Hepatic Metastases from Colorectal Cancer: Preoperative Detection and Assessment of Resectability with Helical CT

Valls, Carlos; Andía, Eduard; Sánchez, Anna; Gumà, Anna; Figueras, Juan; Torras, Jaume; Serrano, Teresa

doi:10.1148/radiology.218.1.r01dc1155

Cited by 233 publications

(104 citation statements)

References 23 publications

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“…In terms of the cumulative rate of recurrence in situ, the KaplanMeier curve in our study appeared identical to or slightly more favorable than that reported in two previous studies (8,9) CT appears to be the most commonly used imaging modality in the evaluation of the effect of chemotherapy according to RECIST criteria (12). It has been reported that the sensitivity of helical CT is 66-84% (13)(14)(15)(16). In patients with persistent macroscopic disease at surgery, morphological changes in the structure of the liver due to chemotherapy, including steatosis, sinusoidal dilatation and fibrosis, may be responsible for underestimation of liver metastases (17).…”

Section: Discussionsupporting

confidence: 85%

Outcome in disappearing colorectal cancer liver metastases during oxaliplatin-based chemotherapy

et al. 2012

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Abstract. Some colorectal cancer liver metastases (CLMs) disappear on serial imaging during chemotherapy and the optimal treatment strategy for such lesions remains undetermined. The purpose of this study was to investigate the outcome in disappearing CLMs, as few studies have focused on this topic, with conflicting results. Among 125 patients with CLMs treated with modified FOLFOX6 with or without bevacizumab, those in whom all CLMs disappeared on computed tomography were identified. Recurrence of such disappearing lesions in situ was examined on a tumor-by-tumor basis. Five (4%) patients with a total of 44 CLMs met the evaluation criteria. The median number of CLMs prior to chemotherapy was 8 (range, 2-16). The median maximal diameter of the CLMs was 1.8 cm (range, 1.0-2.4). The median time-todisappearance of all eligible lesions was 6.5 months (range, 4.5-7.5). Histological examination of scar lesions on the liver surface revealed no viable cancer cells. Two lesions were surgically resected. During clinical follow-up of the remaining 42 lesions, in situ recurrence was observed in 8. The cumulative 1-, 2-and 3-year rates of relapse in situ were 9.1, 9.1 and 31.1%, respectively. Given the low risk of recurrence in situ, the results suggest that the sites of disappearing CLMs may be left unresected but should be carefully monitored during follow-up, with resection an option if the lesion should recur. However, to validate such a treatment strategy, further investigation with a larger series of patients is warranted. IntroductionRecent advances in chemotherapy have resulted in an increasing number of patients with colorectal cancer liver metastases (CLMs) being treated with systemic chemotherapy prior to hepatic metastasectomy, either as neoadjuvant treatment for initially resectable lesions or in an attempt to make unresectable lesions resectable. When used as first-line chemotherapy for CLMs, new and effective regimens, including 5-fluorouracil (5-FU)/leucovorin (LV), irinotecan and oxaliplatin in combination with targeted agents, have yielded a complete response in 1 to 9% of patients with CLMs (1-3). The optimal treatment strategy in such cases, however, remains to be determined as, to the best of our knowledge, little research has been carried out on this topic and the results thus far have been conflicting. Patients and methodsPatients. The study protocol conformed to the standards of good practice and ethics of our institution. Informed consent was obtained from the individuals included in the study. A retrospective review of all consecutive patients who had been diagnosed with CLM and who were treated with first-line oxaliplatin-based chemotherapy (modified FOLFOX6; mFOLFOX6) with or without bevacizumab between January 2006 and December 2010 was carried out. The mFOLFOX6 regimen comprised intravenous infusion of oxaliplatin (80 mg/m 2 ) over 2 h, followed by rapid intravenous bolus infusion of 5-FU (400 mg/m 2 ) for 5 min and continuous intravenous infusion of 5-FU (2,400 mg/m 2 ) over 46 h. This regimen ...

