eligible to undergo resection. 9,11 Data on temporal trends in perioperative management, utilization of hepatic resection versus thermal ablation, morbidity and mortality, as well as survival after liver-directed surgery for CRLM remain poorly characterized. Most data are derived from case series from large academic institutions, 5,12-16 which may provide information that is inappropriate to extrapolate outside of the respective institution.…”

The surgical component of treatment for metastatic colorectal cancer: The current state of the problem

“…и множественное -несколько метастати-ческих узлов, в нескольких органах (билобарное поражение пече-ни и легких) [1,19,24,32,[34][35][36][37][38][39]. С хирургической точки зрения это имеет принципиальное значение, так как, несмотря на мно-жественный характер поражения метастазами, могут быть вы-полнены хирургические вмешательства по удалению части пора-женного органа (бисегментэктомия, лобэктомия и т.д.).…”

“…Гри-нев и соавт. [37] гия в лечении колоректального рака IV стадии» считают, что ци-торедуктивные операции включают в себя обязательное удаление первичной опухоли или основной ее массы с синхронным или метахронным удалением отдаленных метастазов. Главной целью при этом является не «абластичность» удаления отдаленных ме-тастазов, а максимально возможная степень уменьшения объема опухоли в организме, несмотря на диссеминацию опухолевого процесса.…”