Marking Disappearing Colorectal Liver Metastases After Complete Response to Neoadjuvant Chemotherapy <i>via</i> CT – A Pilot Study

Vujić, J; Schöllnast, Helmut; Marsoner, Katharina; Wienerroither, Valerie; Bacher, H.; Mischinger, Hans‐Jörg; Kornprat, Peter

doi:10.21873/anticanres.13534

Cited by 4 publications

(7 citation statements)

References 19 publications

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“…However, radiologists’ role is not focused on guiding surgical plans and positioning the residual lesions, but their role is critical in multidisciplinary teams. For instance, in the initial setting, during a multidisciplinary assessment, radiologists should detect the DLM high-risk lesions, for which a fiducial marker could reduce the risk of DLM, representing the real ghostbuster [ 63 , 64 ]. Image interpretation by radiologists could guide initial therapy discussions as well as interpret post-treatment imaging following liver-directed therapy, providing additional information to all the members of multidisciplinary team.…”

Section: The Role Of the Radiologistmentioning

confidence: 99%

“…On the basis that maximizing resection of CRLM still remains the main objective, some authors have experimented with marking lesions at high risk of disappearing with a fiducial prior to initiation of chemotherapy or immediately before surgery. Vujic et al demonstrated the importance of positioning a CT-guided marker in DLM after neoadjuvant treatments and observed a complete histological response in only 18% of resected sites [ 63 , 64 ].…”

Section: Novel Strategies In the Management Of Patients With Dlmmentioning

confidence: 99%

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Disappearing Colorectal Liver Metastases: Do We Really Need a Ghostbuster?

et al. 2022

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The development of new systemic treatment strategies has resulted in a significant increase in the response rates of colorectal liver metastases (CRLM) in the last few years. Although the radiological response is a favorable prognostic factor, complete shrinkage of CRLM, known as disappearing liver metastases (DLM), presents a therapeutic dilemma, and proper management is still debated in the literature. In fact, DLM is not necessarily equal to cure, and when resected, pathological examination reveals in more than 80% of patients a variable percentage of the tumor as residual disease or early recurrence in situ. Moreover, while a higher incidence of intrahepatic recurrence is documented in small series when surgery is avoided, its clinical significance for long-term OS is still under investigation. In light of this, a multidisciplinary approach and, in particular, radiologists’ role is needed to assist the surgeon in the management of DLM, thanks to emerging technology and strategy. Therefore, the aim of this review is to provide an overview of the DLM phenomenon and current management.

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Section: The Role Of the Radiologistmentioning

confidence: 99%

Section: Novel Strategies In the Management Of Patients With Dlmmentioning

confidence: 99%

Disappearing Colorectal Liver Metastases: Do We Really Need a Ghostbuster?

et al. 2022

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“…Meanwhile, the use of contrast-enhanced intraoperative ultrasound (IOUS) had the highest sensitivity (99%) compared with IOUS without contrast (88%), contrast-enhanced MRI (83%), and contrast-enhanced CT (81%)[ 78 ]. While DLM has been described in 7%-37% of patients undergoing preoperative systemic therapy, residual disease, either macroscopic microscopic, or early disease recurrence in situ has been observed in 61%-83% of CRLM that appear to have a complete response on imaging[ 67 , 79 - 84 ]. For patients with DLM left in situ , the intrahepatic recurrence rate is significantly higher.…”

Section: Technical Considerationsmentioning

confidence: 99%

“…Lesions at greatest risk for disappearance are those that are < 2 cm in diameter or deeper than 1 cm into the liver parenchyma, while the likelihood of developing DLM increases with longer duration of NCT[ 80 , 85 ]. In these situations, the placement of a fiducial marker can facilitate the localization of metastatic disease that has otherwise become undetectable on imaging[ 84 , 85 ]. Alternatively, patients at highest risk for DLM may benefit from upfront surgery rather than NCT if clinically feasible.…”

Section: Technical Considerationsmentioning

confidence: 99%

Neoadjuvant chemotherapy for colorectal liver metastases: A contemporary review of the literature