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Section: Discussionsupporting

confidence: 85%

Outcome in disappearing colorectal cancer liver metastases during oxaliplatin-based chemotherapy

et al. 2012

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“…A large meta-analysis by Bipat et al [21] that included 90 studies showed similar accuracies between ultrasound, CT and MRI for the assessment of nodal involvement by rectal cancer. In a study of 137 patients, Valls et al [22] showed good accuracy (85.1%), high positive predictive value (96.1%) and low positive predictive value (3.9%) of CT for the detection of liver metastases. For the detection of CRC metastases, CT imaging in the portal venous phase is the technique of choice.…”

Section: Pre-treatment Stagingmentioning

confidence: 97%

Use of computed tomography in the management of colorectal cancer

Tan

Iyer²

2010

WJR

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Computed tomography (CT) plays an important role in the management of colorectal cancer (CRC). The use of CT (colonography) as a screening tool for CRC has been validated and is expected to rise over time. The results of prior studies suggest that CT is suboptimal for assessment of local T stage and moderate for N stage disease. Recent advances in CT technology are expected to lead to some improvement in staging accuracy. At present, the main role of CT in pretreatment imaging assessment lies in its use for the detection of distant metastases, especially in the liver. In a select group of patients, routine post-treatment surveillance with CT confers survival benefits. The role of CT for post-treatment assessment has been radically altered and improved with the advent of fusion positron emission tomography/CT. Perfusion CT shows promise as another functional imaging modality but further experience with this technique is necessary before it can be applied to routine clinical practice.

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“…CLMs are often missed at laparotomy or even preoperative diagnostic tools, including multislice contrast-enhanced computed tomography or magnetic resonance imaging, which have higher sensitivity rates for the disease [7,8]. Thus, intraoperative ultrasound (IUS) has been routinely used for detecting additional lesions which were not identified with preoperative radiological evaluations [9,10].…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Excision of Additional Lesions Detected with Intraoperative Ultrasound Examination During Radiofrequency Dissecting Sealar (Habib®) Assisted Hepatic Metastasectomy: Report of 4 Cases

Altuntas

Unel²,

Gezen

et al. 2012

Indian J Surg

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Intraoperative ultrasound has been using to achieve a proper resection strategy in patients undergoing a hepatic colorectal metastasectomy. This study aims to describe and reveal the place of stereotactic metastasectomy in nonpalpable colorectal liver metastases (CLM). A chart review was initiated for all patients underwent resection for CLM between 2006 and 2011. The data concerning perioperative data and intraoperative strategy were abstracted. Among the 58 patients, who underwent a resection for CLM, 4 (6.9 %) (all men, median age 65.5, range 49-72, years) necessitated a stereotactic metastasectomy. Preoperative evaluations showed 1 (n01), 2 (n02), or 3 (n01) lesions, and intraoperative ultrasound (IUS) found an additional lesion in a case. Stereotactic marking was performed for nonpalpable lesions located in segments IVA, II, and VI and at the junction of segments V and VI. The margins were negative for all lesions both resected with conventional and stereotactic techniques. The examinations of the stereotactic resection materials revealed metastatic adenocarcinoma (patients n02), focal nodular hyperplasia (n 01), and abnormal benign liver histology probably induced by chemotherapy (n01). The median (range) operation and hospitalization periods were 217.5 (150-310) minutes and 5.5 (2-9) days. No complications were observed except biliary fistula in a case, which spontaneously disappeared within 2 weeks. A patient died due to systemic disease including hepatic metastases 33 months after the liver surgery. Stereotactic metastasectomy may be feasible for the removal of nonpalpable CLM. Further evaluations are necessitated to understand the accurate place of this novel technique.

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Hepatic Metastases from Colorectal Cancer: Preoperative Detection and Assessment of Resectability with Helical CT

Abstract: Helical CT is a noninvasive, reliable, and accurate technique for imaging the liver and should be considered as the standard preoperative work-up of hepatic metastases from colorectal cancer.

Cited by 233 publications

References 23 publications

Outcome in disappearing colorectal cancer liver metastases during oxaliplatin-based chemotherapy

Outcome in disappearing colorectal cancer liver metastases during oxaliplatin-based chemotherapy

Use of computed tomography in the management of colorectal cancer

Stereotactic Excision of Additional Lesions Detected with Intraoperative Ultrasound Examination During Radiofrequency Dissecting Sealar (Habib®) Assisted Hepatic Metastasectomy: Report of 4 Cases

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