Disappearing colorectal liver metastases: Strategies for the management of patients achieving a radiographic complete response after systemic chemotherapy

Araújo, Raphael L. C.; Milani, Jean Michel; Armentano, Daniela Pezzutti; Moreira, Raphael Brandão; Pinto, Gustavo Sanches Faria; Castro, Luís Antônio de; Lucchesi, Fabiano Rubião

doi:10.1002/jso.25784

Cited by 12 publications

(8 citation statements)

References 60 publications

(103 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For best planning a liver resection, an MRI should also be done to study the liver and the anatomical relations of the lesion for a putative hepatic resection ( 4 ). The detection rate can also be enhanced by using the liver-specific contrast-enhancing agent (gadoxate disodium) and diffusion-weighted evaluations ( 37 ). Macera et al compared MRI methods, finding significant differences in accuracy between contrasting-enhance plus diffusion, contrasting-enhancing, and diffusion-weighted MRI, 89.2%, 76.5%, and 65.1%, respectively ( 38 ).…”

Section: Pre-operative Stagingmentioning

confidence: 99%

Molecular profiling and patient selection for the multimodal approaches for patients with resectable colorectal liver metastases

Araujo,

Fonseca,

Silva

et al. 2024

Hepatobiliary Surg Nutr

View full text Add to dashboard Cite

Colorectal cancer represents the third most common cancer and about 20% are diagnosed with synchronous metastatic disease. From a historical point of view, surgery remains the mainstream treatment for resectable colorectal liver metastases (CRLM). Furthermore, disease outcomes are improving due significant advances in systemic treatments and diagnostic methods. However, the optimal timing for neoadjuvant chemotherapy or upfront surgery for CRLM has not yet been established and remains an open question. Thus, patient selection combining image workouts, time of recurrence, positive lymph nodes, and molecular biomarkers can improve the decision-making process. Nevertheless, molecular profiling is rising as a promising field to be incorporated in the multimodal approach and guide patient selection and sequencing of treatment. Tumor biomakers, genetic profiling, and circulating tumor DNA have been used to offer as much personalized treatment as possible, based on the precision oncology concept of tailored care rather than a guideline-based therapy. This review article discusses the role of molecular pathology and biomarkers as prognostic and predictor factors in the diagnosis and treatment of resectable CRLM.

show abstract

Section: Pre-operative Stagingmentioning

confidence: 99%

Molecular profiling and patient selection for the multimodal approaches for patients with resectable colorectal liver metastases

Araujo,

Fonseca,

Silva

et al. 2024

Hepatobiliary Surg Nutr

View full text Add to dashboard Cite

show abstract

“…This difference was more evident when comparing patients with Oslo score 2 and TBS 9 having a 5year OS of 14.6% in the LR group compared with 69.1% in the LT group [26 ]. Another concern in this group of patients is related to disappearing liver metastases (DLM), as previous studies have shown that patients with CRLM treated with systemic chemotherapy could demonstrate a complete radiographic response, without necessarily translating into a complete pathologic response, and residual invasive cancer can be found in up to 80% of the disappearing tumors after resection [27,28] (Fig. 1).…”

Section: Andandmentioning

confidence: 99%

“…Notably, these patients have a high recurrence rate after LT; however, total hepatectomy and LT for uCRLM has garnered attention due to its ability to shift the recurrence pattern in transplanted patients [30,31]. Most patients who undergo LT for this indication do not recur in the liver graft; instead, when disease recurs, it often does so as manageable pulmonary metastases [27,28,32]. This becomes particularly relevant, since it is evident that recurrence after LT for CRLM is not an accurate surrogate for survival when compared to recurrence after LR.…”

Section: Recurrencementioning

confidence: 99%

Liver transplantation for unresectable colorectal liver metastasis

Chávez-Villa

Ruffolo

Hernandez‐Alejandro

2023

Current Opinion in Organ Transplantation

View full text Add to dashboard Cite

Purpose of review To summarize the current state of liver transplantation (LT) for unresectable colorectal liver metastases (uCRLM), and to address future directions. Recent findings The Norwegian secondary cancer (SECA) I and SECA II studies demonstrated that after LT the 5-year survival of a highly selected group of patients with uCRLM could be as high as 60% and 83%, respectively. After long-term follow-up, the 5- and 10-year survival was shown to be 43% and 26%, respectively. Furthermore, data has accumulated in other countries and a North American study reported a 1.5-year survival of 100%. In addition, steady growth has been demonstrated in the US, with 46 patients transplanted to date and 19 centers enrolling patients for this indication. Lastly, although recurrence is almost universal in patients with a high tumor burden, it has not been an accurate surrogate for survival, reflecting the relatively indolent nature of recurrence after LT. Summary Growing evidence has shown that excellent survival and even cure can be achieved in highly selected patients with uCRLM, with survival rates far superior than in patients treated with chemotherapy. The next step is to create national registries to standardize selection criteria and establish the optimal approach and best practices for incorporating LT for uCRLM into the treatment armamentarium.

show abstract

“…In this regard, surgical planning revolves around strategizing for the full removal of the tumor while preserving a sufficient remnant of healthy liver tissue (future liver remnant [FLR]) to limit the risk of postoperative liver dysfunction/failure [ 34 ]. Resection of disappearing liver metastases should be included in this plan, as more than half of these lesions will recur if left in situ [ 35 , 36 , 37 ]. Microscopic residual disease is found in up to 90% of specimens harboring radiologically occult liver metastases [ 38 , 39 , 40 ].…”

Section: Assessment Of Resectabilitymentioning

confidence: 99%

Current Surgical Management Strategies for Colorectal Cancer Liver Metastases

Ivey

Johnston

Azad

et al. 2022

Cancers

View full text Add to dashboard Cite

Colorectal cancer is the third most common cancer diagnosis in the world, and the second most common cause of cancer-related deaths. Despite significant progress in management strategies for colorectal cancer over the last several decades, metastatic disease remains difficult to treat and is often considered incurable. However, for patients with colorectal liver metastases (CRLM), surgical resection offers the best opportunity for survival, can be curative, and remains the gold standard. Unfortunately, surgical treatment options are underutilized. Misperceptions regarding resectable and unresectable CRLM likely play a role in this. The assessment of factors that impact resectability status like medical fitness, technical considerations, and disease biology can be difficult, necessitating careful multidisciplinary input and discussion. The identification of ideal operative time windows that align with the multimodal management of these patients can also be perplexing. For all patients with CRLM it may therefore be advantageous to obtain surgical evaluation at the time of discovering liver metastases to mitigate these challenges and minimize the risk of undertreatment. In this review we summarize current surgical management strategies for CRLM and discuss factors to be considered when determining resectability.

show abstract

Disappearing colorectal liver metastases: Strategies for the management of patients achieving a radiographic complete response after systemic chemotherapy

Cited by 12 publications

References 60 publications

Molecular profiling and patient selection for the multimodal approaches for patients with resectable colorectal liver metastases

Molecular profiling and patient selection for the multimodal approaches for patients with resectable colorectal liver metastases

Liver transplantation for unresectable colorectal liver metastasis

Current Surgical Management Strategies for Colorectal Cancer Liver Metastases

Contact Info

Product

Resources

About