Guo¹,

Jin²,

Pawlik³

et al. 2021

WJGO

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Colorectal carcinoma (CRC) is one of the leading causes of cancer-related deaths worldwide, and up to 50% of patients with CRC develop colorectal liver metastases (CRLM). For these patients, surgical resection remains the only opportunity for cure and long-term survival. Over the past few decades, outcomes of patients with metastatic CRC have improved significantly due to advances in systemic therapy, as well as improvements in operative technique and perioperative care. Chemotherapy in the modern era of oxaliplatin- and irinotecan-containing regimens has been augmented by the introduction of targeted biologics and immunotherapeutic agents. The increasing efficacy of contemporary systemic therapies has led to an expansion in the proportion of patients eligible for curative-intent surgery. Consequently, the use of neoadjuvant strategies is becoming progressively more established. For patients with CRLM, the primary advantage of neoadjuvant chemotherapy (NCT) is the potential to down-stage metastatic disease in order to facilitate hepatic resection. On the other hand, the routine use of NCT for patients with resectable metastases remains controversial, especially given the potential risk of inducing chemotherapy-associated liver injury prior to hepatectomy. Current guidelines recommend upfront surgery in patients with initially resectable disease and low operative risk, reserving NCT for patients with borderline resectable or unresectable disease and high operative risk. Patients undergoing NCT require close monitoring for tumor response and conversion of CRLM to resectability. In light of the growing number of treatment options available to patients with metastatic CRC, it is generally agreed that these patients are best served at tertiary centers with an expert multidisciplinary team.

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“…To date, only one clinical study on percutaneous CT-guided marking for metastatic liver tumors has been reported [ 10 ], and, to our knowledge, no reports of transcatheter marking in liver resection have been published. Preoperative marking is a standard practice for deep-seated tumors in other solid organs, such as the lung [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Prospective Exploratory Phase I Clinical Trial Assessing the Safety of Preoperative Marking for Small Liver Tumors

Takei,

Kuroda,

Kobayashi

et al. 2023

Cureus

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Background Small tumors in liver cirrhosis are difficult to distinguish using intraoperative ultrasonography. In addition, preoperative chemotherapy for metastatic liver cancer may diminish tumor size, thus making tumors difficult to identify intraoperatively. To address such difficulties, we devised a method to mark liver tumors preoperatively to facilitate intraoperative identification. This study aimed to investigate the safety of a preoperative liver tumor marking method. Methodology This exploratory prospective clinical trial included patients with liver tumors measuring ≤20 mm requiring resection. Preoperative marking was performed by placing a coil for embolization of blood vessels near the tumor using either the transcatheter or percutaneous approach. The tumor was identified and resected by intraoperative ultrasonography based on the marker. The study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000028608). Results Overall, 19 patients (9 with primary liver cancer and 10 with metastatic tumors) were recruited. The transcatheter and percutaneous methods were used in 13 and 6 patients, respectively. Marking was not possible in two patients in the transcatheter group because the catheter could not be guided to the vicinity of the tumor. There were no marking-related complications. Hepatectomy was performed in all but one patient who was not fit for hepatectomy owing to the development of a metastatic liver tumor. The markers were adequately identified during hepatectomy. Additionally, there were no difficulties in the surgical procedure or postoperative complications. Conclusions Preoperative marking with embolization coils can be performed safely for intraoperative identification of liver nodules.

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Marking Disappearing Colorectal Liver Metastases After Complete Response to Neoadjuvant Chemotherapy via CT – A Pilot Study

Cited by 4 publications

References 19 publications

Disappearing Colorectal Liver Metastases: Do We Really Need a Ghostbuster?

Disappearing Colorectal Liver Metastases: Do We Really Need a Ghostbuster?

Neoadjuvant chemotherapy for colorectal liver metastases: A contemporary review of the literature

Prospective Exploratory Phase I Clinical Trial Assessing the Safety of Preoperative Marking for Small Liver Tumors

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