Early Start of Chemotherapy after Resection of Primary Colon Cancer with Synchronous Multiple Liver Metastases:A Case Report

Yoshida, Yoichiro; Hoshino, Seiichiro; Shiwaku, Hironari; Beppu, Richiko; Tanimura, Syu; Tanaka, Shinnosuke; Yamashita, Yuichi

doi:10.1159/000328805

Cited by 11 publications

(7 citation statements)

References 14 publications

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“…reported the independent prognostic value on survival of primary tumor resection in patients with CRC and unresectable metastases [13]. Other authors have suggested deferring the resection of minimally symptomatic colorectal tumors because most of these patients succumb to progressive systemic disease instead of the complications related to the intact primary lesion [8,10,14]. We reported on a case involving an early chemotherapy start in a patient who had undergone right hemicolectomy for synchronous multiple liver metastases [14].…”

Section: Resultsmentioning

confidence: 99%

Pilot study of the early start of chemotherapy after resection of primary colorectal cancer with distant metastases (Pearl Star 01)

et al. 2013

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BackgroundThe start of chemotherapy usually requires a delay of about 4 weeks after surgical resection of colorectal cancer. However, there is no evidence for the required length of this delay interval. In addition, there is a chance that a patient may die because postoperative chemotherapy was not started soon enough and a metastatic tumor was able to develop rapidly. We therefore conducted a pilot study to determine the safety and feasibility of an early start of chemotherapy after the resection of colorectal cancer with distant metastases.MethodsFive patients were enrolled. They received XELOX therapy (130 mg/m2 of oxaliplatin on day 1 plus 1,000 mg/m2 of capecitabine twice daily on days 1 to 14) on the 7th postoperative day and XELOX + bevacizumab (7.5 mg/kg of bevacizumab on day 1) after the 2nd cycle of chemotherapy.ResultsFive patients underwent open surgery. The procedures included right hemicolectomy in 1 patient, sigmoidectomy in 2 patients, high anterior resection in 1 patient, and Hartmann procedure in 1 patient. All patients started chemotherapy on postoperative day 7. The median number of cycles of chemotherapy was 11 (8 to 22). No postoperative complications were observed. The tumor reduction rate was 44.3% (32.0 to 66.6%). Progression-free survival was 10.3 months.ConclusionsAn early start of chemotherapy after surgery is feasible and safe. These findings suggest possible changes in the start time of chemotherapy after surgery in the future. We have already started a new phase II trial to confirm the effects of the early start of chemotherapy after surgery.Trial registrationUMIN000004361.

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Section: Resultsmentioning

confidence: 99%

Pilot study of the early start of chemotherapy after resection of primary colorectal cancer with distant metastases (Pearl Star 01)

et al. 2013

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“…Furthermore, even for patients with metastatic colorectal cancer in the IV phase, several reports proposed that early initiation of PAC could significant ameliorate the prognosis after palliative operation. Two case reports conducted by Yoshida Y. et al, [18] [19] in 2011 and 2012 had shown that stage IV colon cancer with liver metastases and brain metastases, after palliative resection of tumor associated metastasis, prescribing the first PAC within one week, not only the patients suffered from little chemotherapy induced adverse reactions, but the PFS had reached six months and four months, respectively. It was still Yoshida Y. et al, [20] [4] summarized PAC interval ≥ 8 weeks wouldn't impact 5-year OS or RFS.…”

Section: Discussionmentioning

confidence: 99%

Stage II/III Rectal Cancer Patients Benefit from Extremely Early Initiation of Postoperative Adjuvant Chemotherapy: A Retrospective Study

Xiao¹,

Zhu²,

Chen³

et al. 2019

JCT

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Background: For Stage II/III rectal cancer patients, curative resection is the primary treatment, prescribing of postoperative adjuvant chemotherapy (PAC) is regarded as a standard therapy. The interval between surgery and the initiation of PAC is usually within 8 weeks. However, the optimal cutoff is still controversial. This study aimed to explore the impact of extremely early initiation of PAC for II/III rectal cancer. Methods: Patients with Stage II/III rectal cancer treated from January 2013 to December 2015 were retrospectively collected at the Department of Tongji Hospital. According to the starting point of PAC, patients were categorized into two groups: extremely early group (The interval of PAC ≤ 2 weeks) and normal group (The interval of PAC within 3-5 weeks). For the sake of evaluating the effectiveness of different intervals, Overall Survival rate (OS), Progress-Free Survival rate (PFS) and Recurrence or Metastasis Rate (RMR) were analyzed, as well as the Quality of Life Score. To estimate the safety of the extremely early PAC, we evaluated the first post chemotherapy adverse reactions and defecation ability, and analyzed the variance laboratory indexes around the first postoperative adjuvant chemotherapy. Results: A total of 267 patients were included in this study. Compared to normal group (192 cases), extremely early group (75 cases) of patients attained a better tendency of OS and PFS, although there were no significant statistical differences (OS: P = 0.0930; PFS: P = 0.1058). However, the RMR was significant lower (P = 0.0452) and the Quality of Life Score was significantly higher (P = 0.0090) in extremely early group. Multivariate analysis also showed that extremely early group had better defecation ability (P = 0.0149) and less side reactions of post chemotherapy, such as vomiting (P < 0.

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“…In most clinical trials, patients who underwent an operation within 4 weeks were excluded. We reported a case involving the early initiation of chemotherapy on postoperative day 7 who had undergone right hemicolectomy for synchronous multiple liver, lung, and peritoneal metastases 26. He survived without postoperative complications for 22 months despite huge liver metastases.…”

Section: Discussionmentioning

confidence: 99%

Phase II study on early start of chemotherapy after excising primary colorectal cancer with distant metastases (Pearl Star 02)

Yoshida

Aisu

Kojima

et al. 2017

Annals of Gastroent Surgery

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Initiating chemotherapy usually requires a delay of more than 4 weeks after surgically resecting colorectal cancer. However, there is little evidence regarding the required delay interval. We have previously reported a pilot study to determine the safety and feasibility of early initiation of chemotherapy after resecting primary colorectal cancer with distant metastases. We aimed to determine the safety and efficacy of early initiation of chemotherapy after resecting colorectal cancer with distant metastases.This phase II study (trial number UMIN000006310) was a prospective, single‐arm trial. A total of 20 patients (men, 15 and women, 5) were enrolled. They underwent XELOX therapy (130 mg/m2 oxaliplatin on day 1+1000 mg/m2 capecitabine twice daily on days 1‐4) on postoperative day 7 and XELOX+bevacizumab (7.5 mg/kg bevacizumab on day 1) after the second chemotherapy cycle.Baseline characteristics included a median age of 64 (range, 43‐72) years. Surgical procedures included right hemicolectomy in six patients, sigmoidectomy in three, anterior resection in five, and Hartmann procedure in six. All patients started chemotherapy on postoperative day 7. Median progression‐free survival was 14.9 months; overall response rate was 80%. Disease control rate was 100%. Grade 3 or higher hemotoxicity and grade 3 or higher non‐hematological toxicity was noted in 5.0% and 25.0% of patients, respectively. Postoperative complications were observed in two patients (superficial incisional surgical site infection and ileus).Early initiation of chemotherapy after surgery is feasible. These findings suggest future changes of the start time of chemotherapy after surgery.

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Early Start of Chemotherapy after Resection of Primary Colon Cancer with Synchronous Multiple Liver Metastases:A Case Report

Cited by 11 publications

References 14 publications

Pilot study of the early start of chemotherapy after resection of primary colorectal cancer with distant metastases (Pearl Star 01)

Pilot study of the early start of chemotherapy after resection of primary colorectal cancer with distant metastases (Pearl Star 01)

Stage II/III Rectal Cancer Patients Benefit from Extremely Early Initiation of Postoperative Adjuvant Chemotherapy: A Retrospective Study

Phase II study on early start of chemotherapy after excising primary colorectal cancer with distant metastases (Pearl Star 02)

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